Photo Essay.

Purpose: To evaluate an optical coherence tomography (OCT)-based positioning regimen for patients undergoing macular hole surgery. Method: We reviewed the medical records of all patients in our practice who underwent macular hole repair, instituting a modified OCT-based positioning regimen from November 1, 2011 through July 31, 2013. The regimen consisted of prone positioning at the conclusion of surgery with daily OCT imaging until the hole was confirmed closed at which point positioning was halted. Clinical data that were collected and recorded included visual acuities, stage of hole, size of hole, chronicity, preoperative and postoperative OCT imaging, and length of ...

Purpose: To report the evolution of treatment in managing diabetic macular edema (DME) in a "real world" clinical setting. Methods: Retrospective observational case series of 1,862 patients treated for DME over the last decade. Change in selection of treatment modalities used for controlling DME, visual acuity, and degree of DME on optical coherence tomography were recorded. Results: Over the past decade, there was a linear decrease in laser use, with exponential growth in the utilization of intravitreal injections. An increase in the frequency of clinic visits from 3 +/- 2 visits per year to 9 +/- 2 visits per year with ...

Purposes: To evaluate the effects of axial length and age on the circumpapillary retinal nerve fiber layer (cpRNFL) and the inner macular parameters measured using 3 spectral-domain optical coherence tomography (OCT) instruments. Methods: A total of 102 normal eyes (1 eye per subject) were imaged using Cirrus, RTVue, and 3D-OCT. The cpRNFL and the macular retinal nerve fiber layer (mRNFL), the ganglion cell layer+inner plexiform layer (GCLIPL), and the mRNFL+GCLIPL ganglion cell complex, GCC thicknesses were analyzed. The correlations between these values and the axial length or age were evaluated using a partial correlation analysis. These correlations were ...

Purpose: To determine and validate the diagnostic ability of a linear discriminant function (LDF) based on retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness obtained using high-definition optical coherence tomography (Cirrus HD-OCT) for discriminating between healthy controls and early glaucoma subjects. Methods: We prospectively selected 214 healthy controls and 152 glaucoma subjects (teaching set) and another independent sample of 86 healthy controls and 71 glaucoma subjects (validating set). Two scans, including 1 macular and 1 peripapillary RNFL scan, were obtained. After calculating the LDF in the teaching set using the binary logistic regression analysis, receiver operating ...

Purpose: To assess the agreement and reproducibility of retinal pigment epithelial detachment (RPED) volumetric measurements using a commercially available optical coherence tomography software available for the Zeiss Cirrus HD-OCT. Methods: Twelve eyes of 10 patients with a diagnosis of neovascular age-related macular degeneration with RPED, seen at the New England Eye Center between October 2012 and December 2012, were enrolled in the study. Three separate scans per affected eye were obtained using the "Macular Cube 512 x 128" protocol. "Retinal pigment epithelial (RPE) elevation analysis" software was used to measure RPED volumes in the central 3-mm and 5-mm circles by ...

Purpose: To report the findings of optical coherence tomography (OCT) in the corneas of patients with recurrent corneal erosion syndrome (RCES). Methods: Ten normal subjects and 25 patients with RCES were recruited for the study. Ten patients with RCES suffered from an acute episode of pain and 15 patients complained of typical chronic symptoms of RCES. All eyes were scanned with the anterior segment 5 line raster acquisition protocol of the Cirrus HD-OCT platform (Zeiss). The etiology of RCES was investigated and treatment was provided following a standard clinical protocol. Scans were obtained at different stages of the pathology and ...

Photo essay.

Purpose: To highlight the use of high-density spectral domain optical coherence tomography (SD-OCT) in the detection of tamoxifen retinopathy. Case Report: An 82-year-old asymptomatic woman with a history of tamoxifen therapy for breast cancer was found to have bilateral refractile retinal deposits on fundus examination. Detection on SD-OCT was compared across imaging techniques. High-density SD-OCT demonstrated hyperreflective deposits in the inner retinal layers of each eye consistent with the diagnosis of tamoxifen retinopathy. Conclusions: The optimal SD-OCT scan technique depends on the ocular condition being imaged. High-density scan techniques require longer acquisition time but may enhance the detection of focal ...

Purpose: To evaluate the test-retest variability of spectral-domain optical coherence tomography (OCT) in measurement of retinal nerve fiber layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Methods: A total of 65 eyes of healthy subjects were enrolled in this observational cross-sectional study. RNFL thickness and GCIPL thickness were measured using the repeat scan optic cube and macular cube protocol using Cirrus HD-OCT (software version 6.0). A single operator obtained 3 measurements during 1 session to determine test-retest variability. Intrasession repeatability was defined by intraclass correlation, limits of agreement, and coefficient of variation. Results: The mean age ...

Background: Epidural needle insertion is traditionally a blind technique whose success depends on the experience of the operator. The authors describe a novel method using a fiber-needle-based swept-source optical coherence tomography (SSOCT) to identify epidural space. Methods: An optical fiber probe was placed into a hollow 18-gauge Tuohy needle. It was then inserted by an experienced anesthesiologist to continuously construct a series of two-dimensional SSOCT images by mechanically rotating the optical probe. To quantify this observation, both the average SSOCT signal intensities and their diagnostic potentials were assessed. The insertions were performed three times into both the lumbar and thoracic ...

Purpose: The detection of changes in the retinal nerve fiber layer (RNFL) as measured by optical coherence tomography (OCT) is crucial in glaucoma diagnosis and management. We investigated the short-term repeatability of peripapillary RNFL measurements in a commercially available spectral domain OCT focusing on a broad clinical spectrum of patients. Methods: Two consecutive peripapillary RNFL measurements were taken on 227 eyes with Cirrus HD-OCT (Carl Zeiss Meditec, Version 6.5 software) using the optic disc 200 x 200 protocol. Repeatability was assessed as Bland-Altman limits of agreement and intraclass coefficients (ICCs). Results: Limits of agreement showed the greatest variability in ...

Purpose To investigate the features of corneal epithelial thickness topography with Fourier-domain optical coherence tomography (OCT) in dry eye patients. Methods In this cross-sectional study, 100 symptomatic dry eye patients and 35 normal subjects were enrolled. All participants answered the ocular surface disease index questionnaire and were subjected to OCT, corneal fluorescein staining, tear breakup time, Schirmer 1 test without anesthetic (S1t), and meibomian morphology. Several epithelium statistics for each eye, including central, superior, inferior, minimum, maximum, minimum − maximum, and map standard deviation, were averaged. Correlations of epithelial thickness with the symptoms of dry eye were calculated. Results The mean ...

Photo essay

Purpose: To determine if pseudodrusen seen in fundus photography, particularly infrared scanning laser ophthalmoscopy, colocalize with subretinal drusenoid deposits imaged by optical coherence tomography. Methods: The patients were scanned with spectral domain optical coherence tomography having an A-scan spacing of 5.9 [mu]m and a B-scan spacing of 11 [mu]m. En face slabs were derived from this data set at distances 50 [mu]m to 90 [mu]m above the Bruch membrane reference plane to image the subretinal drusenoid deposit and also 6 [mu]m below Bruch membrane to image the level of the choriocapillaris. The corresponding infrared ...

Letter to the Editor

Photo Essay

Objectives: The aim of this study was to investigate the spatial location of vulnerable plaques at coronary artery bifurcations using frequency domain-optical coherence tomography. Background: In-vivo data on geometric location of vulnerable plaques in relation to coronary bifurcation are limited. Materials and methods: A total of 40 patients with left anterior descending artery bifurcation were studied. Plaque characteristics in five regions in relation to a side branch were compared: opposite flow divider (OFD); bifurcation site (BF); main branch side proximal (MBP); side branch side proximal (SBP); and flow divider (FD). Frequency domain-optical coherence tomography was used for plaque characterization. Results ...

Background: Vulvar squamous cell carcinoma (VSCC) is treated with wide local excision. The challenge is to remove as much skin as necessary to prevent recurrence, but meanwhile preserve genital skin to diminish morbidity. Optical coherence tomography (OCT) is a noninvasive imaging tool that produces cross-sectional images. Optical coherence tomography could be helpful in determining appropriate surgical margins during excision of VSCC. Objective: This study aimed to assess the value of OCT in determining appropriate surgical margins in patients operated for VSCC. We hypothesize that benign tissue will differ qualitatively (presence of clear epidermal layers) and quantitatively (epidermal layer thickness and ...

Purpose: To compare the reproducibility of the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness map between glaucomatous and fellow normal eyes of unilateral glaucoma patients. Methods: In this prospective case-control study, Cirrus HD-OCT was performed for 79 unilateral glaucoma patients 3 times on the first visit and on 3 subsequent visits within a 2-month period. Test-retest standard deviation (TRT-SD) and tolerance limit based on the 1.645x[square root]2xTRT-SD formula were derived for RNFL thicknesses at the respective superpixels of the RNFL thickness map. Results: The TRT-SDs and tolerance limits of the glaucomatous eyes (TRT-SD: 2 ...

Purpose: To assess combined hamartoma of the retina and retinal pigment epithelium with enhanced depth imaging optical coherence tomography. Methods: Retrospective, observational cases series in eight eyes of eight patients, with comparison between affected and unaffected eyes regarding enhanced depth imaging optical coherence tomography features of tumor, fovea, and choroid. Results: The mean age at presentation was 7 years. The tumor was macular (n = 5) or extramacular (n = 3). Enhanced depth imaging optical coherence tomography revealed irregularities in inner retina (n = 8) and/or all retinal layers (n = 3), with epiretinal membrane (n = 8), causing an inner retinal sawtooth (mini-peak ...

A 71-year-old man presented in emergency department for non-ST-elevation myocardial infarction. At admission, 12-lead ECG was in sinus rhythm without sign of myocardial ischemia, and troponin slightly increased. The only notable feature of the patient's medical history was single-vessel coronary artery disease revealed 10 years previously, treated by stenting of the second segment of the right coronary artery with a 3.0 x 25 mm bare metal stent. Three months later, intrastent restenosis was managed by implantation of a 3.0 x 28 mm paclitaxel-eluting stent. Two years before the present admission, following a non contributive stress test for ...

Purpose: Using anterior chamber optical coherence tomography to evaluate changes in angle anatomy in patients with primary angle-closure glaucoma (PACG) before and after trabeculectomy. Methods: This is a prospective observational study in 38 eyes of 38 patients with PACG, who underwent trabeculectomy. We used customized software to analyze optical coherence tomography images (Visante) of all participants before and after the surgical treatment. Multivariate linear regression analysis was performed for predictors of percentage change in mean angle parameters, including scleral spur angle, angle opening distance, angle recess area, and trabecular-iris surface area. The main outcome measures were changes in angle parameters ...