The Value of Spectral Domain Optical Coherence Tomography in Central Serous Chorioretinopathy Hare J 1 , Hussain A 2 , Stangos A 2 , Zheng Y 1 , Sahni J 1, 2 1. Eye and Vision Sciences Department, University of Liverpool 2. St Paul’s Eye Unit, Royal Liverpool University Hospital NHS Trust OBJECTIVE To qualitatively and quantitatively analyse spectral domain optical coherence tomography (OCT) features in patients with treatment-naïve central serous chorioretinopathy (CSCR) and correlate morphometric findings with vision and duration of symptoms. Figure 1. Normal spectral domain OCT scan, showing the individual layers of the retina. Figure 2. Typical appearance of subretinal fluid in CSCR on spectral domain OCT. INTRODUCTION ● CSCR is a disorder of the eye whereby fluid collects between two layers of the retina, termed subretinal fluid (SRF). The presence of SRF disrupts the photoreceptors, causing visual problems. 1 ● Spectral domain OCT is a recently developed non-invasive imaging modality utilising infrared waves. It can be used to provide a high resolution ‘optical biopsy’. 2 ● Previous descriptions of the appearance of CSCR have used older OCT machines that cannot distinguish individual retinal layers. 3,4 ● We used manual segmentation and feature analysis to gather quantitative and qualitative data from OCT scans. ● We investigated whether or not clinical features correlate with appearance on OCT in CSCR. Figure 3. Manual segmentation of the retinal layers and fluid. RESULTS ● Data from 31 eyes from 29 consecutive patients diagnosed with CSCR were collected, 19 of whom were men (65.5%). ● The mean age of the patients at presentation was 50 (SD ± 11) years, (range 30 – 70). ● Two eyes (6.5%) were asymptomatic, 13 eyes (41.9%) had acute (<3 months duration) symptoms and 15 eyes (48.4%) had chronic (>3 months duration) symptoms; data on symptom duration was missing for one patient (3.1%). ● Mean visual acuity at presentation was 0.35 (SD ± 0.38) LogMAR, (range -0.08 – 1.48). ● SRF was present in 28 (90.3%) eyes, intraretinal fluid was present in 3 (9.68%) and pigment epithelium detachment in 5 (16.1%). Irregularities of photoreceptor inner/outer segment layer were seen in all 31 eyes, 26 (83.8%) eyes had irregularities on the inner boundary of the SRF and an intact external limiting membrane was identified in 10 (32.26%) eyes. ● Mean central foveal thickness (including fluid) was 327 µm (SD ± 146.7); mean area of SRF was 0.25 mm 2 (SD ± 0.26). ● The only statistically significant relationship found was between central foveal thickness (excluding fluid) was found to be significantly correlated with visual acuity. There were no further statistically significant correlations between these features and duration of symptoms or visual acuity at presentation. CONCLUSIONS Feature analysis of spectral domain OCT images has identified several hallmark microstructural abnormalities in patients with CSCR. However, morphometric changes on OCT did not appear to correlate with clinical presentation in CSCR. REFERENCES 1. Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment. Eye. 2010;24:1743-1756. 2. Drexler W, Fujimoto JG. State-of-the-art retinal optical coherence tomography. Progress in Retinal and Eye Research. 2008;27(1):45-88. 3. Montero JA, Ruiz-Moreno JM. Optical coherence tomography characterisation of idiopathic central serous chorioretinopathy. British Journal of Ophthalmology. 2005;89(5):562-564. 4. Piccolino FC, de la Longrais RR, Ravera G, et al. The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. American Journal of Ophthalmology. 2005;139(1):87-99. METHODS ● We undertook a retrospective study of consecutive patients with CSCR presenting at a tertiary referral ophthalmic clinic. ● If a diagnosis of CSCR was suspected, the patient underwent OCT imaging. Only patients with confirmed CSCR were included in the study. ● Patient (age, sex, presenting eye) and clinical (visual acuity, duration of symptoms) data were collected at the time of presentation. ● The foveal scan from each patient was selected; the retinal layers and fluid were then segmented by hand using an open source imaging program. ● We then used an in-house software program to calculate the measurements of various features on the scan. ● Each scan was also studied for the presence of features that have been previously been reported to be associated with CSCR. ACKNOWLEDGEMENTS Yalin Zheng, Jayashree Sahni, Ahsen Hussain, Huiqi Lu and all at the Eye and Vision Sciences Department. FURTHER INFORMATION This project was completed as part of JH’s Clinical Sciences MRes degree. Contact [email protected] for more information. CHOROID RPE/BRUCH’S COMPLEX RPE INTERDIGITATION OUTER PHOTORECEPTOR SEGMENTS INNER/OUTER PHOTORECEPTOR JUNCTION INNER PHOTORECEPTOR SEGMENTS EXTERNAL LIMITING MEMBRANE OUTER NUCLEAR LAYER OUTER PLEXIFORM LAYER INNER NUCLEAR LAYER INNER PLEXIFORM LAYER GANGLION CELL LAYER NERVE FIBRE LAYER OUTER NUCLEAR LAYER BLOOD VESSELS FOVEA
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The Value of Spectral Domain Optical Coherence Tomography in Central Serous Chorioretinopathy
Hare J1, Hussain A2, Stangos A2, Zheng Y1, Sahni J1, 2
1. Eye and Vision Sciences Department, University of Liverpool 2. St Paul’s Eye Unit, Royal Liverpool University Hospital NHS Trust
OBJECTIVETo qualitatively and quantitatively analyse spectral domain optical coherence tomography (OCT) features in patients with treatment-naïve central serous chorioretinopathy (CSCR) and correlate morphometric findings with vision and duration of symptoms.
Figure 1. Normal spectral domain OCT scan, showing the individual layers of the retina.
Figure 2. Typical appearance of subretinal fluid in CSCR on spectral domain OCT.
INTRODUCTION ● CSCR is a disorder of the eye whereby fluid collects between two
layers of the retina, termed subretinal fluid (SRF). The presence of SRF disrupts the photoreceptors, causing visual problems.1
● Spectral domain OCT is a recently developed non-invasive imaging modality utilising infrared waves. It can be used to provide a high resolution ‘optical biopsy’.2
● Previous descriptions of the appearance of CSCR have used older OCT machines that cannot distinguish individual retinal layers.3,4
● We used manual segmentation and feature analysis to gather quantitative and qualitative data from OCT scans.
● We investigated whether or not clinical features correlate with appearance on OCT in CSCR.
Figure 3. Manual segmentation of the retinal layers and fluid.
RESULTS ● Data from 31 eyes from 29 consecutive patients diagnosed with
CSCR were collected, 19 of whom were men (65.5%).
● The mean age of the patients at presentation was 50 (SD ± 11) years, (range 30 – 70).
● Two eyes (6.5%) were asymptomatic, 13 eyes (41.9%) had acute (<3 months duration) symptoms and 15 eyes (48.4%) had chronic (>3 months duration) symptoms; data on symptom duration was missing for one patient (3.1%).
● Mean visual acuity at presentation was 0.35 (SD ± 0.38) LogMAR, (range -0.08 – 1.48).
● SRF was present in 28 (90.3%) eyes, intraretinal fluid was present in 3 (9.68%) and pigment epithelium detachment in 5 (16.1%). Irregularities of photoreceptor inner/outer segment layer were seen in all 31 eyes, 26 (83.8%) eyes had irregularities on the inner boundary of the SRF and an intact external limiting membrane was identified in 10 (32.26%) eyes.
● Mean central foveal thickness (including fluid) was 327 µm (SD ± 146.7); mean area of SRF was 0.25 mm2 (SD ± 0.26).
● The only statistically significant relationship found was between central foveal thickness (excluding fluid) was found to be significantly correlated with visual acuity. There were no further statistically significant correlations between these features and duration of symptoms or visual acuity at presentation.
CONCLUSIONSFeature analysis of spectral domain OCT images has identified several hallmark microstructural abnormalities in patients with CSCR. However, morphometric changes on OCT did not appear to correlate with clinical presentation in CSCR.
REFERENCES1. Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy:
an update on pathogenesis and treatment. Eye. 2010;24:1743-1756.
2. Drexler W, Fujimoto JG. State-of-the-art retinal optical coherence tomography. Progress in Retinal and Eye Research. 2008;27(1):45-88.
3. Montero JA, Ruiz-Moreno JM. Optical coherence tomography characterisation of idiopathic central serous chorioretinopathy. British Journal of Ophthalmology. 2005;89(5):562-564.
4. Piccolino FC, de la Longrais RR, Ravera G, et al. The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. American Journal of Ophthalmology. 2005;139(1):87-99.
METHODS ● We undertook a retrospective study of consecutive patients with
CSCR presenting at a tertiary referral ophthalmic clinic.
● If a diagnosis of CSCR was suspected, the patient underwent OCT imaging. Only patients with confirmed CSCR were included in the study.
● Patient (age, sex, presenting eye) and clinical (visual acuity, duration of symptoms) data were collected at the time of presentation.
● The foveal scan from each patient was selected; the retinal layers and fluid were then segmented by hand using an open source imaging program.
● We then used an in-house software program to calculate the measurements of various features on the scan.
● Each scan was also studied for the presence of features that have been previously been reported to be associated with CSCR.
ACKNOWLEDGEMENTSYalin Zheng, Jayashree Sahni, Ahsen Hussain, Huiqi Lu and all at the Eye and Vision Sciences Department.
FURTHER INFORMATIONThis project was completed as part of JH’s Clinical Sciences MRes degree. Contact [email protected] for more information.
CHOROIDRPE/BRUCH’S COMPLEX
RPE INTERDIGITATIONOUTER PHOTORECEPTOR SEGMENTS
INNER/OUTER PHOTORECEPTOR JUNCTIONINNER PHOTORECEPTOR SEGMENTS
EXTERNAL LIMITING MEMBRANE
OUTER NUCLEAR LAYEROUTER PLEXIFORM LAYER
INNER NUCLEAR LAYERINNER PLEXIFORM LAYER
GANGLION CELL LAYERNERVE FIBRE LAYER
OUTER NUCLEAR LAYERBLOOD VESSELS
FOVEA
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