OCT (Optical Coherence Tomography) of Macular Diseases
by
Subrata Roy (Fellow LVPEI)

Uses of OCT:
  1. Diagnosis, monitoring, quantitative and qualitative assessment of macular pathology.
  2. Most common indications are:
·         Macular Edema.
·         Macular Hole.
·         Epiretinal Membrane in Diabetic Retinopathy.
·         Central Serous Retinopathy.
·         Foveal thining in Retinitis Pigmentosa and in Myopic Degeneration.
·         Age Related Macular Degeneration.
·         Post Retinal Detachment Surgery.
  1. Useful in study.
  2. Good tools to educate the patient and also shows changes with treatment.
Interpretation:
(Following things need to observe when you do OCT)
  1. Vitro-retinal interface.
  2. Retinal Thickness:
·         Increases:  Edema, Traction.
·         Decreases: Foveal atrophy.
  1. Reflectivity:
Following lesions are hyper-reflective:
·         Hard Exudates.
·         Blood.
·         Scars.
Following lesions are hypo-reflective:
·         Serous Fluid.
·         Hypo-pigmented lesions of Retinal Pigment Epithelium.
·         Media Hazy.
  1. Foveal Contour.
  2. Continuity of tissues
  3. Distinction between:
·         Serous fluid and blood.
·         Detachment of neurosensory retina and Retinal Pigment Epithelium.

Normal Retinal Structures:

Diabetic Macular Edema has different type of patterns:
  1. Sponge like retinal thickness.
  2. Macular edema and Cystoid Macular Edema.
  3. Serous Retinal Detachment.
  4. Epi-retinal Membrane.
  5. Vitro-macular traction.
Spongy Macular Edema:

Macular Edema:

Cystoid Macular Edema:

Spongy and Cystoid Macular Edema:

Exudates:

Epi-retinal Membrane:

Tractional Retinal Detachment:

OCT patterns in Age Retinal Macular Degeneration:
                                                 
  1. Focal elevation of Retinal Pigment Epithelium.
  2. Large drusen shows irregular elevation of Retinal Pigment Epithelium with shadow from underlying choroid.
  3. Large drusen carry high risk of Choroidal Neo-Vascular Membrane.
Irregular Retinal Pigment Epithelium:

Choroidal Neo-Vascular Membrane:

Retinal Thinning in Scarred Choroidal Neo-Vascular Membrane:

Retinal thinning due to retinal Scar in Choroiditis

Retinal Thinning in Myopic Degeneration:

Macular Hole:
There are three type of macular hole we can see:
  1. Impending Macular Hole.
  2. Lamellar Macular Hole.
  3. Full Thickness Macular Hole.

Impending Macular Hole:

Lamellar Macular Hole:

Full thickness Macular Hole:


Serous Retinal Detachment with Spongy Macular Edema in Supro-temporal Branch Retinal Vein Occlusion:


Cystoid Macular Edema in Central Retinal vein Occlusion:
                     
Some cases and their comparison after treatment:


CASE NO-1:
Fundus photograph and OCT shows Central Serous Retinopathy. Visual acuity was 6/36 on 14/03/08 and on 02/04/08 visual acuity improved to 6/9p and serous retinal detachment also decreased.


CASE NO-2:                  
Fundus photograph and shows Epi-retinal Membrane and visual acuity was 6/36 after removing the surgery (Membrane Peeling) visual acuity improved to 6/24.

CASE NO-3:
Supro-temporal Branch Retinal Vein Occlusion on 10/03/08 vision was 6/60 after Avastin Injection on 02/04/08 vision improved to 6/24p and OCT picture shows Macular Edema decreased.
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