Download Advances in retinal imaging of eyes with hazy media: Further

Advances in retinal imaging of eyes
with hazy media: Further Studies
4036/A174
Wendy Chen, MD, Thomas R. Friberg, MD, Andrew W. Eller, MD, Carlos Medina, MD
Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA
Purpose
In eyes with media opacities, dense cataracts, corneal edema, small
pupils, or vitreous opacities, biomicroscopy or indirect ophthalmoscopy
of the fundus may prove impossible even for the most experienced
clinician. We investigated the feasibility of using an ultra-wide angle
imaging system to study the retina in eyes where indirect
ophthalmoscopy could not be accomplished.
Methods
Case 1: Dense Cataract, Small pupil
49 yo female with history of
Stickler’s syndrome and Fuch’s
corneal dystrophy, poorly dilated
pupil, 2+ guttata, 3-4+ NS. Optos
view revealed extensive lattice
degeneration and macular scar.
Using the Optos P200A system, we evaluated a series of 20 patients
where a view to the retina was precluded because of dense cataract (8
eyes), corneal edema (4 eyes), keratic precipitates (4 eyes), small
pupils (6 eyes), pupillary membranes (2 eyes), or vitreous hemorrhage
(6 eyes). The primary outcome measure was a fundus or fluorescein
angiographic image that was deemed to reveal sufficient information,
as assessed by an independent retinal specialist, from which clinical
treatment decisions could be made.
Topcon
Results
Clinically useful retinal details were revealed in 85% of eyes using this
technique. In 6 eyes, fluorescein angiography was successfully
performed despite the fact that substantial vitreous hemorrhage or
dense vitreous opacities were present. Angiography revealed the cause
of the hemorrhage in 5 of 6 eyes. Moderate to severe corneal edema
degraded the images substantially, presumably secondary to light
scatter, and represented a major impediment to imaging. Lens opacities
provide much less problematic, even with 4+ nuclear sclerotic cataracts.
Conventional photography failed to produce any interpretable retinal
images in these eyes. The likely explanation for the utility of the Optos
system in scanning through media opacities is the narrow illuminating
beam (0.3mm), and long wavelength laser beam (633 nm). Both act to
reduce back scatter induced by media opacities.
Case 3: Dense Vitreous Hemorrhage
86 yo female with hypertension, presents with vitreous hemorrhage.
Optos view shows sub- and intra-retinal hemorrhage, sclerosed vessel,
and fibrin clot in this patient with presumed macroaneurysm.
Optos
Case 4: Dense Vitreous Hemorrhage
Topcon
Optos
Case 2: Keratic Precipitates, Small Pupil
63 yo female with hypertension, presents with vitreous hemorrhage.
Initial clinical impression was hemorrhagic PVD. Optos with FA revealed
areas of nonperfusion and neovascularization which subsequently led to
diagnosis of proliferative retinopathy secondary to sickle cell disease.
32 yo Vietnamese female with 4+
AC cell, 2+ KP, secluded pupil.
Optos view revealed multiple
chorioretinal lesions without active
disease on FA in this patient with
presumed Harada’s Disease.
Conclusions
While ultra-wide angle imaging is used primarily to obtain an image of
the sensory retina in a single exposure, a specialized, simple, yet
potentially important clinical application of such as system is the clinical
assessment of eyes with dense media opacities. Substantial corneal
edema was a greater impediment to imaging than lens or vitreous
opacities, in general.
References
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Ultrawide angle fluorescein angiographic imaging: a comparison to conventional digital acquisition systems.
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Structural features anterior to the retina represented in Panoramic Scanning Laser fundus images. Dunphy, RW.,
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Case 5: Corneal Edema
References
64 yo female s/p PKP with graft edema and infectious ulcer. Optos view
was of limited use in this case.