Hyporeflective Areas Research Articles

Intracorneal Silicone Oil Following Retinal Detachment Surgery With Silicone Oil Tamponade

Silicone oil (SO) is used for the management of complex retinal detachments. But SO may result in a number of complications. We report here on 2 eyes of 2 patients who were admitted to our clinic with intracorneal SO and who underwent complicated vitreoretinal surgery with SO infusion. In both cases, the presence of SO was identified via clinical assessments. The SO bubble was detected in the center of the cornea in the first case. Scheimpflug camera imaging demonstrated sharply demarcated hyporeflective areas into the intrastromal space. In the second case, intrastromal bright and emulsified SO particles were noted by slit-lamp examination. Scheimpflug camera imaging demonstrated sharply demarcated hyperreflective areas into the intrastromal space. SO droplets may be seen in the cornea. Scheimpflug camera imaging may be helpful in understanding the pathogenesis of this condition.

Corrigendum.

British Journal of HaematologyVolume 181, Issue 5 p. 712-712 CorrigendumFree Access Corrigendum This article corrects the following: How we diagnose and treat vitreoretinal lymphoma Falko Fend, Andrés J. M. Ferreri, Sarah E. Coupland, Volume 173Issue 5British Journal of Haematology pages: 680-692 First Published online: May 2, 2016 First published: 29 April 2018 https://doi.org/10.1111/bjh.15395AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL An error has been identified in Fend et al (2016). The findings in Fig. 2B, which shows the Optical Coherence Tomography (OCT) of a patient with choroidal marginal B-cell lymphoma, are described incorrectly. After consultation with the consultant ophthalmologist, who provided the clinical image, it has been concluded that the hyporeflective areas highlighted by the arrows do not represent a retinal detachment. Enhanced depth imaging OCT (EDI-OCT) is necessary to assess the thickness of the choroid, which is essential for diagnosing this rare lymphoma type. The authors would like to apologise for this mistake. Reference Fend, F., Ferreri, A.J. & Coupland, S.E. (2016) How we diagnose and treat vitreoretinal lymphoma. Br J Haematol, 173, 680– 92. https://doi.org/10.1111/bjh.14025 Volume181, Issue5June 2018Pages 712-712 ReferencesRelatedInformation

Choroidal and Sub-Retinal Pigment Epithelium Caverns: Multimodal Imaging and Correspondence with Friedman Lipid Globules

To survey Friedman lipid globules by high-resolution histologic examination and to compare with multimodal imaging of hyporeflective caverns in eyes with geographic atrophy (GA) secondary to age-related macular (AMD) and other retinal diseases. Histologic survey of donor eyes with and without AMD. Clinical case series with multimodal imaging analysis. Donor eyes (n= 139; 26 with early AMD, 13 with GA, 40 with nAMD, 52 with a healthy macula, and 8 with other or unknown characteristics) and 41 eyes of 28 participants with GA (n= 16), nAMD (n= 8), Stargardt disease (n= 4), cone dystrophy (n= 2), pachychoroid spectrum (n= 6), choroidal hemangioma (n= 1), and healthy eyes (n= 4). Donor eyes were prepared for macula-wide epoxy resin sections through the foveal and perifoveal area. In patients, caverns were identified as nonreflective spaces on OCT images. Multimodal imaging included color and red-free fundus photography; fundus autofluorescence; fluorescein and, indocyanine green angiography; OCT angiography; near-infrared reflectance; and confocal multispectral (MultiColor [Spectralis, Heidelberg Engineering, Germany]) imaging. Presence and morphologic features of globules, and presence and appearance of caverns on multimodal imaging. Globules were found primarily in the inner choroidal stroma (91.0%), but also localized to the sclera (4.9%) and neovascular membranes (2.1%). Mean diameters of solitary and multilobular globules were 58.9±37.8 μm and 65.4±27.9 μm, respectively. Globules showed morphologic signs of dynamism including pitting, dispersion, disintegration, and crystal formation. Evidence for inflammation in the surrounding tissue was absent. En face OCT rendered sharply delimited hyporeflective areas as large as choroidal vessels, frequently grouped around choroid vessels or in the neovascular tissue. Cross-sectional OCT revealed a characteristic posterior hypertransmission. OCT angiography showed absence of flow signal within caverns. Based on prior literature documenting OCT signatures of tissue lipid in atheroma and nAMD, we speculate that caverns are lipid rich. Globules, with similar sizes and tissue locations in AMD and healthy persons, are candidates for histologic correlates of caverns. The role of globules in chorioretinal physiologic features, perhaps as a lipid depot for photoreceptor metabolism, is approachable through clinical imaging.

Relations Among Foveal Blood Flow, Retinal-Choroidal Structure, and Visual Function in Retinitis Pigmentosa

To investigate the relationships between foveal blood flow as measured by laser speckle flowgraphy (LSFG), the retinal-choroidal structure in enhanced depth imaging-optical coherence tomography (EDI-OCT), and central visual function in patients with retinitis pigmentosa (RP). We studied 52 consecutive typical RP patients ≤50 years old and 21 age- and sex-matched controls. The mean blur rate (MBR), which represents the blood flow volume, was calculated in a 2.4-mm2 area centered on the fovea by LSFG. Subfoveal horizontal EDI-OCT images were recorded, and the choroidal area, choroidal hyporeflective area, and choroidal hyperreflective area were analyzed in the central 2.4-mm-wide region. The central foveal thickness (CFT), subfoveal choroidal thickness (SCT), and ellipsoid zone (EZ) width were also measured. Visual acuity (VA) and retinal sensitivity (Humphrey 10-2 program) were measured in the RP patients. The MBR, choroidal area, hyporeflective area, hyperreflective area, and SCT were significantly decreased in the RP patients (all P < 0.001, versus controls). Spearman's rank testing demonstrated no significant correlation between the MBR and the choroidal structural parameters in the RP patients. Decreased MBR was significantly associated with reductions in VA, retinal sensitivity, CFT, and EZ width (all P < 0.05). The choroidal structural parameters did not correlate with central visual function, and the choroidal area, hyperreflective area, and SCT were inversely associated with CFT (all P < 0.05). These results demonstrated the divergence between the choroidal structure and blood function, and suggest that decreased choroidal flow, rather than the structural alteration, is closely associated with foveal degeneration in RP.

The mirror artifact effect on OCTA reconstructions of patients with high myopia

Optical coherence tomography angiography (OCTA) is a useful technique for the noninvasive study of retinal vascularization; nevertheless artifacts may occur, especially in myopic patients, and this may lead to diagnostic issues. Four myopic patients (2 males, mean age 45 years, axial length 27–30 mm) were analyzed using swept source OCT Triton Topcon (DRI Triton; Topcon, Tokyo, Japan) and 3 × 3, 4.5 × 4.5, and 9 × 9 mm scans were obtained. Topcon Image6 software was used to segment retinal layers and to extract both OCTA reconstructions of superficial, deep and choriocapillary plexa, and en face images. OCT analysis clearly revealed retinochoroidal structures, including both inner and outer choroidal segments, the external limiting membrane, and the retinal pigment epithelium in all patients. OCTA analysis was able to reconstruct superficial, deep and choriocapillary plexa in all patients. On 9 × 9 OCTA and en face reconstructions of every patient, a circular, linear, hyporeflective area was found circumscribing the retinal vascular arcades, as a frame; no vessels were detected in this area. In accordance with previous studies, vessel rarefaction was reported. The dark circular area found in 9 × 9 scans had characteristic aspects, as the presence in both eyes, specularity, absence of vascularization, and lack of ophthalmoscopic evidence. In the B‑scan images, a mirror reflection of retinal profile, appearing upside down, was observed. This aspect can be due to the reflection of retinal reconstruction caused by the high curvature of the eye and to the staphyloma. Differential diagnosis might be choroidal rupture, even though the specularity and the presence of the dark area in all the layers clear the picture. This study confirmed that OCTA in high myopia can be affected by a number of pitfalls and this should be taken into account for the right interpretation of OCTA reconstructions.

EXPLORING PHOTORECEPTOR REFLECTIVITY THROUGH MULTIMODAL IMAGING OF OUTER RETINAL TUBULATION IN ADVANCED AGE-RELATED MACULAR DEGENERATION.

To investigate the microscopic structure of outer retinal tubulation (ORT) and optical properties of cone photoreceptors in vivo, we studied ORT appearance by multimodal imaging, including spectral domain optical coherence tomography (SD-OCT) and adaptive optics scanning laser ophthalmoscopy. Four eyes of four subjects with advanced age-related macular degeneration underwent color fundus photography, infrared reflectance imaging, SD-OCT, and adaptive optics scanning laser ophthalmoscopy with a high-resolution research instrument. Outer retinal tubulation was identified in closely spaced (11 μm) SD-OCT volume scans. Outer retinal tubulation in cross-sectional and en face SD-OCT was a hyporeflective area representing a lumen surrounded by a hyperreflective border consisting of cone photoreceptor mitochondria and external limiting membrane, per previous histology. In contrast, ORT by adaptive optics scanning laser ophthalmoscopy was a hyporeflective structure of the same shape as in en face SD-OCT but lacking visualizable cone photoreceptors. Lack of ORT cone reflectivity by adaptive optics scanning laser ophthalmoscopy indicates that cones have lost their normal directionality and waveguiding property due to loss of outer segments and subsequent retinal remodeling. Reflective ORT cones by SD-OCT, in contrast, may depend partly on mitochondria as light scatterers within inner segments of these degenerating cells, a phenomenon enhanced by coherent imaging. Multimodal imaging of ORT provides insight into cone degeneration and reflectivity sources in optical coherence tomography.

Three-dimensional printing using open source software and JPEG images from optical coherence tomography of an epiretinal membrane patient.

Three-dimensional printing using open source software and JPEG images from optical coherence tomography of an epiretinal membrane patient.

Changes in Choroidal Structures in Eyes with Chronic Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy.

PurposeTo determine the structural changes in the choroid after half-dose photodynamic therapy (hPDT) in eyes with chronic central serous chorioretinopathy (CSC).MethodsThis was a retrospective interventional study of 29 eyes of 29 patients who underwent hPDT for chronic CSC with serous retinal detachment (SRD) and were followed for ≥3 months. Enhanced depth imaging optical coherence tomographic (EDI-OCT) images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), the cross sectional subfoveal choroidal area, the hyporeflective and hyperreflective areas of the inner, outer, and whole choroid were determined at the baseline, and at 1, 3, and 12 months after the hPDT.ResultsThe SRDs were resolved in 26 (89.7%) eyes at 3 months after the hPDT. The mean CCT (P = 0.001), the total choroidal area (P = 0.001), and the hypo-reflective area (P = 0.003) of the whole choroid were significantly decreased from the baseline at 3 months. The hyperreflective area of whole choroid was not significantly changed during the study period (P = 0.083). The hyperreflective but not the hyporeflective area of the inner choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively). The hyporeflective but not the hyperreflective area of the outer choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively).ConclusionsThe hyperreflective area of the inner choroid and hyporeflective area of the outer choroid were significantly decreased after hPDT for chronic CSC. Because the hyperreflective and hyporeflective area correspond to the choroidal stroma and vessels, respectively, the decreased CCT and subfoveal choroidal area after hPDT may be attributed to a decrease in the exudative changes in the inner choroidal stroma and the reduction of the dilation of the outer choroidal vessels.

DEVELOPMENT OF INTRARETINAL CYSTOID LESIONS IN EYES WITH INTERMEDIATE AGE-RELATED MACULAR DEGENERATION.

To evaluate the development of intraretinal cystoid lesions (ICLs) in eyes with intermediate age-related macular degeneration. Serial multimodal retinal imaging data of 105 eyes from 87 age-related macular degeneration subjects (median age of 75.0 years) with no late age-related macular degeneration at baseline from the prospective longitudinal natural history "molecular diagnostic of age-related macular degeneration-study" were included. The presence of ICLs-defined as lacunar hyporeflective areas within the neurosensory retina-was determined by spectral-domain optical coherence tomography at Month 24. Both baseline and further follow-up data were additionally evaluated. At Month 24, ICLs were identified in 12 of 105 (11.7%) eyes of which 4 had developed signs of choroidal neovascularization since baseline. Intraretinal cystoid lesions in these four eyes with choroidal neovascularization were mostly found at the level of the outer nuclear layer. Intraretinal cystoid lesions in the remaining 8 eyes occurred mainly at the level of the inner nuclear layer, showed smaller horizontal and vertical dimensions, and were not spatially confined to an increase in retinal thickness. The results indicate that ICLs may develop also in the absence of active neovascularization. Distinctive morphologic features and localization of ICLs may be indicative of different underlying pathogenetic mechanisms. If no manifest choroidal neovascularization can be established in the presence of ICLs, close monitoring as well as awareness and self-monitoring seem to be advisable.

Structural Changes of Inner and Outer Choroid in Central Serous Chorioretinopathy Determined by Optical Coherence Tomography.

PurposeTo determine the structural changes of the choroid in eyes with central serous chorioretinopathy (CSC) by enhanced depth imaging optical coherence tomography (EDI-OCT).MethodsA retrospective comparative study was performed at two academic institutions. Forty eyes with CSC, their fellow eyes, and 40 eyes of age-matched controls were studied. Subfoveal cross sectional EDI-OCT images were recorded, and the hypo reflective and hyperreflective areas of the inner and outer choroid in the EDI-OCT images were separately measured. The images were analyzed by a binarization method to determine the sizes of the hyporeflective and hyperreflective areas.ResultsIn the inner choroid, the hyperreflective area was significantly larger in the CSC eyes (35,640±10,229 μm2) than the fellow eyes (22,908±8,522 μm2) and the control eyes (20,630±8,128 μm2; P<0.01 vs control for both, Wilcoxon signed-rank test). In the outer choroid, the hyporeflective area was significantly larger in the CSC eyes (446,549±121,214 μm2) than the control eyes (235,680±97,352 μm2, P<0.01). The average ratio of the hyporeflective area to the total choroidal area was smaller in the CSC eyes (67.0%) than the fellow eyes (76.5%) and the control eyes (76.7%) in the inner choroid (P<0.01, both). However, the ratio was larger in the CSC eyes (75.2%) and fellow eyes (71.7%) than in the control eyes (64.7%) in the outer choroid (P<0.01, both).ConclusionsThe larger hyperreflective area in the inner choroid is related to the inflammation and edema of the stroma of the choroid in the acute stage of CSC. The larger hyporeflective areas in the outer choroid is due to a dilatation of the vascular lumens of the larger blood vessels. These are the essential characteristics of eyes with CSC regardless of the onset.

Uveo-scleral outflow pathways after ultrasonic cyclocoagulation in refractory glaucoma: an anterior segment optical coherence tomography and in vivo confocal study

AimsTo evaluate, using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM), the uveo-scleral aqueous humour (AH) outflow pathways after ultrasonic circular cyclocoagulation (UCCC).MethodsForty-four patients with refractory...

En face OCT in Stargardt disease

To evaluate the structural features of the macular region by enface OCT imaging in patients with clinical diagnosis of Stargardt disease, confirmed by the detection of ABCA4 mutations. Thirty-two STGD patients were included in the study for a total of 64 eyes. All patients received a comprehensive ophthalmological examination, color fundus photography, fundus auto-fluorescence imaging and OCT. Five OCT scans were considered: ILM and RPE scans (both automatically obtained from the instrument), above-RPE slab, photoreceptor slab and sub-RPE slab (these last three manually obtained). ILM scans showed evident radial folds on the retinal surface in 8/64 eyes (12.5%). In 6 of the 7 patients, these vitreo-retinal interface abnormalities were unilateral. The photoreceptor slab showed some macular alterations ranging from dis-homogeneous, hypo-reflective abnormalities (7/64 eyes, 11%) to a homogeneous, well-defined, roundish, hypo-reflective area (17/64 eyes, 27%) in all the eyes. The sub-RPE slab showed a centrally evident, hyper-reflective abnormality in 58/64 eyes (90.6%). Superimposing the sub-RPE slab over the images corresponding to the photoreceptor slab, the area of the photoreceptor atrophy sharply exceeded that of the RPE atrophy (44/46 eyes, 96%). Enface OCT proved to be a clinically useful tool for the management of STGD patients, illustrating in vivo the structural abnormalities of the different retinal layers.

Loculation of Fluid in the Posterior Choroid in Eyes With Central Serous Chorioretinopathy

To evaluate potential accumulation of fluid in the outer choroid in eyes with central serous chorioretinopathy. Retrospective observational case series. Patients in 2 community-based retinal practices were evaluated for hyporeflective areas in the outer choroid consistent with collections of fluid using enhanced depth imaging optical coherence tomography. Eligible patients were examined over the preceding 2 years, had a history of central serous chorioretinopathy, and did not have a history of choroidal neovascularization or photodynamic therapy. In the New York group there were 131 eyes of 70 patients who had a mean age of 56.3 (± 12.5) years, and 88 (67.2%) had hyporeflective regions consistent with posterior loculation of fluid in the macular region. In the Minnesota data set there were 91 eyes of 48 patients who had a mean age of 47.9 (± 9.9) years and hyporeflective regions consistent with posterior loculation of fluid was present in 59 (64.8%). In the entire group the mean subfoveal choroidal thickness of those without loculated fluid was 344μm, as compared with 498μm with loculated fluid (P < .001). The areas of loculated fluid were hyporeflective, were larger topographically than the large choroidal vessels, had an angular inner border, and did not have a bounding vascular wall. Posterior loculation of fluid is a common finding in central serous chorioretinopathy, but it has a different pattern and distribution than do collections of fluid in the outer choroid and suprachoroidal space as seen in other forms of choroidal effusion.

En face mode of swept-source optical coherence tomography in circumscribed choroidal haemangioma

PurposeTo describe the findings in circumscribed choroidal haemangioma (CCH) using en face swept-source optical coherence tomography (SS-OCT).MethodsEn face images were obtained employing DRI-1 Atlantis OCT (Topcon, Tokyo, Japan), using a...

Optical Coherence Tomography in the Diagnosis of Scleritis and Episcleritis

To describe the optical coherence tomography (OCT) findings in eyes with active anterior scleritis and compare the findings to those with episcleritis and normal controls. Prospective evaluation of a diagnostic test. We included a total of 30 eyes of 30 patients with unilateral anterior scleral or episcleral inflammation. The contralateral 30 eyes with no active ocular disease served as controls. OCT was performed over the anterior sclera in the inflamed area on all cases. The OCT images were analyzed to determine the thickness of the sclera and the presence or absence of scleral hyporeflective areas representing intrascleral edema. There were 17 male and 13 female patients. The mean age was 43 years with an age range of 21-77 years. Eighteen patients had anterior scleritis and 12 patients had episcleritis. The mean transconjunctival scleral thickness was 747μm (SD ± 68.97) with a range of 616-877μm in normal eyes, 882μm (SD ± 87.35) with a range of 773-1089μm in patients with scleritis, and 825μm (SD ± 85.57) with a range of 718-949μm in patients with episcleritis. Patients with active anterior scleritis showed increased thickness of the sclera and presence of intrascleral hyporeflective areas of edema by OCT compared to patients with episcleritis and normal eyes. OCT adds both qualitative and quantitative information to diagnosis and monitoring of patients with scleritis.

In Vivo Confocal Microscopy and Anterior Segment Optic Coherence Tomography Findings in Ocular Ochronosis.

Purpose. To report clinical and in vivo confocal microscopy (IVCM) findings of two patients with ocular ochronosis secondary due to alkaptonuria. Materials and Methods. Complete ophthalmologic examinations, including IVCM (HRT II/Rostock Cornea Module, Heidelberg, Germany), anterior segment optical coherence tomography (AS-OCT) (Topcon 3D spectral-domain OCT 2000, Topcon Medical Systems, Paramus, NJ, USA), corneal topography (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany), and anterior segment photography, were performed. Results. Biomicroscopic examination showed bilateral darkly pigmented lesions of the nasal and temporal conjunctiva and episclera in both patients. In vivo confocal microscopy of the lesions revealed prominent degenerative changes, including vacuoles and fragmentation of collagen fibers in the affected conjunctival lamina propria and episclera. Hyperreflective pigment granules in different shapes were demonstrated in the substantia propria beneath the basement membrane. AS-OCT of Case 1 demonstrated hyporeflective areas. Fundus examination was within normal limits in both patients, except tilted optic discs with peripapillary atrophy in one of the patients. Corneal topography, thickness, and macular OCT were normal bilaterally in both cases. Conclusion. The degenerative and anatomic changes due to ochronotic pigment deposition in alkaptonuria can be demonstrated in detail with IVCM and AS-OCT. Confocal microscopic analysis in ocular ochronosis may serve as a useful adjunct in diagnosis and monitoring of the disease progression.

Automatic segmentation of microcystic macular edema in OCT.

Microcystic macular edema (MME) manifests as small, hyporeflective cystic areas within the retina. For reasons that are still largely unknown, a small proportion of patients with multiple sclerosis (MS) develop MME-predominantly in the inner nuclear layer. These cystoid spaces, denoted pseudocysts, can be imaged using optical coherence tomography (OCT) where they appear as small, discrete, low intensity areas with high contrast to the surrounding tissue. The ability to automatically segment these pseudocysts would enable a more detailed study of MME than has been previously possible. Although larger pseudocysts often appear quite clearly in the OCT images, the multi-frame averaging performed by the Spectralis scanner adds a significant amount of variability to the appearance of smaller pseudocysts. Thus, simple segmentation methods only incorporating intensity information do not perform well. In this work, we propose to use a random forest classifier to classify the MME pixels. An assortment of both intensity and spatial features are used to aid the classification. Using a cross-validation evaluation strategy with manual delineation as ground truth, our method is able to correctly identify 79% of pseudocysts with a precision of 85%. Finally, we constructed a classifier from the output of our algorithm to distinguish clinically identified MME from non-MME subjects yielding an accuracy of 92%.

Predictive value of outer retina Enface OCT imaging in geographic atrophy progression

AbstractPurpose To determine wether there was a correlation between hypo reflective area in Enface OCT of outer retina at baseline, and geographic atrophy (GA) area 1 year later in dry age‐related macular degeneration (AMD)Methods Retrospective study. We included all patients who underwent a clinical examination for dry AMD from July to November 2013 and who had macular captured Enface OCT. Eyes with previously treated wet AMD were excluded. We analysed hypo reflectivity on Enface SD‐OCT extraction (Cirrus 2, Carl Zeiss Meditec,Dublin) of the outer retina 20 µm above retinal pigmented epithelium (RPE), corresponding to the disruption of ellipsoid line (EZ), and extraction below RPE corresponding to GA, the speed of progression of these 2 parameters, the pattern of these areas, best corrected visual acuity (BCVA) on ETDRS scale, and foveal involvement in GA. Our endpoint was the correlation between the difference area EZ‐GA and GA enlargement over 1 year on Enface OCT. Our secondary endpoint was the pattern similarities between both of these parameters.Results We included 38 eyes of 31 patients with dry AMD, mean age was 84,9 years. At baseline, mean size of GA area was 7.1 mm2, mean size of hypo reflectivity was 9.28 mm2, fovea was involved in GA in 49% of cases, BCVA was 64.2 letters. One year later, mean size of GA area was 9.2 mm2, fovea was involved in 54% of cases, BCVA was 58.8 letters. The rate of progression of GA was 2.04 mm2 per year. The difference EZ‐GA at baseline and GA enlargement were not strongly correlated. The pattern of EZ disruption on Enface OCT was correlated in more than 2/3rd of cases with the pattern of GA 1 year later.Conclusion EZ disruption and GA 1 year later are not constantly correlated

Clinical Analysis of Macular Edema with New Software for SD-OCT Imaging

To evaluate the clinical efficacy of user-friendly software for the measurement of intraretinal hyporeflective spaces expression of macular edema. Fifteen consecutive patients with diabetic retinopathy with clinically significant macular edema were examined using conventional spectral domain optical coherence tomography (OCT). A new composite software application, OCT-measurement analysis tool (OCT-MAT), was developed to automatically process and analyze OCT B-scans by means of image acquisition, filtering, and elaboration, together with hyporeflective area recognition and measurement in µm2. The same macular areas were measured manually, and then compared to the measurements obtained by the automated OCT-MAT software. A statistical t test analysis was applied (statistical significance level at p<0.05). The repeatability and reproducibility coefficient for the automated software was computed using the Wilcoxon matched pair test (5% significance level). In all patients, the software effectively measured the number and extension of intraretinal hyporeflective spaces in µm2. The comparison between mean manual measurements and OCT-MAT measurements (0.478 ± 0.300 × 10(6) µm2 vs 0.471 ± 0.321 × 10(6) µm2) showed correct correspondence (p>0.05). Moreover, the OCT-MAT software showed good repeatability and reproducibility (coefficient below 3%). OCT-MAT allows the precise measurement of macular edema in terms of the number of empty spaces and their size in all patients. Its daily clinical application might give precise information regarding the evolution of macular edema and the efficacy of therapy.

Computerized Assessment of Intraretinal and Subretinal Fluid Regions in Spectral-Domain Optical Coherence Tomography Images of the Retina

To evaluate a new computerized segmentation technique for the quantification of intraretinal and subretinal fluid in spectral-domain optical coherence tomography (SD OCT) images of the retina. Prospective, cross-sectional study. Thirty-seven B-scan images of 37 patients with exudative age-related macular degeneration were chosen randomly from SD OCT volume scans (1 per volume scan). All hyporeflective areas in the image first were segmented automatically as candidate regions by the program. Researchers who were masked to the candidate region information selected each fluid region from the original image using a single mouse click. The program then delineated the boundary of each region selected and calculated quantitative parameters, including total area of fluid regions if multiple regions were selected. The performance of our technique was validated by comparing the results with the measurements obtained from boundaries manually delineated by 2 masked observers. Time efficiency, agreement with manual delineation, and intraobserver and interobserver agreement of using the program were evaluated. The proposed technique reduced the average processing time per image approximately 6-fold (15seconds for computerized segmentation vs 90 seconds for manual delineation). There was good agreement between computerized segmentation and manual delineation measured by intraclass correlation coefficient (range, 0.897 to 0.979) and the Dice coefficient (range, 0.721 to 0.785). The proposed technique has excellent intraobserver and interobserver agreement (intraclass correlation coefficient range, 0.998 to 0.999; Dice coefficient range. 0.959 to 0.981). This computerized segmentation method allows for accurate and fast quantification of fluidinretinal SD OCT images and could assist in monitoring disease progression and evaluating therapeutic intervention.