Optical Coherence Tomography In Diagnosis Research Articles

Study of clinical significance of optical coherence tomography in diagnosis & management of diabetic macular edema

Background: 26 million people were estimated to be affected by diabetes in 2010 across the globe. Diabetic macular edema (DME) is the most important cause of visual impairment due to diabetic retinopathy. Optical Coherence Tomography (OCT) is a non-invasive modality which produces cross-sectional or three-dimensional, high-resolution images of the retinal layers and quantitative assessment of retinal thickness. Aim of study was to study the incidence of different patterns of diabetic macular edema on Optical coherence tomography (OCT), to decide treatment & follow-up protocol. Material & Methods: 200 eyes of 167 patients attending the M & J Institute of Ophthalmology and having diabetic macular edema were enrolled in this study. Base line examination like best corrected visual acuity, anterior segment examination, indirect ophthalmoscopy, slit lamp biomicroscopy, OCT and fundus fluorescein angiography were done in all patients. The patients will be classified according to type of macular edema on OCT. Follow up visits will be scheduled one week, one month post procedure and every two monthly thereafter. Results: In this non-randomized, prospective study, 200 eyes of 167 patients with diabetic macular edema were enrolled. Out of 167 patients 33 (19.7%) patients were having DME in both eyes. Single type of edema was present in 122 (61%) eyes, combination of two types of edema in 56 (28%) eyes & combination of three types of edema in 22 (11%) eyes. Grid laser treatment was given in 72 (36%) eyes. Intravitreal triamcinolone injection was given in 110 (55%) eyes. Parsplana vitrectomy was done in 18 (9%) eyes. Discussion: Diabetic macular edema is the most important cause of visual impairment in patients with diabetes. OCT is a non-invasive and reproducible tool for obtaining high resolution, cross-sectional images of the retina. In our study spongy edema was most common type found (36%), followed by cystoid edema (14%), serous detachment (7%) & vitreomacular traction

表在型食道癌に対するOptical Coherence Tomography診断の有用性

表在型食道癌に対するOptical Coherence Tomography診断の有用性

Optical Coherence Tomography in Diagnosis of Primary Open Angle Glaucoma

Optical Coherence Tomography in Diagnosis of Primary Open Angle Glaucoma

Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma.

Optical coherence tomography (OCT) is a noninvasive imaging tool used invivo in real time for diagnosis, treatment delineation and monitoring of basal cell carcinoma (BCC). Features of BCC on OCT have been widely described and reviewed. However, the diagnostic accuracy of OCT in these various applications is unclear. We systematically reviewed the literature to assess the accuracy of OCT in diagnosis and management of BCC using the Embase and Medline databases. In total 179 unique references were identified in the initial search, of which 22 studies with 556 histologically proven BCCs were eligible. Assessment of the quality of eligible studies was undertaken using the STROBE criteria. Data extraction and quality assessment were performed independently by the two authors. This systematic review provides an overview of the clinical applications of OCT in the diagnosis and management of BCC. OCT has been suggested to be useful in the diagnosis, treatment planning and treatment monitoring of BCC. As the technology improves and its utility increases, further studies with good methodological quality will be needed to implement OCT into daily practice.

Comparison between Heidelberg retinal tomography-II and Heidelberg optical coherence tomography in diagnosis of pre-perimetric glaucoma

Objective To compare the clinical value of Heidelberg retinal tomography (HRT-Ⅱ) and Heidelberg optical coherence tomography (HRA-OCT) in discriminating healthy eyes and pre-perimetric glaucoma eyes. Methods A total of 33 patients with pre-perimetric glaucoma and 37 healthy subjects were included in this study. All individuals underwent imaging tests with HRT-Ⅱ and HRA-OCT within 1-month period. ANOVA and Kruskal-Wallis test were used to compare all of the parameters from HRT-Ⅱ and HRA-OCT between pre-perimetric glaucoma eyes and normal eyes. Receiver operating characteristic curves (ROC) were calculated for all of the parameters to seek the best discriminant point of each instrument between pre-perimetric glaucoma and healthy eyes. Results Statistically significant differences were found in most of the HRT-Ⅱ parameters except for disc area and height variation contour between pre-perimetric glaucomatous eyes and normal eyes (all P 0.05). Conclusions Both HRT-Ⅱ and HRA-OCT can well reflect the damage of optic disc and retinal nerve fiber layer in eyes with pre-perimetric glaucoma. HRT-Ⅱ and HRA-OCT have higher accuracy and similar sensitivity and specificity for the diagnosis of pre-perimetric glaucoma. Key words: Retina; Visual fields; Glaucoma

Optical coherence tomography for the diagnosis and evaluation of human otitis media.

We report the application of optical coherence tomography (OCT) to the diagnosis and evaluation of otitis media (OM). Whereas conventional diagnostic modalities for OM, including standard and pneumatic otoscopy, are limited to visualizing the surface of the tympanic membrane (TM), OCT effectively reveals the depth-resolved microstructure below the TM with very high spatial resolution, with the potential advantage of its use for diagnosing different types of OM. We examined the use of 840-nm spectral domain-OCT (SD-OCT) clinically, using normal ears and ears with the adhesive and effusion types of OM. Specific features were identified in two-dimensional OCT images of abnormal TMs, compared to images of healthy TMs. Analysis of the A-scan (axial depth scan) identified unique patterns of constituents within the effusions. The OCT images could not only be used to construct a database for the diagnosis and classification of OM but OCT might also represent an upgrade over current otoscopy techniques.

OCT-BASED INTERPRETATION OF THE VITREOMACULAR INTERFACE AND INDICATIONS FOR PHARMACOLOGIC VITREOLYSIS

To review the role of optical coherence tomography (OCT) in diagnosis and management of vitreomacular disease and the impact of OCT on potential uses of ocriplasmin, a new pharmacologic vitreolysis agent recently approved by the U.S. Food and Drug Administration for the treatment of symptomatic vitreomacular adhesion. Analysis of current literature regarding OCT in diagnosis and management of vitreomacular interface disease. Posterior vitreous detachment is typically a nonpathologic age-related event. Anomalous posterior vitreous detachment emerges when the vitreous cortex fails to cleanly detach from the macula, optic nerve, or other adherent sites. Focal vitreomacular adhesion is a nonpathologic anatomical designation associated with perifoveal posterior vitreous detachment but normal retinal morphology on OCT. Vitreomacular traction is a pathologic consequence of persistent vitreous attachment with structural disturbance of the macular retina visible on OCT. Full-thickness macular holes are foveal defects continuous through all retinal layers to the retinal pigment epithelium. Vitreomacular traction and macular hole with focal vitreomacular adhesion are indications for pharmacologic vitreolysis. Noninvasive high-resolution OCT imaging has transformed the understanding of vitreomacular interface disease. Careful evaluation of the vitreomacular interface with OCT has increased in importance with the introduction of ocriplasmin for vitreomacular adhesion associated with symptomatic anatomical retinal changes.

Fluorescein Angiography versus Optical Coherence Tomography for Diagnosis of Uveitic Macular Edema

To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) results for diagnosis of macular edema in patients with uveitis. Multicenter cross-sectional study. Four hundred seventy-nine eyes with uveitis from 255 patients. The macular status of dilated eyes with intermediate uveitis, posterior uveitis, or panuveitis was assessed via Stratus-3 OCT and FA. To evaluate agreement between the diagnostic approaches, κ statistics were used. Macular thickening (MT; center point thickness, ≥ 240 μm per reading center grading of OCT images) and macular leakage (ML; central subfield fluorescein leakage, ≥ 0.44 disc areas per reading center grading of FA images), and agreement between these outcomes in diagnosing macular edema. Optical coherence tomography (90.4%) more frequently returned usable information regarding macular edema than FA (77%) or biomicroscopy (76%). Agreement in diagnosis of MT and ML (κ = 0.44) was moderate. Macular leakage was present in 40% of cases free of MT, whereas MT was present in 34% of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40% and 45% of cases of MT and ML, respectively, and diagnosed 17% and 17% of cases with macular edema that did not have MT or ML, respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4%) had MT. No factors were found that effectively ruled out ML when MT was absent. Optical coherence tomography and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but nonidentical macular pathologic characteristics. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after negative results on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema erred frequently, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. Proprietary or commercial disclosure may be found after the references.

Optical coherence tomography for classification of oral mucosal lesions

Introduction: Not having to take a biopsy of oral mucosal lesions can be a great relief for patients. Optical coherence tomography (OCT) allows non-invasive imaging of epithelial layers and subsequently of epithelial lesions. The aim of this study is to establish whether OCT can aid in clinical diagnosis and in the decision of taking a biopsy or not. Methods: Patients with a lesion of the oral mucosa were selected for this study. Before taking biopsies an OCT image (Niris, Imalux, USA) as well as a white light image was made. The spot was marked with a felt pen, which was biopsied. Histolopathology was the gold standard. Uninformed on the diagnosis, two independent observers graded the OCT image and clinical white light image. Results: 36 biopsies were taken in 22 patients. Three images were graded as unable to interpret (2 squamous cell carcinoma, 1 lichen planus). On white light images the observers graded the lesions correctly in 67{%} and 68{%} of the cases. In 6{%} resp 20{%} of the cases OCT was considered relevant in the diagnosis of which 50{%} resp 39{%} was diagnosed incorrectly. The number of biopsies correctly omitted was 1.5{%} resp 3{%}. Interobserver agreement ranged from 41-80{%} on items of the grading list. Conclusion: In newly diagnosed lesions the value of OCT seems limited. Images are difficult to interpret and the OCT diagnosis is often wrong. In selected cases OCT may have an added value in long term follow up of lesions.

Arthroscopic Optical Coherence Tomography in Diagnosis of Early Arthritis

Osteoarthritis (OA) is a progressive, debilitating disease that is increasing in prevalence. The pathogenesis of OA is likely multifactorial but ultimately leads to progressive breakdown of collagen matrix and loss of chondrocytes. Current clinical modalities employed to evaluate cartilage health and diagnose osteoarthritis in orthopaedic surgery include, radiography, MRI, and arthroscopy. While these assessment methods can show cartilage fissuring and loss, they are limited in ability to diagnose cartilage injury and degeneration prior breakdown of the articular surface. An improved clinical ability to detect subsurface cartilage pathology is important for development and testing of chondroprotective and chondrorestorative treatments because the pathological changes following surface breakdown are generally considered to be irreversible. Optical Coherence Tomography (OCT), is a novel, non-destructive imaging technology capable of near-real time cross-sectional images of articular cartilage at high resolutions comparable to low power histology. This review discusses a series of bench to bedside studies supporting the potential use of OCT for enhanced clinical diagnosis and staging of early cartilage injury and degeneration. OCT was also found to be useful as a translations research tool to assist in clinical evaluation of novel quantitative MRI technologies for non-invasive evaluation of articular cartilage.

Significance of optic disc topography and retinal nerve fiber layer thickness measurement by spectral-domain OCT in diagnosis of glaucoma

To study the significance of optic disc tomography and retinal nerve fiber layer (RNFL) thickness measurement by spectral-domain optical coherence tomography (OCT) in the diagnosis of glaucoma. It was a noninterventional, observational study. The optic disc topographic parameters and total and regional RNFL thickness were measured by RTVue OCT in 60 normal eyes and 97 glaucomatous eyes. One-way analysis of variance was used to compare the parameters above mentioned between normal and glaucomatous groups. The area under the receiver operating characteristic curve (AUC) and the sensitivity at 80% specificity were used to assess the ability of each testing parameter in the differentiation between normal and glaucoma eyes. There were statistically significant differences in all RTVue OCT measurement parameters (F = 1.024, P = 0.596;F = 36.519, 54.464, 27.659, 36.176, 20.562, 63.833, 30.031, 54.652, 98.146, 78.705, 99.839, 43.728, 75.720, 45.709, 39.380, 33.590, 66.887, 78.335, 45.485;P = 0.000) except disc area. The average RNFL thickness in normal, early, moderate and advanced glaucomatous eyes was 109.950, 93.313, 80.374 and 65.570 µm, respectively. Among the eight regions around the optic disc, the thickest RNFL was located at the inferotemporal (150.066 µm) and superotemporal (146.285 µm) regions in normal eyes, and the superotemporal (108.569, 103.420 and 88.708 µm in early, moderate and advanced glaucomatous eyes, respectively) and inferotemporal (108.201, 102.830 and 86.369 µm in early, moderate and advanced glaucomatous eyes, respectively) regions in glaucomatous eyes. Both in normal and glaucomatous eyes, the thinnest RNFL was located at the nasal and temporal regions, respectively. For optic disc topographic parameters, the highest AUC was vertical cup/disc ratio (AUC = 0.762, 0.946 and 0.988 in early, moderate and advanced glaucomatous eyes, respectively), and the sensitivity at 80% specificity was 62.2%, 76.5% and 99.2% in early, moderate and advanced glaucomatous eyes, respectively. For RNFL thickness, the highest AUC was superotemporal region RNFL thickness (AUC = 0.915) and the sensitivity at 80% specificity was 89.5% in early glaucomatous eyes. The highest AUC was inferior average RNFL thickness (AUC = 0.967) and the sensitivity at 80% specificity was 94.1% in moderate glaucomatous eyes. The highest AUC was average RNFL thickness (AUC = 0.985) and the sensitivity at 80% specificity was 99.2% in advanced glaucomatous eyes. Among the eight regions around the optic disc, RNFL thickness of region ST (AUC = 0.915, 0.926 and 0.966 in early, moderate and advanced glaucomatous eyes, respectively) achieved the highest AUC. RNFL thicknesses of the nasal and temporal regions showed the lowest AUCs. RTVue OCT shows fair discriminating ability in distinguishing normal from glaucomatous eyes. RTVue OCT is a useful equipment for the diagnosis of glaucoma.

Three-dimensional High-speed Optical Coherence Tomography for Diagnosis of Hypotony Maculopathy After Glaucoma Filtration Surgery

To describe the clinical findings of hypotony maculopathy using 3-dimensional (3D) topography maps reconstructed from spectral domain optical coherence tomography (SD-OCT) imaging, and compare SD-OCT with time domain OCT (TD-OCT) for hypotony maculopathy diagnosis. This was an observational noncomparative case series comprising 7 patients with hypotony maculopathy after trabeculectomy with mitomycin-C. All patients underwent consecutive imaging with TD-OCT (Stratus OCT) and SD-OCT using various high-resolution instruments. 3-D surface maps obtained using SD-OCT were compared with linear scans obtained using TD-OCT. Two of 7 eyes had minimally detectable folds with TD-OCT imaging in the vertical axis. Five eyes did not show folds on TD-OCT. 3-D topographic maps using SD-OCT demonstrated advanced retinal and subretinal folds throughout the macular region in all 7 patients. All eyes (4 cases) with no topographically detectable folds using SD-OCT within the foveal avascular zone had visual acuity of 20/25 or better. Three eyes with obvious contour disruption within the foveal pit had visual acuity ranging from 20/30 to 20/70. SD-OCT using 3-D surface topography mapping provides greater sensitivity for hypotony maculopathy diagnosis and monitoring as compared with TD-OCT. Disruption of the foveal pit as detected using SD-OCT is associated with reduced visual acuity.

Potential of optical coherence tomography for early diagnosis of oral malignancies

With nearly 1,500,000 new patients diagnosed every year in the USA, cancer poses a considerable challenge to healthcare today. Oral cancer is responsible for a sizeable portion of deaths due to cancer, primarily because it is diagnosed at a late stage when the prognosis is poor. Current methods for diagnosing oral cancer need to be augmented by better early detection, monitoring and screening modalities. A new approach is needed that provides real-time, accurate, noninvasive diagnosis. The results of early clinical trials using in vivo optical coherence tomography for the diagnosis of oral dysplasia and malignancy are encouraging.

Optical Coherence Tomography for Diagnosis of Posterior Vitreous Detachment at the Macular Region

To assess optical coherence tomography (OCT) for diagnosing posterior vitreous detachment (PVD) at the macular region compared to kinetic B-scan ultrasonography. In the present study, the authors prospectively investigated the frequency of PVD at the posterior pole utilizing ocular kinetic B-mode sonography in 315 eyes of 188 patients (113 female, 75 male; mean age, 72.8 years; range, 39-94) prior to cataract surgery. In addition, OCT scans of the macular region were performed in all subjects for detection of PVD at the macula. A total of 130 eyes (41.3%) had no sonographic signs of PVD. In this subset of patients in 36 eyes (27.7%), OCT revealed a flat PVD at the macular region with the distance between the posterior hyaloid and retinal surface being less than 400 microm (mean distance, 234 +/- 112 microm, range, 24-398). When combining both methods, the diagnosis of PVD at the posterior pole was made in 221 of 315 eyes (70.2%). OCT is a valuable tool for detecting PVD at the macular region, particularly in cases with small distances between the retinal surface and posterior hyaloid. Proof of attachment of the posterior hyaloid can be established only by combining kinetic ultrasonography and OCT.

Assessment of Optical Coherence Tomography Imaging in the Diagnosis of Non-Melanoma Skin Cancer and Benign Lesions Versus Normal Skin

Optical coherence tomography (OCT) is an optical imaging technique that may be useful in diagnosis of non-melanoma skin cancer (NMSC). To describe OCT features in NMSC such as actinic keratosis (AK) and basal cell carcinoma (BCC) and in benign lesions and to assess the diagnostic accuracy of OCT in differentiating NMSC from benign lesions and normal skin. OCT and polarization-sensitive (PS) OCT from 104 patients were studied. Observer-blinded evaluation of OCT images from 64 BCCs, 1 baso-squamous carcinoma, 39 AKs, two malignant melanomas, nine benign lesions, and 105 OCT images from perilesional skin was performed; 50 OCT images of NMSC and 50 PS-OCT images of normal skin were evaluated twice. Sensitivity was 79% to 94% and specificity 85% to 96% in differentiating normal skin from lesions. Important features were absence of well-defined layering in OCT and PS-OCT images and dark lobules in BCC. Discrimination of AK from BCC had an error rate of 50% to 52%. OCT features in NMSC are identified, but AK and BCC cannot be differentiated. OCT diagnosis is less accurate than clinical diagnosis, but high accuracy in distinguishing lesions from normal skin, crucial for delineating tumor borders, was obtained.

Spectral-Domain OCT and Microperimeter Characterization of Morphological and Functional Changes in X-linked Retinoschisis

A case of X-linked retinoschisis with anatomic and functional issues correlated by a constellation of methods, including spectral-domain optical coherence tomography, microperimeter, electroretinography, and multifocal electroretinography, is described. This case highlights the importance of microperimetry in the presence of normal or subtle abnormalities in full-field electroretinography. The ability of spectral-domain optical coherence tomography in diagnosis and follow-up in cases with X-linked retinoschisis is demonstrated.

Optical coherence tomography guided cystoscopy in diagnosis and management of clinical bladder tumors

15518 Background: Optical coherence tomography (OCT) is a novel tool that permits high-resolution cross-sectional imaging of bladder urothelium during cystoscopy. OCT delineates morphological features of the bladder urothelium, the lamina propria, and the muscularis layer based on their backscattering patterns. We hypothesize that application of microelectromechanical systems (MEMS) mirrors for OCT can improve cross-sectional image resolution of bladder lesions. We report preliminary results from our prospective non-randomized study using MEMS mirror OCT imaging during cystoscopy. Methods: Following our institutional IRB approval, a prospective correlative study was performed evaluating the role of cross-sectional OCT in diagnosis and treatment of bladder cancers. OCT cystoscopy was performed in thirty patients undergoing cystoscopy or transurethral resection for suspected bladder tumors. Any suspicious lesions or tumors seen on cystoscopy were either biopsied or resected as per standard of care. The primary endpoints were patient safety and the correlation between OCT images and histology. Results: Bladder cancer was identified in twenty five patients by pathological evaluation. Twenty four out of twenty five patients were correctly diagnosed with cross-sectional OCT imaging. Four out of five patients with benign lesions were correctly identified. There was one false positive and one false negative in our series. Overall sensitivity and specificity of cross-sectional OCT in diagnosing bladder cancer was 96 and 80%, respectively. There were no complications related to OCT cystoscopy. Axial and lateral resolutions were 10 and 12 microns, respectively. The field of view was measured at 4.5 mm with the depth of penetration measured to be 2 mm. Conclusions: OCT cystoscopy is a promising new tool in diagnosis of bladder cancer. Our preliminary data suggests OCT with MEMS mirrors resulted in high resolution images that may aid in the diagnosis of bladder cancer during cystoscopy. Application of OCT cross sectional imaging may have additional benefits: improved diagnosis, identification of surgical margins, and more complete resection of bladder tumors. No significant financial relationships to disclose.

1086: Cystoscopic Optical Coherence Tomography in Diagnosis and Management of Clinical Bladder Tumors

1086: Cystoscopic Optical Coherence Tomography in Diagnosis and Management of Clinical Bladder Tumors

Optical coherence tomography for diagnosis and monitoring of angle-closure glaucoma induced by topiramate

Optical coherence tomography for diagnosis and monitoring of angle-closure glaucoma induced by topiramate

Advances in the diagnosis, evaluation and management of cholangiocarcinoma

Cholangiocarcinoma is an enigmatic malignancy of the biliary tract that has recently been shown to be increasing in incidence globally. There has been recent progress in identifying potential risk factors for the tumor, and in the use of emerging technologies for diagnosis and palliative treatment. Hepatitis B and C, cirrhosis and alcohol have been described as risk factors for cholangiocarcinoma. A morphology-based classification for cholangiocarcinoma is proposed that will facilitate future descriptive epidemiology, diagnosis and comparative therapeutic studies. Diagnosis may be improved by new approaches to enhance the diagnostic yield and utility of biliary cytology. The role of new imaging approaches such as positron emission tomography scanning, endoscopic ultrasound or optical coherence tomography for diagnosis are being examined and defined. Long-term results for transplantation protocols for curative intent in non-resectable localized disease have been described. Photodynamic therapy looks extremely promising for adjunct therapy of intrahepatic mass lesions. Recent advances in the epidemiology, classification, diagnosis and therapy of cholangiocarcinoma are expected to enhance the evaluation and management of patients with this devastating malignancy.