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'Quantitative OCT Analysis of Idiopathic Perifoveal Telangiectasia'

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'Quantitative OCT Analysis of Idiopathic Perifoveal Telangiectasia' Barthelmes, D; Gillies, M C; Sutter, F K P (2008). Quantitative OCT analysis of idiopathic perifoveal telangiectasia. Investigative Ophthalmology and Visual Science (IOVS), 49(5):2156-2162. Postprint available at: http://www.zora.uzh.ch University of Zurich Posted at the Zurich Open Repository and Archive, University of Zurich. Zurich Open Repository and Archive http://www.zora.uzh.ch Originally published at: Investigative Ophthalmology and Visual Science (IOVS) 2008, 49(5):2156-2162. Winterthurerstr. 190 CH-8057 Zurich http://www.zora.uzh.ch Year: 2008 Quantitative OCT analysis of idiopathic perifoveal telangiectasia Barthelmes, D; Gillies, M C; Sutter, F K P Barthelmes, D; Gillies, M C; Sutter, F K P (2008). Quantitative OCT analysis of idiopathic perifoveal telangiectasia. Investigative Ophthalmology and Visual Science (IOVS), 49(5):2156-2162. Postprint available at: http://www.zora.uzh.ch Posted at the Zurich Open Repository and Archive, University of Zurich. http://www.zora.uzh.ch Originally published at: Investigative Ophthalmology and Visual Science (IOVS) 2008, 49(5):2156-2162. Quantitative OCT analysis of idiopathic perifoveal telangiectasia Abstract PURPOSE: To identify and quantitate specific changes in optical coherence tomography (OCT) images of patients with type 2 idiopathic perifoveal telangiectasia (IPT). METHODS: In a prospectively designed, observational, case-control study, 28 eyes of 14 consecutive patients with IPT were examined with OCT and compared with eyes of 14 unaffected control subjects. Light reflectivity profiles of raw scan data of OCT images were quantitatively analyzed for differences in distance between different retinal reflectivity layers and their respective reflectivities. Maculae were examined in four separate regions: (1) central fovea, (2) nasal perifovea, (3) temporal perifovea, and (4) outside the fovea. RESULTS: Retinal thinning, shortening of the photoreceptor outer segments and loss of reflectivity of the photoreceptor ellipsoid region were found in the central foveal region as well as the nasal and temporal perifoveal regions in eyes with IPT. In addition, increased reflectivity of the outer nuclear layer was found in a sharply demarcated area of the inferotemporal perifoveal region in all affected eyes. Retinal tissue located more than 2000 mum away from the foveola was indistinguishable from that in normal eyes. CONCLUSIONS: Quantitative OCT analysis shows unique and specific changes in the photoreceptors of the central macula in IPT which can be detected from first clinical presentation. These changes may be of use as an additional diagnostic tool. Correlation of the findings in the outer nuclear layer with histologic studies may help identify the nature of the reflectivity increase and define more clearly the type of damage sustained by the photoreceptors in this condition. Quantitative OCT Analysis of Idiopathic Perifoveal Telangiectasia Daniel Barthelmes,1 Mark C. Gillies,2 and Florian K. P. Sutter3 PURPOSE. To identify and quantitate specific changes in optical angiography but without retinal thickening or exudation. Loss coherence tomography (OCT) images of patients with type 2 of central macular transparency is a common early feature, idiopathic perifoveal telangiectasia (IPT). discrete superficial white crystals may also be found. The ETHODS clinical onset of the disease is usually in the fifth decade, with M . In a prospectively designed, observational, case– 1,2 control study, 28 eyes of 14 consecutive patients with IPT no preference for sex or race. were examined with OCT and compared with eyes of 14 Optical coherence tomography (OCT) is a noncontact, non- unaffected control subjects. Light reflectivity profiles of raw invasive imaging technology, that is already established as a frequently used tool for the diagnosis and follow-up of various scan data of OCT images were quantitatively analyzed for 4,5 differences in distance between different retinal reflectivity retinal diseases. OCT scans through a normal macula, cen- layers and their respective reflectivities. Maculae were exam- tered on the foveola, show clearly distinguishable reflective ined in four separate regions: (1) central fovea, (2) nasal peri- layers. An analysis of the reflectivity of these layers as a func- fovea, (3) temporal perifovea, and (4) outside the fovea. tion of scan-depth (Fig. 1) results in a curve with several peaks, from now on referred to as P1 to P6.6,7 Corresponding to RESULTS. Retinal thinning, shortening of the photoreceptor retinal anatomy,8 these peaks represent the retinal pigment outer segments and loss of reflectivity of the photoreceptor epithelium (P1), a highly reflective layer between the inner and ellipsoid region were found in the central foveal region as well outer segments of the photoreceptors (P2), the external limit- as the nasal and temporal perifoveal regions in eyes with IPT. ing membrane (P3), the outer plexiform layer (P4), the inner In addition, increased reflectivity of the outer nuclear layer was plexiform layer (P5), and the nerve fiber layer–vitreoretinal found in a sharply demarcated area of the inferotemporal interface (P6). It has been suggested that P2 arises from tightly perifoveal region in all affected eyes. Retinal tissue located ␮ packed mitochondria in the ellipsoid region of the photore- more than 2000 m away from the foveola was indistinguish- ceptors.6 Because of its unique anatomy, the foveola lacks P4 able from that in normal eyes. and P5. CONCLUSIONS. Quantitative OCT analysis shows unique and spe- A quantitative analysis of these light-reflection profiles cific changes in the photoreceptors of the central macula in (LRPs) has been used to examine changes in animal models9 IPT which can be detected from first clinical presentation. and in rare human retinal diseases.6 In this study, quantitative These changes may be of use as an additional diagnostic tool. (q)OCT was used to detect and quantify changes in eyes with Correlation of the findings in the outer nuclear layer with IPT. histologic studies may help identify the nature of the reflectiv- ity increase and define more clearly the type of damage sus- tained by the photoreceptors in this condition. (Invest Oph- METHODS thalmol Vis Sci. 2008;49:2156–2162) DOI:10.1167/iovs.07- 0478 Twenty-eight eyes of 14 consecutive patients participating in a natural history study of IPT (see www.mactelresearch.org) and 28 eyes of 14 diopathic macular telangiectasia is an uncommon, slowly healthy control subjects were studied. Patients had no other macular Iprogressive disease of the macula. A recent revised classifi- diseases, such as diabetic retinopathy or age-related changes. The cation stresses two distinct disease processes: type 1, or aneu- diagnosis was made by a retinal specialist (MG) based on the unique rysmal telangiectasia with exudation and type 2, idiopathic clinical features of the disease and confirmed by the Reading Center of perifoveal telangiectasia (IPT).1–3 IPT, the most common form, Moorfields Eye Hospital (London, UK). All patients underwent slit lamp usually occurs bilaterally and is characterized by small telangi- examination, fluorescein angiography, fundus photography, and OCT ectatic vessels characteristically found inferotemporally within scanning (Stratus OCT software ver. 4.01; Carl Zeiss Meditec AG, 1 disc diameter of the foveola, with staining by fluorescein on Oberkochen, Germany). Best corrected logMAR visual acuity was mea- sured by certified refractionists using ETDRS (Early Treatment of Dia- betic Retinopathy Study) charts. OCT studies were performed twice 1 over a period of 9 months. A custom-designed scan program was used From the Klinik und Poliklinik fu¨r Augenheilkunde, Inselspital to create a dense raster of data points across the macula. A scan of 12 Bern, Bern, Switzerland; the 2Save Sight Institute, University of Sydney, radial scan-lines of 6-mm length at 15° intervals centered on the fovea Sydney, Australia; and the 3Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland. (similar to the built-in Macular Thickness Map program) was per- Supported by the Paul Schiller Foundation Zurich Switzerland and formed (Fig. 2). Raw scan data were exported from the OCT device for the Lowy Medical Research Foundation. MCG is Executive Scientific further analysis. For the analysis the raw data from the Stratus OCT Manager of the MacTel Research Project. were opened as a 32-bit gray-scale image resulting in gray-scale values Submitted for publication April 22, 2007; revised September 5 and ranging from 0 to 4095. Since levels of gray were used when analyzing October 17, 2007; accepted March 27, 2008. the reflectivity and not decibels, as provided by the Stratus OCT, Disclosure: D. Barthelmes, None; M.C. Gillies, None; F.K.P. arbitrary units (AU) were used instead of decibels. Calculation of the Sutter, None LRP was performed with a scientific graphing, data analysis, and visu- The publication costs of this article were defrayed in part by page alization software package (IGOR 5.04a; Wavemetrics Inc., Lake Os- charge payment. This article must therefore be marked “advertise- ment” in accordance with 18 U.S.C. §1734 solely to indicate this fact. wego, OR). LRP reflectivity, which ranged from 0 to 4095 AU, was Corresponding author: Mark C. Gillies, Save Sight Institute, Sydney calculated every 50 ␮m along each scan. Based on the results from Eye Hospital Campus, 8 Macquarie Street, Sydney 2000 GPO Box 4337, healthy control subjects, ranges for detecting peaks in the LRPs were
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