HANDBOOK of RETINAL OCT Content Strategist: Russell Gabbedy Content Development Specialist: Sharon Nash Project Manager: Julie Taylor Design: Christian Bilbow Illustration Manager: Jennifer Rose Illustrator: Antbits Ltd Marketing Manager(s) (UK/USA): Gaynor Jones/Abby Swartz HANDBOOK of RETINAL OCT Lead Editor Associate Editors Jay S. Duker MD Nadia K. Waheed MD MPH Director, New England Eye Center Assistant Professor of Ophthalmology Professor and Chairman, New England Eye Center Department of Ophthalmology Tufts Medical Center Tufts Medical Center Tufts University School of Medicine Tufts University School of Medicine Boston, MA, USA Boston, MA, USA Darin R. Goldman MD Vitreoretinal Surgeon Retina Group of Florida Fort Lauderdale, FL, USA For additional online content visit expertconsult London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/ permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-323-18884-5 e-book ISBN: 978-0-323-18885-2 The publisher’s policy is to use paper manufactured from sustainable forests Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contents Preface..........................................................................................................................viii List of Contributors........................................................................................................ix Acknowledgements........................................................................................................x Dedications.....................................................................................................................x Glossary..........................................................................................................................xi Part 1: Introduction to OCT..........................................................................................1 Section 1:. OCT: What It Is...............................................................................2 Chapter 1.1. Scanning Principles...................................................2 Chapter 1.2. Basic Scan Patterns and OCT Output.......................4 Section 2:. OCT Interpretation..........................................................................8 Chapter 2.1. OCT Interpretation.....................................................8 Section 3:. OCT Artifacts................................................................................10 Chapter 3.1. Artifacts on OCT......................................................10 Section 4:. Normal Retinal Anatomy and Basic Pathologic Appearances..............................................................14 Chapter 4.1. Normal Retinal Anatomy and Basic Pathologic Appearances..........................................14 Part 2: Optic Nerve Disorders.....................................................................................23 Section 5:. Interpretation of Optic Nerve OCTs............................................24 Chapter 5.1. Basic Optic Nerve Scan Patterns and Output.........24 Daniela Ferrara Section 6:. Optic Nerve Disorders..................................................................28 Chapter 6.1. Glaucoma................................................................28 Daniela Ferrara and Alexandre S.C. Reis Chapter 6.2. Optic Neuropathies and Papilledema.......................30 Daniela Ferrara and Alexandre S.C. Reis Chapter 6.3. Congenital Optic Nerve Head Abnormalities............32 Daniela Ferrara and Alexandre S.C. Reis Part 3: Macular Disorders...........................................................................................35 Section 7:. Dry Age-Related Macular Degeneration.....................................36 Chapter 7.1. Dry Age-Related Macular Degeneration...................36 Section 8:. Wet Age-Related Macular Degeneration....................................38 Chapter 8.1. Wet Age-Related Macular Degeneration..................38 Section 9:. Macular Pathology Associated with Myopia..............................46 Chapter 9.1. Posterior Staphyloma..............................................46 Chapter 9.2. Myopic Choroidal Neovascular Membrane..............48 Chapter 9.3. Myopic Macular Schisis...........................................50 Chapter 9.4. Dome-Shaped Macula.............................................52 Chapter 9.5. Myopic Tractional Retinal Detachment.....................53 v Section 10:.Vitreomacular Interface Disorders...............................................54 Chapter 10.1. Vitreomacular Adhesion and Vitreomacular Traction.............................................54 Chapter 10.2. Full-Thickness Macular Hole....................................56 Chapter 10.3. Epiretinal Membrane................................................58 s Section 11:.Miscellaneous Causes of Macular Edema..................................60 nt e Chapter 11.1. Postoperative Cystoid Macular Edema....................60 nt Chapter 11.2. Macular Telangiectasia............................................62 o C Chapter 11.3. Uveitis......................................................................68 Section 12:.Miscellaneous Macular Disorders...............................................70 Chapter 12.1. Central Serous Chorioretinopathy............................70 Chapter 12.2. Hydroxychloroquine Toxicity....................................72 Chapter 12.3. Pattern Dystrophy....................................................74 Chapter 12.4. Oculocutaneous Albinism........................................76 Chapter 12.5. Subretinal Perfluorocarbon......................................78 Chapter 12.6. X-Linked Juvenile Retinoschisis...............................80 Part 4: Retinal Vascular Disorders.............................................................................83 Section 13:.Diabetic Retinopathy....................................................................84 Chapter 13.1. Non-Proliferative Diabetic Retinopathy.............................................................84 Chapter 13.2. Diabetic Macular Edema..........................................88 Chapter 13.3. Proliferative Diabetic Retinopathy.............................90 Section 14:.Retinal Vein Occlusion.................................................................92 Chapter 14.1. Branch Retinal Vein Occlusion.................................92 Chapter 14.2. Central Retinal Vein Occlusion.................................94 Section 15:.Retinal Artery Occlusion..............................................................96 Chapter 15.1. Branch Retinal Artery Occlusion..............................96 Chapter 15.2. Central Retinal Artery Occlusion..............................98 Chapter 15.3. Cilioretinal Artery Occlusion...................................100 Part 5: Inherited Retinal Degenerations..................................................................103 Section 16:.Inherited Retinal Degenerations................................................104 Chapter 16.1. Retinitis Pigmentosa..............................................104 Chapter 16.2. Stargardt Disease..................................................106 Chapter 16.3. Best Disease.........................................................108 Chapter 16.4. Cone Dystrophy.....................................................110 Part 6: Uveitis And Inflammatory Diseases.............................................................113 Section 17:.Posterior Non-Infectious Uveitis................................................114 Chapter 17.1. Multifocal Choroiditis..............................................114 Sana Nadeem Chapter 17.2. Birdshot Chorioretinopathy....................................116 Sana Nadeem Chapter 17.3. Serpiginous Choroiditis..........................................118 Sana Nadeem Chapter 17.4. Vogt–Koyanagi–Harada Disease............................120 Sana Nadeem Chapter 17.5. Sympathetic Ophthalmia........................................122 Sana Nadeem Chapter 17.6. Posterior Scleritis...................................................124 Sana Nadeem vi Section 18:.Posterior Infectious Uveitis........................................................126 Chapter 18.1. Toxoplasma Chorioretinitis.....................................126 Chapter 18.2. Tuberculosis..........................................................128 Chapter 18.3. Acute Syphilitic Posterior Placoid Chorioretinitis.........................................................130 Chapter 18.4. Candida Albicans Endogenous s nt Endophthalmitis.....................................................132 e Chapter 18.5. Acute Retinal Necrosis Syndrome.........................134 nt o C Part 7: Trauma............................................................................................................137 Section 19:.Physical Trauma.........................................................................138 Chapter 19.1. Commotio Retinae.................................................138 Chapter 19.2. Choroidal Rupture and Subretinal Hemorrhage.....140 Chapter 19.3. Valsalva Retinopathy..............................................142 Section 20:.Photothermal, Photomechanical, and Photochemical Trauma........................................................................................144 Chapter 20.1. Laser Injury (Photothermal and Photomechanical)..................................................144 Chapter 20.2. Retinal Light Toxicity (Photochemical)....................146 Part 8: Tumors............................................................................................................149 Section 21:.Choroidal Tumors.......................................................................150 Chapter 21.1. Choroidal Nevus....................................................150 Chapter 21.2. Choroidal Melanoma..............................................152 Chapter 21.3. Choroidal Hemangioma.........................................154 Section 22:.Retinal Tumors............................................................................156 Chapter 22.1. Retinal Capillary Hemangioma...............................156 Chapter 22.2. Retinoblastoma......................................................158 Section 23:.Other Tumors..............................................................................160 Chapter 23.1. Metastatic Choroidal Tumor..................................160 Chapter 23.2. Vitreoretinal Lymphoma.........................................162 Part 9: Peripheral Retinal Abnormalities.................................................................165 Section 24:.Retinal Detachment....................................................................166 Chapter 24.1. Retinal Detachment...............................................166 Section 25:.Retinoschisis...............................................................................168 Chapter 25.1. Retinoschisis..........................................................168 Section 26:.Lattice Degeneration..................................................................170 Chapter 26.1. Lattice Degeneration.............................................170 Index............................................................................................................................173 vii Preface Optical coherence tomography (OCT) was ‘discovered’ in an optics lab at the Massachu- setts Institute of Technology in the late 1980s by James Fujimoto and his collaborators: Carmen Puliafito, Joel Schuman, David Huang, Eric Swanson and Mike Hee. It began as an effort to experimentally measure excimer laser corneal ablation in real time. While it failed in that regard, the founders quickly identified the possibility that OCT could be employed to measure static ocular tissue thickness in real time. The first publication on OCT was in Science in 1991 and by 1996 the technology was transferred to a commercial company and soon thereafter commercial devices began to be sold. In 2013, it is safe to say that OCT is one of the most important ancillary tests in oph- thalmology and it is indisputably THE most important ancillary test in the subspecialty of the retina. We set out to produce an easy-to-read, brief but complete handbook of OCT images that was disease-based. Given the importance of OCT in our practices, we con- cluded that the OCT images should be the major focus of the book. Consistency of chapter layout, excellent images, and well-documented pathologic features were all goals. This book has minimal clinical description of the pathologic entities. There are plenty of excellent textbooks that cover these entities in more depth. We hope you find this handbook useful in your clinical practice on a daily basis. viii List of Contributors Daniela Ferrara MD PhD Alexandre S.C. Reis MD Researcher Department of Ophthalmology New England Eye Center University of São Paulo Tufts University School of Medicine São Paulo, SP, Brazil Boston, MA, USA Sana Nadeem MBBS FCPS Senior Registrar Ophthalmology Department Fauji Foundation Hospital Rawalpindi, Pakistan ix