12/4/2015 UCSF December Course, 2015 Applications of Imaging in Uveitis SD-OCT Imaging in Uveitis • Diagnosis • Location and Extent of Disease • Cause(s) of Vision Loss • Progression Emmett T. Cunningham, Jr., M.D., PhD., M.P.H Department of Ophthalmology, California Pacific Medical Center Department of Ophthalmology, Stanford University School of Medicine • Response to Therapy Francis I. Proctor Foundation, UCSF School of Medicine West Coast Retina Medical Group Spatial Representations Applications of SD-OCT in Uveitis • Diagnosis MRI • Location and Extent of Disease • Cause(s) of Vision Loss Sagittal Coronal Axial 3D • Progression • Response to Therapy 1
12/4/2015 SD-OCT Representations Spatial Representations Line Scans En Face 3D Vertical Horizontal En Face Horizontal (Retinal Thickness; ILM – RPE) Vertical 3D Anatomical En Face Imaging SD-OCT = Virtual Histology Fovea (“pit”) Slab RPE-based Slab ILM-based Slab < 10 µm resolution Courtesy of Ralph Eagle, MD 8 Wills Eye Hospital Courtesy Dr. Brandon Lujan 2
12/4/2015 Normal SD-OCT International Nomenclature for OCT Meeting Consensus Normal OCT Terminology ‘The Essentials’ Posterior Cortical Vitreous Henle’s-ONL Formed Vitreous junction (subtle) Preretinal Space Nerve Fiber Layer Ganglion Cell Layer Inner Plexiform Layer Inner Nuclear Layer Outer Plexiform Layer (dendritic) 250 µm Henle Fiber Layer (axonal OPL) Outer Nuclear Layer Outer Segments Sattler’s Layer (Inner Choroid) Haller’s Layer (Outer Choroid) 250 µm External Limiting Membrane Choriocapillaris Myoid Zone Choroid RPE/ Bruch’s Ellipsoid Zone (EZ) Complex Normal Lacunae – No Infiltration or Masses Sclera = 1000µm Choroid Sclera Interdigitation Zone (IZ) Junction 3 Nerve Fiber Layers 3 Nerve Fiber Layers Normal SD-OCT Normal SD-OCT 3 Nuclear Layers 3 Nuclear Layers ‘The Essentials’ ‘The Essentials’ 4 Outer Retinal Bands PR-RPE Complex NFL NFL GCL GCL IPL IPL INL INL OPL OPL 250 µm 250 µm ONL ONL 250 µm 250 µm Choroid Choroid Normal Lacunae – No Infiltration or Masses Normal Lacunae – No Infiltration or Masses Sclera = 1000µm Sclera = 1000µm 3
12/4/2015 Dozens of Disorders Diagnosis Plus those not listed . . . 20/80 Syphilis Syphilis 4
12/4/2015 20/80 20/80 Vitreous Cells Nodular Nodular SRF RPE RPE 20/80 20/80 En Face PR Layer 5
12/4/2015 20/80 20/80 1 :10.87 FAF Acute Syphilitic Posterior Placoid 20/80 20/80 5 :46.90 Chorioretinitis 6
12/4/2015 Location and Extent of Disease APMPPE APMPPE OD OD 20/16 20/16 Disruption / Hyper-reflectivity Outer Retina 7
12/4/2015 OD OS 20/16 20/16 Placoid Lesions En Face PR Layer OD Acute Mulifocal Acute Mulifocal 20/16 Placoid Pigment Epitheliopathy Placoid Pigment Epitheliopathy AMPPE Early Hypo-FA, Late Hyper-FA Case of the Month http://westcoastretina.com/august-2013.html 8
12/4/2015 Sarcoidosis Sarcoidosis Cause(s) of Vision Loss OS OS 20/25-1 20/25-1 9
12/4/2015 OS OS 20/25-1 20/25-1 INL Cysts HFL Cysts OS OS 20/25-1 20/25-1 En Face Henle Fiber Layer En Face INL 10
12/4/2015 Progression BSCR BSCR 20/30+2 20/30+2 00:20.29 HLA-A29+ BSCR “Dry type” BSCR 11
12/4/2015 20/30+2 20/30+2 At Presentation 07:52.73 BSCR “Dry type” 20/50-2 + Two Years Lost to Follow Up No Treatment 20/30+2 Baseline + Two Years 20/50-2 Lost to Follow Up No Treatment 12
12/4/2015 Response to Therapy VKH VKH 20/125 Vitreous Cells SRD SRD Convex PR-RPE RPE Adhension 13
12/4/2015 20/125 20/125 7 :06.84 2:23.93 Vogt-Koyanagi-Harada Disease 20/125 20/25 Three Months After Initiating High-Dose Prednisone 14
12/4/2015 Applications of SD-OCT in Uveitis • Diagnosis • Location and Extent of Disease Hashizume • Cause(s) of Vision Loss • Progression • Response to Therapy Hashizume et al, Long-term Observation Of Choroidal Thickness In Vogt-Koyanagi-Harada Disease. ARVO 2012; Program / Poster 3203/A48. emmett_cunningham@yahoo.com 15
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