Multimodal imaging in persistent placoid maculopathy.

IMPORTANCE: Persistent placoid maculopathy (PPM) is a rare clinical entity with features that superficially resemble acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and macular serpiginous choroidopathy. It is important to differentiate PPM from APMPPE because both conditions may appear similar at presentation. OBJECTIVE: To investigate the short-term and long-term retinal changes in patients with PPM using spectral domain optical coherence tomography (SD-OCT), indocyanine green angiography (ICG-A), fluorescein angiography (FA), and fundus autofluorescence (FAF). DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective medical record review in 5 patients diagnosed as having PPM at tertiary retinal practices. MAIN OUTCOMES AND MEASURES: Findings on SD-OCT, FA, digital FAF, and ICG-A images. RESULTS: Patients presented within 2 weeks of subjective symptoms. Mean best-corrected visual acuity was 20/144 (range, 20/25-20/400). At presentation, all but 1 patient had bilateral macular lesions. Four eyes developed extramacular lesions during follow-up. On SD-OCT, the acute placoid lesions revealed hyperreflectivity of the outer nuclear layer; disruption of the external limiting membrane, ellipsoid layer, and interdigitation zone; and, in some patients, hyporeflective spaces at the level of absent outer segments. On follow-up, lesions revealed either partial or complete restoration of the outer retinal architecture or they progressed to atrophy. On FA, all placoid lesions were hypofluorescent in early frames and hyperfluorescent in late frames. In the acute stage, ICG-A revealed sharply delineated dense hypofluorescent lesions, which persisted on late frames in all patients. Hypofluorescent lesions faded completely or partially after resolution of the placoid lesions on SD-OCT and clinical examination. Variability was seen on the FAF patterns; most lesions were hyperautofluorescent, except in 1 patient, in whom they were hypoautofluorescent. Bilateral choroidal neovascularization developed in only 1 patient. The mean follow-up was 28 weeks (range, 2-92 weeks). On the final follow-up visit, mean best-corrected visual acuity was 20/125 (range, 20/25-20/400). CONCLUSIONS AND RELEVANCE: On SD-OCT, acute retinal changes in PPM involve the outer nuclear layer, external limiting membrane, ellipsoid layer, and interdigitation zone. The retinal pigment epithelium and choroid are involved in severely affected patients. The variable extent of retinal pigment epithelium involvement was reflected in variable FAF findings. We discuss clinical features that differentiate this entity from other white spots, including acute placoid multifocal pigment epitheliopathy. Additional long-term imaging studies are needed to further clarify the exact location and pathogenesis of this rare disease.

Effects of changing operators and instruments on time-domain and spectral-domain OCT measurements of retinal nerve fiber layer thickness.

BACKGROUND AND OBJECTIVE: To determine the amount of interoperator and interinstrument variability introduced into retinal nerve fiber layer (RNFL) thickness measured with Stratus OCT and Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) in normal and glaucomatous eyes. PATIENTS AND METHODS: Thirty-seven eyes from 37 subjects (20 normal and 17 with glaucoma) were included in the study. Each eye was scanned with one Stratus OCT and one Cirrus OCT by two operators. The eyes were then scanned with a different Stratus OCT and Cirrus OCT by one of the operators. Average, quadrant, and clock-hour RNFL measurements were compared between operators and between instruments after determining the proportion of variance due to subjects, operators, and instruments by means of variance component analysis. RESULTS: Significant differences were observed between Stratus OCT instruments, but not between Cirrus OCT instruments, in average (P = .01), inferior (P = .006), and nasal (P < .001) quadrant RNFL thickness in glaucomatous eyes. Interoperator differences in RNFL thickness measured with both types of instruments were non-significant. The interoperator variability ranged from 0% to 1% on Stratus OCT and was 0% on Cirrus OCT, whereas the interinstrument variability ranged from 0% to 3% for Stratus OCT and from 0% to 1% for Cirrus OCT. CONCLUSION: The interoperator variability of RNFL thickness measured with Stratus OCT and Cirrus OCT, as well as the interinstrument variability of measurements obtained with Cirrus OCT, are non-significant. However, there is significant variability between RNFL measurements performed on two different Stratus OCT instruments.

Reproducibility of peripapillary retinal nerve fiber layer thickness and optic nerve head parameters measured with cirrus HD-OCT in glaucomatous eyes.

PURPOSE: To assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters measured with Cirrus HD-OCT in glaucomatous eyes. METHODS: Fifty-five glaucomatous eyes were included in the study. The optic disc cube 200 × 200 protocol was used to obtain three scans during the same visit to evaluate the intravisit reproducibility. One scan on 4 additional days within a 2-month period of the first session was obtained to assess intervisit reproducibility. Intraclass correlation coefficient (ICC), coefficient of variation (CV), and test-retest SD (TRT SD) were calculated for each RNFL and ONH parameter. The formula 1.645 × âˆš2 × intervisit TRT SD provides an upper tolerance limit to variability beyond which nonphysiologic change should be considered. RESULTS: All ICCs were excellent, ranging from 83.9% to 99.2% for intravisit measurements and from 80.8% to 99.1% for intervisit measurements. Cup/disc area ratio had the lowest CV (1.1%) in either type of measurement, followed by average RNFL thickness (1.9% and 2.7%). Nasal clock hours and quadrants showed the poorest reproducibility as did the clock hour directly temporally. The intervisit tolerance limit for average RNFL thickness was 3.89 µm. CONCLUSIONS: Intravisit and intervisit measurements of peripapillary RNFL thickness and ONH parameters with Cirrus HD-OCT showed excellent reproducibility, indicating that this instrument may be useful in monitoring glaucoma progression. When comparing two measurements from the same eye on two different visits, a reproducible decrease in average RNFL thickness of approximately 4 µm or more may be considered a statistically significant change from baseline.

Composite spectral domain optical coherence tomography images of diabetic tractional retinal detachment.

This article describes the spectral domain optical coherence tomography (SD-OCT) findings in three patients with diabetic tractional retinal detachment. Three patients underwent fundus photography and SD-OCT imaging before and after pars plana vitrectomy, endola-ser, and membrane peel. On SD-OCT, all three patients exhibited significant improvement or resolution of subretinal fluid after the surgical release of traction. In this case series, a clinically useful method of visualizing SD-OCT images is demonstrated. Composite images were manually constructed with commercially available software by merging high-density B-scans from the macula and optic nerve. The composite image allowed simultaneous visualization of the effects of proliferative diabetic retinopathy on the macula and optic nerve and is particularly helpful in evaluating tractional macular detachment.