The utility of single-capture ultra-widefield imaging with integrated guided swept-source optical coherence tomography in the management of peripheral vitreous and retinal pathology

Author: Wei Wei LEE (Canada)

Co-authors: Rajeev Muni

Purpose

The diagnosis of peripheral vitreoretinal pathology has to date almost completely relied on peripheral retinal examination with the binocular indirect ophthalmoscope with scleral depression, performed by vitreoretinal specialists. Understanding the intraretinal features of peripheral pathology and the potentially complex characteristics of the vitreoretinal interface in vivo, that would otherwise not be visible, can provide significant advantages to vitreoretinal specialists in terms of diagnosis and management decisions. In this study we assess the clinical utility of a commercially available single-capture ultra-widefield confocal scanning laser ophthalmoscope with an integrated guided widefield swept-source OCT (UWF-SS-OCT) for the diagnosis and management of peripheral vitreoretinal pathology.

Setting/Venue

This is a retrospective cohort study carried out at a single vitreoretinal practice in Toronto, Canada between December 2020 and February 2021.

Methods

Consecutive patients with peripheral retinal pathology who underwent UWF-SS-OCT were included. All patients underwent a detailed dilated fundus examination with slit lamp biomicroscopy and indirect ophthalmoscopy with 360 degrees scleral indentation by a single experienced vitreoretinal surgeon. After the clinical examination, those patients with peripheral retinal pathology underwent imaging with UWF-SS-OCT. The imaging was performed by a single photographer to obtain the ultra-widefield 200 degree fundus photograph. The UWF image was then used to identify the lesion of interest and navigate the built-in 100kHz UWF-SS-OCT to image the pathology. Imaging of the lesion of interest was acquired with a high definition (HD) single line scan or volume scan depending on the location and nature of the retinal pathology. Patients with active disease were followed longitudinally with serial imaging. This included patients who underwent laser retinopexy or cryopexy to the peripheral retina during the study period. Retinal imaging was typically acquired at baseline and on the same day immediately following laser retinopexy and for cryopexy at post-procedure day 1. Subsequently, serial imaging was generally performed at post-procedure day 3-4 and 6-7, week 2 and month 1.

Results

138 eyes of 101 patients with peripheral retinal pathology were imaged with UWF-SS-OCT with interpretable images. Of the eyes imaged, 56.5%(78/138) eyes had rhegmatogenous retinal detachment (RRD) (5 eyes had combined retinoschisis detachment), 31.1%(43/138) had retinal tears/holes and 14.5%(20/138) had lattice degeneration. Other retinal findings imaged included chorioretinal atrophy, white without pressure, vortex veins and other ocular manifestations of systemic diseases. All UWF-SS-OCT features were described in details. UWF-SS-OCT enabled novel findings such as in vivo visualization of vitreous adhesion over the posterior border of a retinal dialysis and typical microcystic degeneration in the pediatric group. We also observed RPE hyperplasia with hyperreflective shadowing seen in a demarcation line in chronic RRD, differentiating it from scarring due to laser retinopexy. UWF-SS-OCT was performed longitudinally before and/or immediately after laser retinopexy (n=22) and cryopexy (n=4). These OCT changes were consistent with histological changes previously described in the literature. We observed microstructural changes immediately after treatment and we found that there is likely chorioretinal adhesion immediately after laser retinopexy compared to cryopexy where there is still retinal separation at Day4 and chorioretinal adhesion noted only by Day6. This has significant implications for the use of these procedures for retinal tears and RRD.

Conlusions

Single-capture ultra-widefield confocal scanning laser ophthalmoscope with integrated guided, navigated, swept-source OCT was useful in the diagnosis and management of common vitreoretinal conditions. Furthermore, it has enabled novel insights in vitreoretinal diseases and their management.

Financial Disclosure

None