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Enhanced Visualization of Macular Pathology With the Use of Ultrahigh-Resolution Optical Coherence Tomography

Wolfgang Drexler, PhD; Harald Sattmann, MS; Boris Hermann, MS; Tony H. Ko, MS; Michael Stur, MD; Angelika Unterhuber, MS; Christoph Scholda, MD; Oliver Findl, MD; Matthias Wirtitsch, MD; James G. Fujimoto, PhD; Adolf F. Fercher, PhD
Arch Ophthalmol. 2003;121(5):695-706. doi:10.1001/archopht.121.5.695.
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Objectives  To demonstrate a new generation of ophthalmic optical coherence tomography(OCT) technology with unprecedented axial resolution for enhanced imaging of intraretinal microstructures and to investigate its clinical feasibility to visualize intraretinal morphology of macular pathology.

Methods  A clinically viable ultrahigh-resolution ophthalmic OCT system was developed and used in clinical imaging for the first time. Fifty-six eyes of 40 selected patients with different macular diseases including macular hole, macular edema, age-related macular degeneration, central serous chorioretinopathy, epiretinal membranes, and detachment of pigment epithelium and sensory retina were included.

Outcome Measures  Ultrahigh-resolution tomograms visualizing intraretinal morphologic features in different retinal diseases.

Results  An axial image resolution of approximately 3 µm was achieved in the eyes examined, nearly 2 orders of magnitude better than conventional ophthalmic ultrasound. Ultrahigh-resolution OCT images provided additional diagnostically important information on intraretinal morphologic features that could not have been obtained by standard techniques.

Conclusions  Ultrahigh-resolution ophthalmic OCT enables unprecedented visualization of intraretinal morphologic features and therefore has the potential to contribute to a better understanding of ocular pathogenesis, as well as to enhance the sensitivity and specificity for early ophthalmic diagnosis and to monitor the efficacy of therapy. This study establishes a baseline for the interpretation of ultrahigh-resolution ophthalmic OCT imaging of macular diseases.

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Figures

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Figure 1.

Horizontal ultrahigh-resolution optical coherence tomographic image of a normal human macula. Intraretinal layers are labeled according to subjective correlation with intraretinal anatomy: ILM, internal limiting membrane; NFL, nerve fiber layer; GCL, ganglion cell layer; IPL and OPL, inner and outer plexiform layers; INL and ONL, inner and outer nuclear layers; HF, Henle fiber layer; ELM, external limiting membrane; IS PR and OS PR, inner and outer segments of photoreceptor layer; and RPE, retinal pigment epithelium.

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Figure 2.

Patient 1. A, Vertical ultrahigh-resolution optical coherence tomographic image of a normal human macula. B, Ultrahigh-resolution optical coherence tomographic image of a patient with recurrent central serous chorioretinopathy. C, Vertical scan approximately at the same location of the same eye 2 months later. D, Corresponding scan position (arrow) on fluorescein angiography.

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Figure 3.

Patient 2, with chronic recurrent central serous chorioretinopathy. A-D, Ultrahigh-resolution optical coherence tomographic images through the foveal region. Arrows indicate subtle retinal pigment epithelial detachments. E and F, Scan positions (arrows) on early-phase(E) and late-phase (F) fluorescein angiographic fundus photographs.

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Figure 4.

Patient 3, with macular branch vein occlusion with cystoid macular edema. A-D, Ultrahigh-resolution optical coherence tomographic images through the foveal region. Arrow indicates intact external limiting membrane. E-G, Corresponding scan positions (arrows) on an infrared fundus photograph (E) and early-phase (F) and late-phase (G) fluorescein angiographic fundus photographs.

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Figure 5.

Patient 4, with cystoid macular edema with subretinal fibrosis and serous detachment of sensory retina. A-C, Ultrahigh-resolution optical coherence tomographic images through the inferior foveal region. The arrow with asterisk depicts the subtle photoreceptor layer detachment. The other arrows indicate the subretinal fibrosis. D-F, Corresponding scan positions (arrows) on fundus photograph (D) and red-free (E) and late-phase(F) fluorescein angiographic fundus photographs.

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Figure 6.

Patient 5, with age-related macular degeneration with minimal classic neovascularization and vascularized retinal pigment epithelial detachment. A-F, Ultrahigh-resolution optical coherence tomographic images through the foveal region providing 3-dimensional information about the morphologic characteristics of the retinal changes. Arrows indicate Bruch membrane underneath the retinal pigment epithelial detachment. G-I, Corresponding scan positions (arrows) on fundus photograph (G) and early-phase(H) and late-phase (I) fluorescein angiographic photographs.

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Figure 7.

Patient 5, with regressing drusen and occult classic neovascularization. A-C, Horizontal cross-sectional ultrahigh-resolution optical coherence tomographic images through the foveal region. Arrows indicate thin layer, possibly corresponding to Bruch membrane underneath the retinal pigment epithelial detachment. D, Corresponding scan positions (arrows) in a late-phase fluorescein angiographic fundus photograph.

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Figure 8.

Patient 6, with a vitelliform lesion of age-related macular degeneration and drusen on the right eye. A, Vertical cross-sectional ultrahigh-resolution optical coherence tomographic image through the foveal region. B and C, Corresponding scan position (arrow) in the fundus photograph (B) and late-phase fluorescein angiographic fundus photograph (C). D-F, Left eye of the same patient with areolar atrophy after a vitelliform lesion of age-related macular degeneration. D, Horizontal cross-sectional ultrahigh-resolution optical coherence tomographic image through the foveal region. Second layer of Bruch membrane (arrow with asterisk), as well as a very weak reflection of the choroidal-scleral interface, allowing visualization and thickness quantification of the choroid (arrows), is indicated. E and F, Corresponding scan position (arrow) in the fundus photograph (E) and late-phase fluorescein angiographic fundus photograph (F).

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Figure 9.

Patient 7, with lamellar macular hole (stage 2). A and B, Horizontal cross-sectional ultrahigh-resolution optical coherence tomographic images through the foveal region providing 3-dimensional information about the morphologic characteristics of the macular hole. C, Corresponding scan positions (arrows) in the fundus photograph. D-F, Patient 8, with macular hole stage 3A. D and E, Horizontal cross-sectional ultrahigh-resolution optical coherence tomographic images through the foveal region providing 3-dimensional information on the morphologic characteristics of the macular hole. Arrow indicates epiretinal membrane. F, Corresponding scan positions (arrows) in the fundus photograph.

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Figure 10.

Patient 9, with an idiopathic macular hole (stage 4). A-D, Ultrahigh-resolution optical coherence tomographic images through the foveal region providing 3-dimensional information on the morphologic characteristics of the macular hole. E, Corresponding scan positions(arrows) in the fundus photograph.

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