0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letters |

Three-Dimensional Reconstruction and Analysis of Vitreomacular Traction: Quantification of Cyst Volume and Vitreoretinal Interface Area FREE

Grant D. Aaker, BA; Luis Gracia, PhD; Jane S. Myung, MD; Vanessa Borcherding, BA; Jason R. Banfelder, MChE; Donald J. D’Amico, MD; Szilárd Kiss, MD
[+] Author Affiliations

Author Affiliations: Department of Ophthalmology (Mr Aaker and Drs Myung, D’Amico, and Kiss) and HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine (Dr Gracia, Ms Borcherding, and Mr Banfelder), Weill Cornell Medical College, New York, New York.


Arch Ophthalmol. 2011;129(6):805-820. doi:10.1001/archophthalmol.2011.123.
Text Size: A A A
Published online

Optical coherence tomography (OCT) has made considerable advancements in retinal imaging, especially with the advent of high-resolution, spectral-domain OCT.1 Nonetheless, viewing and analysis of OCT data are limited to 2-dimensional (2D) slice-based scrolling through consecutive scans (Figure 1).2

Place holder to copy figure label and caption
Figure 1.

Imaging from a patient with idiopathic vitreomacular traction. A, Spectral-domain optical coherence tomography of the macula. Slice-based scrolling through consecutive raster scans reveals multiple cystic retinal changes. However, the relationship of the cysts to one another and the correlation of the cystic volume to the area of traction are not easily ascertained from these 2-dimensional slices. B, A conventional false-color map of retinal thickness (with red representing thicker retina; green, thinner retina) superimposed on an infrared image of the macula. Although the thickened retina is apparent in the area of traction, the individual retinal structures (such as the retinal cysts or the posterior hyaloid) cannot be isolated, manipulated, inspected, or quantified. C, A single 2-dimensional optical coherence tomography slice (the same slice shown in A) superimposed on a 3-dimensional volumetric reconstruction of the posterior hyaloid (dark green), area of traction between the hyaloid and retinal surface (light green), intraretinal cystic spaces (blue), and subretinal fluid (orange). Specific retinal structures can be isolated, examined from any angle, and quantified. Previously unseen tubular connections between cysts can also be appreciated in the 3-dimensional reconstruction.

Graphic Jump Location

In a series of eyes with idiopathic vitreomacular traction, we used a method of rendering 2D raster OCT data into 3-dimensional (3D) volumetric objects. By isolating and quantifying distinct retinal structures within these 3D objects, we sought to determine the following: (1) the correlation between cyst volume and area of vitreoretinal adhesion; and (2) the relationship between individual cysts within the retina.

In this Weill Cornell Medical College Institutional Review Board–approved study, OCT scans (Heidelberg Spectralis HRA + OCT; Heidelberg Engineering, Inc, Carlsbad, California) of idiopathic vitreomacular traction were imported into Avizo visualization software (VSG, Burlington, Massachusetts) using a custom plug-in written in C++. This plug-in extracts all B-scans, the infrared image, and automated segmentations provided by Heidelberg Eye Explorer software version 1.6.2.0 (Heidelberg Engineering, Inc), all registered to the same coordinate system. Using manually set, threshold-based computational algorithms, boundaries of the cystic spaces, internal limiting membrane, and posterior hyaloid face were segmented in an automated fashion. From these segmentations, 3D objects were created and compared for accuracy with the original 2D OCT scans.

Surface areas of attachment and intraretinal cystic volumes were calculated and converted to millimeter equivalents using the scale embedded within the raw data. The correlation between the surface area of attachment and the volume of cystic spaces was calculated.

To assess the relationships between retinal structures, 3D reconstructions were inspected in the fully immersive Computer Assisted Virtual-Reality Environment (Christie Digital Systems USA, Inc, Cypress, California).

Seven eyes of 7 patients with incomplete perifoveal vitreous detachment and cystoid foveal thickening were included. The 2D OCT data were rendered as 3D volumetric objects with defined cysts, internal limiting membrane, and posterior hyaloid surfaces (Figure 1 and Figure 2).

Place holder to copy figure label and caption
Figure 2.

Three-dimensional volumetric reconstruction of the retina in a patient with vitreomacular traction. A, Posterior hyaloid (green), internal limiting membrane (yellow), and cystic retinal spaces (blue) that result from the traction. Arrows indicate the area of attachment between the vitreous and the retina. B, Isolated cystic retinal spaces from the same 3-dimensional volumetric reconstruction. Inspection of the 3-dimensional image from multiple perspectives reveals a previously hidden tubelike connection (arrow) between the smaller and larger cysts.

Graphic Jump Location

The total volume of the cysts ranged from 0.00145 mm3 to 0.647 mm3 (mean [SD], 0.115 [0.218] mm3). The surface area of traction between the posterior hyaloid and internal limiting membrane ranged from 0.0114 mm2 to 1.0226 mm2 (mean [SD], 0.314 [0.316] mm2). There was a strong positive correlation between the tractional surface area and cystic space volume (r = 0.890; P < .01).

Inspection of 3D reconstructions from different viewpoints revealed that several cysts, which appeared separate on conventional OCT, were connected in 3D space (Figure 2 and video.

In vitreomacular traction syndrome, volumetric reconstruction of 2D OCT slices permits isolation and analysis of 3D retinal structures. Quantification of cyst volume and vitreoretinal adhesion area revealed a strong positive correlation. As pharmacological vitreolysis emerges, quantification of the adhesion area may influence the decision between observation, intravitreous injection, or surgery.3

Previous attempts to evaluate vitreomacular traction with OCT were limited to examining individual OCT slices and measuring overall macular volume and retinal thickness with false-color maps, and they did not isolate or individually quantify retinal structures (Figure 1).4 Attempts to calculate drusen volume had similar limitations.5 In these reports, OCT slices were individually segmented rather than reconstructed as 3D objects.5 The technique described here can be used to quantify drusen volume, geographic atrophy area, and cystic changes in age-related macular degeneration.

Analysis of 3D volumetric reconstructions of OCT images may improve our understanding of pathophysiological features of various retinal diseases. Here, 3D reconstructions revealed that some intraretinal cysts were connected via small tubelike channels not obvious on conventional OCT (Figure 2). Furthermore, quantification of 3D structures may provide meaningful parameters in other disorders such as cystoid macular edema, age-related macular degeneration, diabetic macular edema, and retinal vascular occlusion. However, long-term prospective data from larger patient cohorts are necessary to establish accurate predictive models.

ARTICLE INFORMATION

Correspondence: Dr Kiss, Department of Ophthalmology, Weill Cornell Medical College, 1305 York Ave, 11th Floor, New York, NY 10021 (szk7001@med.cornell.edu).

Author Contributions: Mr Aaker and Dr Gracia contributed equally to this work and are considered co–first authors.

Financial Disclosure: Weill Cornell Medical College, Drs Gracia and Kiss, and Mr Banfelder have intellectual property rights to some of the material presented in this article.

Funding/Support: This work was supported by Research to Prevent Blindness.

Role of the Sponsor: The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; and in the preparation, review, or approval of the manuscript.

Previous Presentation: This paper was presented at the 27th Meeting of the Club Jules Gonin; November 4, 2010; Kyoto, Japan.

Drexler  WSattmann  HHermann  B  et al.  Enhanced visualization of macular pathology with the use of ultrahigh-resolution optical coherence tomography. Arch Ophthalmol 2003;121 (5) 695- 706
PubMed Link to Article
Kiernan  DFMieler  WFHariprasad  SM Spectral-domain optical coherence tomography: a comparison of modern high-resolution retinal imaging systems. Am J Ophthalmol 2010;149 (1) 18- 31
PubMed Link to Article
Benz  MSPacko  KHGonzalez  V  et al.  A placebo-controlled trial of microplasmin intravitreous injection to facilitate posterior vitreous detachment before vitrectomy. Ophthalmology 2010;117 (4) 791- 797
PubMed Link to Article
Sayegh  RGGeorgopoulos  MGeitzenauer  WSimader  CKiss  CSchmidt-Erfurth  U High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up. Ophthalmology 2010;117 (10) 2010- 2017, 2017.e1-e2
PubMed Link to Article
Freeman  SRKozak  ICheng  L  et al.  Optical coherence tomography-raster scanning and manual segmentation in determining drusen volume in age-related macular degeneration. Retina 2010;30 (3) 431- 435
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Imaging from a patient with idiopathic vitreomacular traction. A, Spectral-domain optical coherence tomography of the macula. Slice-based scrolling through consecutive raster scans reveals multiple cystic retinal changes. However, the relationship of the cysts to one another and the correlation of the cystic volume to the area of traction are not easily ascertained from these 2-dimensional slices. B, A conventional false-color map of retinal thickness (with red representing thicker retina; green, thinner retina) superimposed on an infrared image of the macula. Although the thickened retina is apparent in the area of traction, the individual retinal structures (such as the retinal cysts or the posterior hyaloid) cannot be isolated, manipulated, inspected, or quantified. C, A single 2-dimensional optical coherence tomography slice (the same slice shown in A) superimposed on a 3-dimensional volumetric reconstruction of the posterior hyaloid (dark green), area of traction between the hyaloid and retinal surface (light green), intraretinal cystic spaces (blue), and subretinal fluid (orange). Specific retinal structures can be isolated, examined from any angle, and quantified. Previously unseen tubular connections between cysts can also be appreciated in the 3-dimensional reconstruction.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Three-dimensional volumetric reconstruction of the retina in a patient with vitreomacular traction. A, Posterior hyaloid (green), internal limiting membrane (yellow), and cystic retinal spaces (blue) that result from the traction. Arrows indicate the area of attachment between the vitreous and the retina. B, Isolated cystic retinal spaces from the same 3-dimensional volumetric reconstruction. Inspection of the 3-dimensional image from multiple perspectives reveals a previously hidden tubelike connection (arrow) between the smaller and larger cysts.

Graphic Jump Location

Tables

References

Drexler  WSattmann  HHermann  B  et al.  Enhanced visualization of macular pathology with the use of ultrahigh-resolution optical coherence tomography. Arch Ophthalmol 2003;121 (5) 695- 706
PubMed Link to Article
Kiernan  DFMieler  WFHariprasad  SM Spectral-domain optical coherence tomography: a comparison of modern high-resolution retinal imaging systems. Am J Ophthalmol 2010;149 (1) 18- 31
PubMed Link to Article
Benz  MSPacko  KHGonzalez  V  et al.  A placebo-controlled trial of microplasmin intravitreous injection to facilitate posterior vitreous detachment before vitrectomy. Ophthalmology 2010;117 (4) 791- 797
PubMed Link to Article
Sayegh  RGGeorgopoulos  MGeitzenauer  WSimader  CKiss  CSchmidt-Erfurth  U High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up. Ophthalmology 2010;117 (10) 2010- 2017, 2017.e1-e2
PubMed Link to Article
Freeman  SRKozak  ICheng  L  et al.  Optical coherence tomography-raster scanning and manual segmentation in determining drusen volume in age-related macular degeneration. Retina 2010;30 (3) 431- 435
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

963 Views
9 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs