Multi-Dimensional SDOCT Analysis of the Spectrum of Vitreoretinal Interface Disorders

Abstract

Purpose: : Spectral domain optical coherence tomography (SDOCT) can provide cross-sectional images of macular pathology which can be reconstructed as three-dimensional volumes. Using 2D and 3D analysis of SDOCT images of the vitreoretinal interface (VRI), we sought to elucidate unifying and distinguishing features across the spectrum of VRI disorders and infer a theory of pathogenesis.

Methods: : Spectral domain optical coherence tomography scans acquired from 2904 consecutively imaged eyes at a referral retina practice were reviewed. Cases demonstrating features of VRI abnormalities, including vitreomacular traction syndrome, lamellar macular hole, myopic schisis, epiretinal membrane, and full-thickness macular holes were identified. From these cases, high quality cross-sectional images and OCT slab images based on reconstructed three-dimensional volumes from were analyzed for pathological features.

Results: : Lamellar holes, myopic schisis and to a lesser extent vitreomacular traction syndrome all commonly demonstrate schisis clefts that occur in the same anatomical location: Henle's fiber layer, between the optical outer nuclear and outer plexiform layers. Additionally, cross-sectional SDOCT images revealed variation along the VRI spectrum in the presence of an interruption of the inner retinal surface, an epiretinal membrane, and disruption of the IS/OS junction. En face SDOCT slab images permitted visualization of spatial relationships between retinal structures that were not apparent using exclusively cross-sectional images. Progression analysis of a subset of eyes with VRI pathology imaged at multiple time points demonstrated the evolution of pathology over time.

Conclusions: : SDOCT images of VRI pathology can be analyzed to gain a better understanding of these forms of visually disabling disease. Vitreomacular pathology may exist along a continuum, and share a common pathogenic mechanism. SDOCT imaging provides anatomical visualization of pathological features that challenge clinical intuition.

Keywords: retina • imaging/image analysis: clinical • vitreous