Avoiding Exam Under Anesthesia: Feasibility of In-Office Multimodal Imaging on an Infant

Abstract

Purpose : Evaluation and diagnosis of pediatric retinal and choroidal disorders is notoriously challenging. Fundus examination and imaging in pediatric patients in the clinic is often limited, and thus diagnosis may ultimately require examination under anesthesia, which can be time consuming, costly, and is not without potential risks to the child. We report the acquisition of in-office multimodal imaging in an 18-month old infant in the evaluation of a choroidal lesion.

Methods : We obtained multimodal imaging to evaluate a choroidal mass in the left eye of an 18 month old infant over the course of 2 office visits. B-scan ultrasonography and fundus photographs were obtained on initial visit after dilated fundus examination revealed a stalk with an elevated chorioretinal lesion in the left eye. Prior to the second visit, dilating drops were given to the parents to pre-dilate the patient, and optical coherence tomography (OCT) images and oral fluorescein angiogram were obtained using the "flying baby" position with assistance from parents.

Results : B-scan ultrasonography of the left eye revealed a vitreous stalk extending from the optic nerve, and an area of elevation corresponding to the retinal findings on funduscopic examination. Oral fluorescein angiography demonstrated late hyperfluorescence without leakage in the lesion. OCT imaging through the choroidal lesion revealed focal area of retinal and retinal pigment epithelium thickening with a suspected choroidal granuloma.

Conclusions : This case report demonstrates the feasibility of in-office multimodal imaging in a young cooperative child without sedation to aid in the diagnosis of a choroidal granuloma. Oral fluorescein can be used to provide high quality angiogram in pediatric cases without the potential distress to the child associated with obtaining intravenous access in conventional angiography. High quality OCT imaging can also be obtained with appropriate positioning and fixation targets. Using this methodology, we illustrate a safe and alternative method for evaluating retinal and choroidal pathology, eliminating the potential risks of general anesthesia in a young child.

This is a 2020 Imaging in the Eye Conference abstract.

 

Figure 1. A. Fundus photograph of left eye demonstrating well-circumscribed lesion inferior to optic disc along inferior arcade and adjacent chorioretinal scar. B. Oral fluorescein angiogram demonstrating hyperfluorescence within chorioretinal scar without leakage.