OCT IN MACULAR HOLES & ARMD

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OCT IN MACULAR HOLES ARMD

• MADHUSUDAN DAVDA, MD,FMRF
• MUMBAI EYE RETINA CLINIC, CHEMBUR

A Super Speciality Retina Care Centre
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The Normal OCT
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When Why do you need an OCT in macular holes?

• document size a full thickness hole
• prognosticate the hole - anatomical closure and
  functional outcome
• planning surgery intraoperative OCT
• timing of prone positioning

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Sizing of holes

• small lt250 microns
• medium 250-500 microns
• large gt 400 microns

ILM peel is not mandatory for holes upto 400
microns
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Anatomy of a macular hole
minimum diameter
i
base diameter
a
height
h
b
arm length
macular hole inner opening
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Macular hole indices

• minimum diameter a
• heightb
• base diameter c
• arm lengths d,e

HFF de/c
MHI b/c
THI b/a
DHI a/c
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Hole closure Visual outcome

• min dia lt311 mic
• THIgt1.41 (more the height, better is closure)
• DHI lt 0.5
• HFF gt0.9 (lt0.5 poor closure rates)

Optical Coherence tomography predictive factors
for macular hole surgery outcome, Ruiz-Morena JM
et al, Br J Ophthalmol. 2008
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Types of hole closure

• type 1 closed hole without any defect of the
  foveal neurosensory retina
• type 2 persistent foveal defect of neurosensory
  retina despite the whole rim of hole attached to
  the underlying RPE with resolution of SRF and CME

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visual outcome

• Type 1 has better prognosis
• intact IS-OS junction has better prognosis
• Intact ELM has better prognosis
• Increased photoreceptor outer segment thickness
  (COST)
• High THI values(gt1.41) low DHI values (lt0.50)
  have better visual prognosis

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Type 1 closure
Intact ELM
BCVA 6/9 post surgery
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Type 1 closure
Disrupted ELM, IS/OS COST
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Type 1 closure
Disrupted ELM, IS/OS COST
BCVA 6/36 post surgery from lt6/60
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Type 1 closure
Reasonably intact ELM, IS/OS COST
However note the RPE
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Spontaneous Closure
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take home..

• OCT is not just to confirm presence of hole
• smaller the size of hole better is the anatomical
  closure
• more the height better is the closure rate
• look for the 4 outer lines for prognosis

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OCT in age related macular degeneration (ARMD)

• defines the location and nature of changes
• detects newly emerging changes like intra sub
  retinal fluid
• helps understand differences between various
  membranes like classic, occult and scars

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OCT in Age Related Macular Degeneration (ARMD)

• Document presence/abscence of activity
• Morphological variants
• Prognosticate - visual, number of injections,
  likelihood of alternative treatments
• Follow up

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OCT in Dry ARMD
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OCT in Dry ARMD

• confluent drusen
• presence of pigment changes
• wet ARMD in the other eye

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OCT in Wet ARMD

• identify morphological type
• understand prognosis
• decide additional investigations
• line of management

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components

• RPE detachments
• sub retinal space
• intraretinal fluid

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RPED RPE rip
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sub retinal space
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PRE RPE (classic) CNVM
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Sub RPE (occult) CNVM
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IPCV
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oct criteria for PCV

• multiple RPEDs
• a sharp RPED peak
• Notched RPED
• Hyporeflective lumen of polyp adhered to hyper
  reflective lesions beneath the RPE
• hyper reflective intraretinal hard exudates

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take home

• multiple serosanguinous PEDs
• massive sub retinal bleeds
• presence of polyps

• multiple PEDs
• notched PED
• presence of hypo lucent polyps

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RAP lesions
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Retinal Angiomatosis Proliferans (RAP lesions)

• inner retinal cyst
• outer retinal cyst
• FVPED
• SRF

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Take Home..

• patient with intra, sub retinal haemorrhage, hard
  exudates and cme
• right angled venue
• usually require quite a few injections
• develop extensive RPE atrophy post PDT

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OCT Treatment
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• special situations

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RPE Rip
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adult vitelliform dystrophy
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Thank you
-team merc