OCT IN MACULAR HOLES & ARMD

MADHUSUDAN DAVDA, MD,FMRFMUMBAI EYE &RETINA CLINIC, CHEMBUR

A Super Speciality Retina Care Centre

The Normal OCT

When & Why do you need an OCT in macular holes?

document & size a full thickness hole prognosticate the hole - anatomical closure and functional outcomeplanning surgery & intraoperative OCTtiming of prone positioning

Sizing of holes

small <250 micronsmedium 250-500 micronslarge > 400 microns

ILM peel is not mandatory for holes upto 400 microns

Anatomy of a macular hole

minimum diameterbase diameter

height

arm lengthmacular hole inner opening

ab

h

i

Macular hole indices

minimum diameter: a height:bbase diameter: carm lengths: d,e

MHI = b/cTHI = b/aDHI = a/c

HFF = d+e/c

Hole closure & Visual outcome

min dia <311 micTHI>1.41 (more the height, better is closure)DHI < 0.5 HFF >0.9 (<0.5 poor closure rates)

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

Types of hole closure

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

visual outcomeType 1 has better prognosisintact IS-OS junction has better prognosisIntact ELM has better prognosisIncreased photoreceptor outer segment thickness (COST)High THI values(>1.41) & low DHI values (<0.50) have better visual prognosis

Type 1 closureIntact ELM

BCVA 6/9 post surgery

Type 1 closureDisrupted ELM, IS/OS & COST

Type 1 closureDisrupted ELM, IS/OS & COST

BCVA 6/36 post surgery from <6/60

Type 1 closure

Reasonably intact ELM, IS/OS & COSTHowever note the RPE

Spontaneous Closure

take home..

OCT is not just to confirm presence of holesmaller the size of hole better is the anatomical closure more the height better is the closure ratelook for the 4 outer lines for prognosis

OCT in Age Related Macular Degeneration

(ARMD)Document presence/abscence of activityMorphological variantsPrognosticate - visual, number of injections, likelihood of alternative treatmentsFollow up

OCT in Dry ARMD

OCT in Dry ARMD

confluent drusenpresence of pigment changeswet ARMD in the other eye

OCT in Wet ARMD

identify morphological typeunderstand prognosisdecide additional investigations line of management

components

RPE detachmentssub retinal spaceintraretinal fluid

RPED & RPE rip

sub retinal space

PRE RPE (classic) CNVM

Sub RPE (occult) CNVM

IPCV

oct criteria for PCVmultiple RPEDsa sharp RPED peakNotched RPEDHyporeflective lumen of polyp adhered to hyper reflective lesions beneath the RPEhyper reflective intraretinal hard exudates

take home

multiple serosanguinous PEDsmassive sub retinal bleedspresence of polyps

multiple PEDsnotched PEDpresence of hypo lucent polyps

RAP lesions

Retinal Angiomatosis Proliferans (RAP

lesions)inner retinal cystouter retinal cystFVPEDSRF

Take Home..

patient with intra, sub retinal haemorrhage, hard exudates and cmeright angled venueusually require quite a few injectionsdevelop extensive RPE atrophy post PDT

OCT & Treatment

special situations

RPE Rip

adult vitelliform dystrophy

“Thank you”

-team merc