Multicolor imaging: Current clinical applications.

Multicolor (MC) imaging is an innovative pseudocolor fundus imaging modality based on confocal scanning laser ophthalmoscopy. It effectively scans the retina at different depths to create a composite image. The green reflectance image depicts the middle retinal while blue reflectance image provides images of the retinal surface. The infrared reflectance image depicts retinal structures at the level of outer retina and choroid. We systematically analyze published case reports, case series, and original articles on MC imaging where it has helped in discovering additional clinical features of retinal diseases not readily apparent on conventional color fundus photography and played a role in monitoring the response to treatment.

Multicolor Imaging Characteristics of Best's Vitelliform Macular Dystrophy.

A 40-year-old woman presented with vitellieruptive stage of Best's vitelliform macular dystrophy (BVMD) in the right eye and pseudohypopyon stage in the left eye. She underwent comprehensive ophthalmic examination and fundus imaging using multicolor (MC) imaging technology of Spectralis (Heidelberg Engineering, Heidelberg, Germany) spectral-domain-optical coherence tomography system. Composite MC imaging revealed larger area of retinal pigment epithelium atrophy in vitellierruptive stage of the disease in the right eye compared to color fundus photograph. Retinal elevation in the pseudohypopyon stage was better delineated on composite MC and blue reflectance images in the left eye. Subretinal lipofuscin was best seen in green reflectance and short-wave autofluorescence images. The present case reports the MC imaging features of BVMD.

Validation of Multicolor Imaging of Diabetic Retinopathy Lesions Vis a Vis Conventional Color Fundus Photographs.

BACKGROUND AND OBJECTIVE: To analyze the visibility of various diabetic retinopathy lesions in multicolor imaging (MCI) and compare them to corresponding color fundus photography (CFP). PATIENTS AND METHODS: Retrospective review of 130 eyes of 65 consecutive patients with diabetic retinopathy who underwent multicolor confocal scanning laser ophthalmoscopy and CFP. RESULTS: Hard exudates (Hex) were seen in 74 eyes (71.2%). In all 74 eyes, Hex were visible on both CFP and MCI. Among other color channels, Hex were picked up most in green reflectance (GR) images in 73 eyes (70.2%). Cotton-wool spots (CWS) were picked up in 29 eyes (27.9%) on MCI and in 27 eyes (26%) on CFP. In both GR and blue reflectance (BR) imaging, they were equally picked up in 29 eyes (27.9%). Retinal hemorrhages were picked up in 83 eyes (79.8%) on MCI and in 82 eyes (72.8%) on CFP. Among other channels, they were picked up most in GR images in 81 (77.9%) eyes. Hex, CWS, and hemorrhages were seen better on MCI and in GR images as compared to CFP, BR, and infrared imaging, respectively. With CFP as the comparator, the sensitivity and specificity of MCI to detect of these lesions were more than 90%. CONCLUSIONS: The authors' pilot study validates the efficacy of MCI in picking up lesions of DR vis a vis CFP. MCI has potential to replace CFP in clinical and DR screening setting. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:8-15.].

Concurrent management of myopic choroidal neovascularization and rhegmatogenous retinal detachment with intravitreal antivascular endothelial growth factor during primary retinal detachment repair.

We report concurrent management of rhegmatogenous retinal detachment and myopic choroidal neovascularization in the left eye of a 24-year-old female who presented with sudden dimness of vision due to retinal detachment and choroidal neovascularization. Intravitreal antivascular endothelial growth factor was injected during primary vitrectomy for retinal detachment. At final follow-up, the retina was attached with scarring of choroidal neovascularization. Ours is the first report of the use of intravitreal antivascular endothelial growth factor during vitrectomy for retinal detachment.

Multimodal imaging characteristics of hydroxychloroquine retinopathy.

Hydroxychloroquine (HCQ) is known to cause retinal toxicity. Early detection of the toxicity is necessary to stop the drug in time. Multicolor imaging (MC) is a new noninvasive retinal imaging modality that simultaneously acquires three reflectance images of the retina using three individual lasers producing a composite image, thereby allowing analysis of changes at various levels within the retina. It is a new and promising addition to the retinal imaging armory. MC characteristics of HCQ toxicity are hitherto unreported. A 61-year-old female presented with history of HCQ intake (400 mg/day) for the last 6 years. She had retinopathy in both eyes. Multicolor composite image showed circumscribed perifoveal arcuate area of darkening, and infrared reflectance showed speckled hyperreflecetance in both eyes. MC imaging shows definite changes in HCQ toxicity, and it might emerge as a possible screening tool in future.

A rare case of bilateral tractional retinal detachment following snakebite.

A 13-year-old female presented with diminution of vision in both eyes for 3 months following snakebite. Best-corrected visual acuities were hand movement in both eyes. Fundoscopy showed vitreous hemorrhage, and B-scan ultrasonography revealed an underlying tractional retinal detachment (TRD) involving the macula in both eyes. Patient underwent 25-gauge pars plana vitrectomy in conjunction with belt buckling, endolaser, and silicone oil tamponade in the left eye. At 6 weeks postoperatively, best-corrected visual acuity of the left eye was noted to be 20/200 with settled TRD and attached retina. Bilateral proliferative retinopathy with TRD is a hitherto unreported complication of snake bite.

Multicolor imaging in optic disc swelling.

Differentiating optic disc edema (ODE) from pseudo optic disc edema (PODE) continues to pose a diagnostic dilemma. Current report highlights the role of multicolor imaging (MC) in differentiating ODE from PODE. Composite multicolor images of the disc in ODE show greenish hyperreflectance that extends beyond the optic disc margins with irregular blurry margins and obscured disc vasculature whereas PODE shows a greenish hyperreflectance with clear and distinct margins and well delineated disc vasculature. MC imaging adds to the present armamentarium of imaging modalities obviating needless neurological evaluation mandatory in a case of true disc edema.

Surgical management of optic disc pit maculopathy with a fovea sparing internal limiting membrane flap.

Optic disc pit (ODP) is rare congenital cavitary anomaly of the optic disc. Serous detachment of macula is the most common complication of ODP and occurs in 25%-75% of these cases. Although various surgical techniques have been used for the treatment of ODP maculopathy; consensus still eludes as far as the optimal surgical approach is concerned. We herein report a case of ODP maculopathy in a young female treated successfully with vitrectomy, fovea sparing internal limiting membrane flap, and C3F8 tamponade.