Retinal imaging with en face and cross-sectional optical coherence tomography delineates outer retinal changes in cancer-associated retinopathy secondary to Merkel cell carcinoma.

BACKGROUND: The study aims to correlate Fourier-domain optical coherence tomography (FD-OCT) with Goldmann visual field (GVF) to show the photoreceptor (PR) structure and function relationship in the first described case of cancer-associated retinopathy (CAR) from Merkel cell carcinoma. FINDINGS: A case study of a patient with CAR who was imaged with serial GVF and FD-OCT over a 2-year period was carried out. En face images were created using a custom algorithm from the volumetric Fourier-domain OCT scans at the PR level. The areas of decreased PR reflectivity on the en face images were compared with GVF obtained at the same time point. Regions of reduced signal on en face scans corresponded with the position and shape of the GVF scotomas. Initially, the vision improved without PR changes. Cross-sectional OCTs showed early recovery of the outer nuclear layer and later improvement in the nerve fiber layer. Worsening vision corresponded with recurrence of the underlying cancer. Progressive global retinal atrophy was seen over time. CONCLUSIONS: Merkle cell carcinoma can cause CAR. Retinal function recovered without structural PR recovery. Transient vision improvements in treated CAR patients may be due to layers other than the PRs, but eventual vision decline results from significant progressive retinal atrophy.

Infectious crystalline keratopathy predominantly affecting the posterior cornea.

A case of infectious crystalline keratopathy that affects mainly the posterior stroma is presented. Crystalline infiltrates presented after multiple epithelial defects and chronic topical steroid use following a penetrating keratoplasty in this patient. His epithelial defects persisted and given the deep location of the crystalline infiltrates, a penetrating keratoplasty was performed again. Slit-lamp photo demonstrates the crystalline plaque. Confocal microscopy also documents the aggregates of crystal-like structures. Histology slides are also presented that show the disruption of the stromal-Descemet interface and the predominance of pathology confined to the posterior stroma which has been documented in the literature as a rare finding.

Optic disc parameters from optovue optical coherence tomography: comparison of manual versus automated disc rim determination.

PURPOSE: To compare optic disc parameters when using manual disc detection versus automated software on RTVue-100 Fourier-domain optical coherence tomography. METHODS: Nonrandomized comparative study using images obtained from a tertiary-care Glaucoma Clinic from August, 2008 to May, 2009. Four hundred thirty-four patients with mean age of 67.1 years (±13.4) underwent OCT imaging with RTVue-100. Optic disc margins were manually defined by a single, trained operator and redefined with automated software that estimates the position of the retinal pigment epithelium edges. Bland-Altman plots and intraclass correlations measured agreement between the 2 detection methods for various optic disc parameters. RESULTS: Bland-Altman plots/intraclass correlations showed good agreement in the following optic disc parameters: optic disc area, cup area, rim area, cup-to-disc area ratio, cup-to-disc ratio, and retinal nerve fiber layer thickness. There was no significant difference in measurements when comparing hand versus automated disc contour determination (P>0.05). CONCLUSIONS: Automated determination of the disc margin was in high agreement with subjective, manual assessment and should be used in clinical practice as it can make optical coherence tomography scanning more efficient and standardized, as disc detection would only be done by the software and not biased by multiple operators.

Comparison of optic disc parameters measured by RTVue-100 FDOCT versus HRT-II.

PURPOSE: To compare optic disc measurements between the new Fourier-domain optical coherence tomography (RTVue-100) and the confocal scanning laser ophthalmoscopy (Heidelberg retinal tomography, HRT-II) in clinical practice. METHODS: Patients seen from the glaucoma service of an academic department of ophthalmology between August 2008 to August 2009 with good-quality RTVue-100 and HRT-II images within 6 months of each other were included (363 patients were included, 1 eye from each patient). The rim of the optic disc was drawn automatically by RTVue-100 and manually by a single experienced observer for HRT-II. Optic disc measurements from both imaging devices were compared using Bland-Altman plots and the Student t test to assess agreement. The main outcome measure was the agreement in optic disc parameters between the two imaging devices. RESULTS: Bland-Altman plots indicate significant differences between the RTVue-100 and HRT-II for all optic nerve parameters. The mean HRT-II values were consistently larger than RTVue-100 values for optic disc area and rim area. The RTVue-100 values were larger for the cup area, cup-to-disc area ratio, and vertical and horizontal cup-to-disc ratio. The Student t test showed P<0.001 for averages of all measurements between the two devices. CONCLUSIONS: We conclude that the disc parameters from these two imaging devices are not interchangeable.