The use of handheld spectral domain optical coherence tomography in pediatric ophthalmology practice: Our experience of 975 infants and children

Abstract

Purpose: Optical coherence tomography (OCT) is an important imaging tool assessing retinal architecture. In this article, we report a single centers experience of using handheld spectral domain (SD)-OCT in a pediatric population using the Envisu 2300 (Bioptigen Inc., Research Triangle Park, NC, USA).

Methods: We studied SD-OCT images from 975 patients imaged from January 2011 to December 2014. The variety of cases that underwent an SD-OCT was analyzed. Cases examples from different case scenarios were selected to showcase unique examples of many diseases.

Results: Three hundred and sixty-eight infants (37.7%) were imaged for retinopathy of prematurity, 362 children (37.1%) underwent the test for evaluation of suboptimal vision or an unexplained vision loss, 126 children (12.9%) for evaluation of nystagmus or night blindness, 54 children (5.5%) for an intraocular tumor or a mass lesion such as retinoblastoma, and 65 children (6.7%) for other diseases of the pediatric retina. The unique findings in the retinal morphology seen with some of these diseases are discussed.

Conclusion: The handheld SD-OCT is useful in the evaluation of the pediatric retinal diseases. The test is useful in the assessment of vision development in premature children, evaluation of unexplained vision loss and amblyopia, nystagmus and night blindness, and intraocular tumors (including retinoblastoma).

Figure 1

An optical coherence tomography image from Case 1 (above) with unexplained vision loss shows disruption in the ellipsoid zone at the fovea with an intact external limiting membrane. An example of normal retina is represented below (CC: Choriocapillaries; EZ: Ellipsoid zone, FP: Foveal pit, FT: Foveal tent, GCL: Ganglion cell layer, INL: Inner nuclear layer, IPL: Inner plexiform layer, IS: Inner segment of the photoreceptor, NFL: Nerve fiber layer, OLM: Outer limiting membrane, ONL: Outer nuclear layer, OPL: Outer plexiform layer, OS: Outer segment of the photoreceptor, RPE: Retinal pigment epithelium complex)

Figure 2

A spectral domain-optical coherence tomography image of Case 2, an 8-year-old girl with unexplained vision loss showing an abnormal ellipsoid zone, and outer segment of photoreceptors layer

Figure 3

A spectral domain-optical coherence tomography image of Case 3 demonstrating foveal hypoplasia (box inset showing the area of the retina scanned, with “*” to indicate where the foveal pit was anticipated). There is an absence of the central foveal pit and the inner retinal layers are present throughout the scan length

Figure 4

A spectral domain-optical coherence tomography image of Case 4 with a cone-rod dystrophy demonstrating an absent foveal tent and an irregularly thickened and hyper-reflective layer of cone outer segment tips

Figure 5

A spectral domain-optical coherence tomography image of Case 5 with complete achromatopsia showing a disrupted outer segment layer at the fovea demonstrating the hypo-reflective zone seen with cone dysfunction

Figure 6

Spectral domain-optical coherence tomography images of Case 6 with a rod-cone dystrophy showing the central retina (above) and peripheral retina (below). Progressive losses of the outer retinal layers are shown in these images as the retina is imaged from the fovea to the periphery

Figure 7

A spectral domain-optical coherence tomography image of an astrocytic hamartoma in a 3 years old demonstrating a smooth, regular, and well defined lesion involving the nerve fiber layer

Figure 8

Spectral domain-optical coherence tomography images of a small retinoblastoma tumor in a 3-month-old boy before (above) and after (below) the first cycle of chemotherapy (Image courtesy: Mallipatna A, Suren V. Retinoblastoma. In: Vinekar A, Avadhani K, editors. Spectral Domain Optical Coherence Imaging of the Eye. New Delhi: Elsevier Health Sciences; 2014.)

Figure 9

Spectral domain-optical coherence tomography images of a retinoblastoma tumor (indicated by an arrow) dispersing vitreous seeds (indicated by FNx01) into the vitreous. The box (inset) shows a single pearl-like vitreous seed with an outer layer of viable cells surrounding a core of necrotic cell debris

Figure 10

A spectral domain-optical coherence tomography image of a recurring tumor (indicated by an arrow) occurring at the edge of a previously treated tumor (irregularly hyper-reflective lesion to the right of the arrow)

Figure 11

Serial OCT images of the fovea of a 4-year-old boy treated with focal lasers, who developed a vitreo-macular traction after treatment (above image from a tabletop SD-OCT: Spectral OCT-SLO, Ophthalmic Technologies Inc., Toronto, Canada), with the traction band spontaneously detaching from the fovea after four months (below image from the hand-held SD-OCT: Envisue 2300)

Figure 12

A spectral domain-optical coherence tomography image of a retinoblastoma tumor in a 3-year-old girl seeming to extend into the optic nerve in her only remaining eye