The role of ultra-widefield imaging with navigated central and peripheral cross-sectional and three-dimensional swept source optical coherence tomography in ophthalmology: Clinical applications

Abstract

Purpose: To assess central and peripheral retinal and choroidal diseases using ultra-widefield (UWF) fundus imaging in combination with navigated central and peripheral cross-sectional and three-dimensional (3D) swept source optical coherence tomography (SS-OCT) scans.

Methods: Retrospective study involving 332 consecutive patients, with a nearly equal distribution of males and females. The mean age of patients was 52 years (range 18-92 years). Average refractive error was -3.80 D (range +7.75 to -20.75 D).

Results: The observations in this study demonstrate the efficacy of peripheral navigated SS-OCT in assessing various ocular conditions. The technology provides high-quality images of the peripheral vitreous, vitreoretinal interface, retina, and choroid, enabling visualization of vitreous floaters and opacities, retinal holes and tears, pigmented lesions, and peripheral retinal degenerations. 3D OCT scans enhance the visualization of these abnormalities and improve diagnostic and therapeutic decisions.

Conclusion: Navigated central and peripheral cross-sectional and 3D SS-OCT scans offer significant complementary benefits in the assessment and management of retinal diseases. Their addition to UWF imaging provides a comprehensive view of central and peripheral ocular structures, aiding in early detection, precise anatomical measurements, and objective monitoring of disease progression. In addition, this technology serves as a valuable tool for patient education, a teaching tool for trainees, and documentation for medico-legal purposes.

Keywords: Branch vein occlusion; diabetic retinopathy; inherited retinal diseases; lattice degeneration; navigated swept source optical coherence tomography; ora serrata; pigmented lesion; retinal detachment; retinal hole; retinal tear; retinal vasculopathies; retinitis pigmentosa; retinoschisis; sickle cell retinopathy; swept source optical coherence tomography; three-dimensional navigated optical coherence tomography; ultra widefield imaging; vitreoretinal tuft; vitreous; vitreous floaters and opacities; widefield imaging.

Figure 1

(a) Sectorial ultra-widefield (UWF) red-green (RG) image (Optos Silverstone) of a healthy 34-year-old female demonstrates a clear representation of the ora serrata and vitreous base (green arrow). (b) A cross-sectional scan using navigated peripheral swept source optical coherence tomography (OCT) (Optos Silverstone) shows a cystic cavity with underlying retinal atrophy corresponding to a pars plana cyst (green arrow). (c) Sectorial UWF RG image of a 58- year-old female suffering from vitreous floaters and opacities. (d) A hyperreflective vitreous cortex condensation corresponding to a Weiss ring (red arrow) can be seen using a central cross-sectional OCT scan. (e) This peripheral three-dimensional (3D) OCT scan highlights the vitreous anatomy and its characteristic cobweb structure (yellow arrow). (f) This central 3D OCT scan clearly visualizes the posterior cortical vitreous (red arrows), allowing a better assessment of an on-going partial posterior vitreous detachment

Figure 2

Retinal Holes and Retinal Tears. (a) Sectorial ultra-widefield (UWF) red-green (RG) image demonstrates a superonasal retinal hole. (b) Cross-sectional peripheral swept source optical coherence tomography (SS-OCT) of A allows to assess the retinal hole (red arrow) and reveals absence of subretinal fluid or vitreoretinal traction. The three-dimensional scan is useful to evaluate the extent of the retinal damage (white arrow). (c) Sectorial UWF RG image demonstrates an inferotemporal retinal hole (red arrow). (d) The three-dimensional (3D) SS-OCT scan of the same eye not only reveals the extent of the damage on the retinal surface (white arrow) but also shows the piece of retinal tissue floating within the vitreous cavity (orange arrow). (e) An extremely peripheral superonasal retinal tear (blue arrow) can be shown using an UWF RG scan. (f) The peripheral 3D SS-OCT scan in the same eye highlights the area of the retina affected (white arrow) and shows vitreoretinal traction on the edge of the tear (yellow arrow)

Figure 3

Peripheral Epiretinal Membrane (pERM). (a) Ultra-widefield (UWF) red-green (RG) image demonstrates a previously treated peripheral retinal tear (white arrow). A retinal area with tortuosity of a retinal blood vessel is observed below the tear (yellow arrow). (b) Cross-sectional swept source optical coherence tomography (SS-OCT) of the same area shows a pERM (red arrow) and the attachment of peripheral vitreous (blue arrow). (c) The UWF FFA scan of the same eye as in image A highlights a scar in a retinal tear area (white arrow) and demonstrates a hyperfluorescent area (yellow arrow) that corresponds to the pERM in the previously treated retinal tear area. (d) Peripheral navigated three-dimensional (3D) SS-OCT scans allow to assess the extension and volume of the pERM (red arrow) of images A to C as well as the vitreous status in the same area (blue arrow). (e) Sectorial UWF image of a patient with advanced geographic atrophy and retinal haemorrhages in all four quadrants possibly due to an inflammatory process. An epiretinal tissue that modifies the direction of a blood vessel (yellow arrow) is shown. (f) Navigated cross-sectional SS-OCT demonstrates a pERM (red arrow) in the same eye as in E. (g) 3D rendering allows to assess the extent and elevation of the pERM (red arrows) of the same eye, providing additional information

Figure 4

Retinal detachment (RD). (a, c and e) Sectorial ultra-widefield (UWF) red-green (RG) images of a RD. (b) Navigated cross-sectional swept source optical coherence tomography (SS-OCT) showing one of the multiple retinal tears that lead to the RD. The high-quality scans allow to visualize the vitreous attached to the retina (green arrows) and an on-going retinal tear (red arrow). (d) In this SS-OCT scan, the vitreous is still attached in some areas (green arrow) while it is pulling away from the retina in other areas causing traction resulting in the RD (yellow arrows). (f) Posterior pole SS-OCT scan demonstrating the RD (red arrow) with an incomplete macular hole (green arrow) and the morphologic changes in the photoreceptor layers (orange arrows). Hyperreflective dots within the vitreous cavity can be observed (white circle). (g) UWF RG image showing a chronic and inferior RD with proliferative vitreoretinopathy (PVR). (h) Peripheral cross-sectional SS-OCT scan of the same eye allows the visualization of PVR with epiretinal (red arrow), intraretinal (orange arrow) and subretinal membranes (blue arrow). (i) UWF RG image demonstrating an asymptomatic chronic RD with retinal tear (red arrow) and recent laser retinopexy spots (white arrow) right next to the chronic RD area. (j) Extreme peripheral SS-OCT scans of the same eye show the morphology of the RD (red arrow) highlighting additional schitic changes within the retina (yellow arrow), which is useful in understanding the chronicity of the RD

Figure 5

Proliferative diabetic retinopathy (PDR). (a) Ultra-widefield (UWF) red-green (RG) image allows to identify retinal haemorrhages (green arrow) in a mid-aged female suffering from PDR. (b) The UWF FFA scan of the same eye as in A demonstrates a vascular pin-point leak (yellow arrow). (c) Cross-sectional swept source optical coherence tomography (SS-OCT) scan showing two blood-vessels growing towards the vitreous cavity (red arrows). (d and e) Peripheral 3D SS-OCT scans of the same eye as in C more accurately allow to identify these two additional new blood vessels (red arrows). (f-h) Clinical features of PDR such as a cotton-wool spot (blue arrow) can be visualized and monitored using a UWF RG image (f), a cross-sectional SS-OCT scan (g) and three-dimensional volume rendering (h)

Figure 6

Sectorial Retinitis Pigmentosa. (a) Ultra-widefield (UWF) red-green (RG) image demonstrating inferior hemiretinal sectorial RP with the distinctive bone spicules. (b) Vitreoretinal traction (green arrow) with central macular oedema can be observed using central cross-sectional optical coherence tomography (OCT) scans. (c) Maximum intensity projection showing the vitreoretinal traction (green arrow). (d) UWF FAF scan highlights the typical sectorial RP pigment dispersion along the inferior hemiretina. (e) Navigated UWF and peripheral cross-sectional SS-OCT around the inferotemporal mid- and far- periphery demonstrating intraretinal pigment dispersion (red arrow). (f) The pigment dispersion is more visible in detail (red arrow) using the peripheral three-dimensional swept source-OCT scan modality