Expanding Indications of Imaging with Optovue Optical Coherence Tomography in Children
from 20/100 to 20/200, in four eyes from 20/60 to 20/100, in two eyes was 20/60 and in two eyes 20/40.
Keratopaty
Keratopaty was observed in 14 eyes (58 %) by slit-lamp exam, whereas various degrees of corneal opacity were found by SD-OCT in 18 eyes (72 %) (see Figure 1A). In four eyes, subtle corneal involvement was not observed by a slit-lamp exam, but was visualised by OCT.
The corneal involvement was consistent with band keratopaty in eight eyes (33.3 %); 11 eyes 45.8 %) showed various degrees of subepithelial fibrosis; and five eyes (20.8 %) were affected by corneal opacity with neovascularisation.
Cataracts
Of the 24 enrolled eyes, 16 (66.6 %) had various degree of lens involvement (see Figure 1B). Posterior subcapsular lens opacity was the most common type of cataract. In 10 eyes (41.6 %), cataracts were considered clinically relevant and phacoemulsification with IOL implant was scheduled. OCT was able to visualise the cataract and the IOL position in the bag after surgery.
Fovea Hypoplasia
Fovea hypoplasia was detected in 15 eyes (62.5 %) by SD-OCT as loss of normal foveal architecture and absence of normal foveal depression (see Figure 1C). Foveal hypoplasia, defined as the absence of a foveal reflex, was found in nine eyes (37.5 %) by slit-lamp exam.
Glaucoma
In total, 15 eyes (62.5 %) were affected by glaucoma; 11 eyes had previous angle surgery; six eyes had previous trabeculectomy; 10 eyes were under topical medication for glaucoma; and three eyes had untreated, newly detected glaucoma.
It was possible to use OCT to investigate the iris hypoplasia and angle depth (see Figure 1D). The angle was open in all patients where glaucoma was associated with aniridia. The optic nerve head was assessed by ophthalmic and OCT exam (see Figure 1E). Both examinations revealed optic nerve changes consistent with glaucoma in 15 eyes (62.5 %). Aniridia-associated findings are summarised in Table 1.
Congenital Cataracts
In total, seven eyes of five consecutive patients were examined. The mean age of the patients was 4.5 ± 2.1 years (range, three to seven years).
It was possible to use OCT to visualise the different types of lens involvement in the paediatric patients enrolled in this study (see Figure 2A). On the basis of the OCT images, we categorised congenital cataracts into five groups: anterior polar cataract (2); anterior sub capsular cataract (1); laminar cataract (1); posterior cortical cataract (2); and posterior sub capsular cataract (1).
After careful examination of two eyes (one with a mild anterior polar cataract and one with a posterior subcapsular cataract), the cataracts were evaluated as clinically unremarkable and surgery was not considered. Five eyes were included in the analysis.
After surgery, the IOL was easily visualised in the bag by OCT and the relationship between the IOL and the bag, and the IOL and the iris was
EUROPEAN OPHTHALMIC REVIEW
recorded. In one case, the OCT exam revealed a slightly tilted IOL because of residual cortex under the IOL plate. However, surgical revision was not necessary (see Figure 2B,C).
The posterior capsule was well visualised in all patients during the follow-up and the posterior capsule thickness was recorded. The ICC for the posterior capsule thickness evaluation was 0.89.
The thickness of the normal, clear posterior capsule on slit-lamp exam was found by OCT to range from 12 to 18 µm. Slit-lamp exam revealed a mild PCO in two cases. Posterior capsule thickness ranged from 28 to 35 µm. A clinically relevant PCO was found in one eye. The thickness of the posterior capsule ranged from 47 to 77 µm. This case required Nd:YAG laser posterior capsulotomy. On the basis on these findings, we suggested a PCO staging using the OCT measurements of the posterior capsule thickness, with the normal, clear posterior capsule ranging from 12 to 20 µm, the incipient PCO ranging from 25 to 45 µm and with the PCO having a posterior capsule thickness >45 µm (see Figure 3).
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A. Keratopaty due to sub epithelial fibrosis; B. Posterior cortical cataract C. Foveal hypoplasia with absence of normal foveal depression; D. Iris hypoplasia and comparison with normal developed iris; E. 3D image of a glaucomatous optic nerve head;
Figure 2: Pre-op and post-op OCT findings in a congenital anterior polar cataract case
AB * 969μm 369μm
Table 1: Aniridia-associated Findings Aniridia-associated findings
diagnosed by OCT Keratopaty (72 %)
subepithelial fibrosis (45.8 %) band keratopaty (33.3 %) neovascularisation (20.8 %)
Cataract (66.6%)
Foveal hypoplasia (62.5 %) Glaucoma (62.5 %)
66.6 % 37.5 % 62.5 %
Figure 1: OCT images in aniridia A D 58 %
Aniridia-associated findings clinically diagnosed
B
E
C
* C
A. Anterior polar cataract; B.OCT reveals residual cortex under the IOL plate; C.OCT scan showed a slightly tilted IOL in the bag due to residual cortex under the IOL plate
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