OCT in der Makuladiagnostik – Möglichkeiten und Grenzen

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die optische Kohärenztomografie (OCT) ist in den letzten Jahren zu einem wichtigen diagnostischen Verfahren in der Augenheilkunde geworden. Zusätzlich zu der Ophthalmoskopie sowie der topografischen Darstellung von Pathologien des Augenhintergrunds mittels Fluorescein- und Indocyaningrün-Angiografie fügt die OCT als weiteres bildgebendes Verfahren tomografische Informationen retinaler Strukturen hinzu. Schon die OCT-Geräte der ersten Generationen (time domain) zeigten dem histologischen Querschnitt der Netzhaut ähnliche Bilder. Mittels der neuen Geräte der Spectral/Frequency/Fourier-Domain-Generation können topografische und tomografische Informationen in unterschiedlichem Maße auch nebeneinander oder kombiniert angezeigt werden, was die Genauigkeit der Lokalisation dargestellter Strukturen erhöht. Aufgrund der nicht invasiven Methodik ohne Kontakt zum Patientenauge und den immer kürzer werdenden Aufnahmezeiten mit immer höherer Bildauflösung ist die OCT zu einem wertvollen Instrument in der modernen anatomisch-strukturellen Makuladiagnostik geworden. Funktionelle Aussagen sind mittels OCT noch nicht im breiten Rahmen möglich, erste Ansätze zeigen sich jedoch in der Auswertung struktureller Informationen aus hochauflösenden Aufnahmen. Im folgenden Artikel soll auf die sich durch den breiten Gebrauch der OCT eröffnenden Möglichkeiten, aber auch auf die sich zeigenden Grenzen dieser diagnostischen Technik eingegangen werden.

Abstract

During the last years, optical coherence tomography (OCT) has evolved to an important diagnostic tool in ophthalmology. In addition to ophthalmoscopy and the topographic visualisation of pathologies of the posterior part of the eye by fluorescein and indocyanine-green angiography, OCT adds complementary tomographic information on the retinal structures. First generation (time domain) OCT machines already generated pictures that resemble histological cross-sections of the retina. With the new OCTs of the spectral/frequency/Fourier domain generation, topographic and tomographic information can be presented side-by-side or in combination, thereby increasing the accuracy of the localisation of the visualised structures. Because of its non-invasive methodology without contact to the patient’s eye and the faster acquisition times with increasing resolution, the OCT has become a valuable instrument in the modern anatomic and structural diagnostics of the macula. Functional statements are not yet possible in a comprehensive manner, but first steps have been made with the interpretation of structural information from high-resolution images. In this paper, the emerging possibilities from a widespread use of the OCT, as well as the limitations of this diagnostic technique, are discussed.

Literatur

• 1 Fercher A F, Roth E. Ophthalmic laser interferometer.  Proc SPIE. 1986;  658 48-51
  Google Scholar
• 2 Fercher A F, Mengedoht K, Werner W. Eye length measurement by interferometer with partially coherent light.  Optics Letters. 1988;  13 186-188
  Google Scholar
• 3 Huang D, Swanson E A, Lin C P et al. Optical coherence tomography.  Science. 1991;  254 (5035) 1178-1181
  Google Scholar
• 4 Fercher A F, Hitzenberger C K, Drexler W et al. In-Vivo Optical Coherence Tomography.  Am J Ophthalmol. 1993;  116 (1) 113-115
  Google Scholar
• 5 Swanson E A, Izatt J A, Hee M R et al. In-vivo retinal imaging by optical coherence tomography.  Optics Letters. 1993;  18 (21) 1864-1866
  Google Scholar
• 6 Fercher A F. Optical coherence tomography.  J Biomed Opt. 1996;  1 157-173
  Google Scholar
• 7 Fujimoto J G. Optical coherence tomography for ultrahigh resolution in vivo imaging.  Nature Biotechnology. 2003;  21 (11) 1361-1367
  Google Scholar
• 8 Antcliff R J, Stanford M R, Chauhan D S. Comparison between optical coherence tomography and fundus fluorescein angiography for the detection of cystoid macular edema in patients with uveitis.  Ophthalmology. 2000;  107 (3) 593-599
  Google Scholar
• 9 Ozdek S C, Erdinc M A, Gürelik G. Optical coherence tomographic assessment of diabetic macular edema: comparison with fluorescein angiographic and clinical findings.  Ophthalmologica. 2005;  219 (2) 86-92
  Google Scholar
• 10 Krebs I, Ansari-Shahrezaei S, Goll A et al. Activity of neovascular lesions treated with bevacizumab: comparison between optical coherence tomography and fluorescein angiography.  Graefes Arch Clin Exp Ophthalmol. 2008;  246 (6) 811-815
  Google Scholar
• 11 Strauss R W, Scholz F, Ulbig M W. Artifacts in optical coherence tomography (OCT) imaging of the retina.  Klin Monatsbl Augenheilkd. 2007;  224 (1) 47-51
  Google Scholar
• 12 Srinivasan V J, Monson B K, Wojtkowski M et al. Characterization of outer retinal morphology with high-speed, ultra-high-resolution optical coherence tomography.  Invest Ophthalmol Vis Sci. 2008;  49 1571-1579
  Google Scholar
• 13 Mori K, Gehlbach P L, Sano A et al. Comparison of epiretinal membranes of differing pathogenesis using optical coherence tomography.  Retina. 2004;  24 (1) 57-62
  Google Scholar
• 14 Koleva-Goergieva D, Sivkova N. Assessment of serous macular detachment in eyes with diabetic macular edema by use of spectral-domain optical coherence tomography.  Graefes Arch Clin Exp Ophthalmol. 2009;  247 (11) 1461-1469
  Google Scholar
• 15 Einwallner E, Ahlers C, Golbaz I et al. Neovascular age-related macular degeneration under anti-angiogenic therapy: Subretinal fluid is a relevant prognostic parameter.  Ophthalmologe. 2010;  107 (2) 158-164
  Google Scholar
• 16 Ahlers C, Golbaz I, Stock G et al. Time course of morphologic effects on different retinal compartment after ranibizumab therapy in age-related macular degeneration.  Ophthalmology. 2008;  115 (8) e39-e46
  Google Scholar
• 17 Kashani A H, Keane P A, Dustin L et al. Quantitative subanalysis of cystoid spaces and outer nuclear layer using optical coherence tomography in age-related macular degeneration.  Invest Ophthalmol Vis Sci. 2009;  50 (7) 3366-3373
  Google Scholar
• 18 Bolz M, Kriechbaum K, Simader C et al. Diabetic Retinopathy Research Group Vienna. In vivo retinal morphology after grid laser treatment in diabetic macular edema.  Ophthalmology. 2010;  117 (3) 538-544
  Google Scholar
• 19 Barthelmes D, Sutter F K, Gillies M C. Differential optical densities of intraretinal spaces.  Invest Ophthalmol Vis Sci. 2008;  49 (9) 3529-3534
  Google Scholar
• 20 Gass J D. Müller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacular retinoschisis.  Arch Ophthalmol. 1999;  117 (6) 821-823
  Google Scholar
• 21 Jorge R, Costa R A, Calucci D et al. Intravitreal bevacizumab (Avastin) associated with the regression of subretinal neovascularization in idiopathic juxtafoveal retinal telangiectasis.  Graefes Arch Clin Exp Opthalmol. 2007;  245 (7) 1045-1048
  Google Scholar
• 22 Mavrakanas N, Mendrinos E, Pournaras C J et al. Intravitreal bevacizumab and ranibizumab for bilateral subretinal neovascularization secondary to idiopathic juxtafoveal telangiectasia type 2A.  Acta Ophthalmol. 2009;  87 (8) 930-932
  Google Scholar
• 23 Bolz M, Schmidt-Erfurth U, Deak G et al. Diabetic Retinopathy Research Group Vienna. Optical coherence tomography hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema.  Ophthalmology. 2009;  116 (5) 914-920
  Google Scholar
• 24 Liakopoulos S, Ongchin S, Bansal A et al. Quantitative optical coherence tomography findings in various subtypes of neovascular age-related macular degeneration.  Invest Ophthalmol Vis Sci. 2008;  49 (11) 5048-5054
  Google Scholar
• 25 Park S S, Truong S, Zawadzki R et al. High resolution Fourier-domain optical coherence tomography of choroidal neovascular membranes associated with age-related macular degeneration.  Invest Ophthalmol Vis Sci. [e-pub ahead of print]
  Google Scholar
• 26 Bolz M, Simander C, Ritter M et al. Morphological and functional analysis of the loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration.  Br J Ophthalmol. 2010;  94 (2) 185-189
  Google Scholar
• 27 Framme C, Panagakis G, Birngruber R. Effects on choroidal neovascularization after anti-VEGF upload using intravitreal ranibizumab, as determined by spectral domain-optical coherence tomography.  Invest Ophthalmo Vis Sci. 2010;  51 (3) 1671-1676
  Google Scholar
• 28 Neue Aspekte in der Therapie der neuovaskulären altersabhängigen Makuladegeneration: Kriterien der Wiederbehandlung bei Anti-VEGF-Therapie. Aktuelle Ergänzungsstellungnahme der Retinologischen Gesellschaft, der Deutschen Ophthalmologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands e. V. Stand: Dezember 2010.  Klin Monatsbl Augenheilkd. 2011;  228(2) 138-143
  Google Scholar
• 29 Oishi A, Otani A, Sasahara M et al. Photoreceptor integrity and visual acuity in cystoid macular oedema associated with retinitis pigmentosa.  Eye. 2009;  23 (6) 1411-1416
  Google Scholar
• 30 Ota M, Tsujikawa A, Kita M et al. Integrity of foveal photoreceptor layer in central retinal vein occlusion.  Retina. 2008;  28 1502-08
  Google Scholar
• 31 Matsumoto H, Sato T, Kishi S. Outer nuclear layer thickness at the fovea determines visual outcomes in resolved central serous chorioretinopathy.  Am J Ophthalmol. 2009;  148 (1) 105-110
  Google Scholar
• 32 Hayashi H, Yamashiro K, Tsujikawa A et al. Association between foveal photoreceptor integrity and visual outcome in neovascular age-related macular degeneration.  Am J Opthalmol. 2009;  148 (1) 83-89
  Google Scholar
• 33 Sakamoto A, Nishijima K, Kita M et al. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy.  Graefes Arch Clin Exp Ophthalmol. 2009;  247 (10) 1325-1330
  Google Scholar
• 34 Suh M H, Seo J M, Park K H et al. Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal.  Am J Opthalmol. 2009;  147 473-480
  Google Scholar
• 35 Wakabayashi T, Oshima Y, Fujimoto H et al. Foveal microstructure and visual acuity after retinal detachment repair.  Opthalmology. 2009;  116 519-528
  Google Scholar

Dr. Maria Andreea Gamulescu

Augenklinik, Universitätsklinikum Regensburg

Franz-Josef-Strauss-Allee 11

93053 Regensburg

Phone:  ++ 49/9 41/9 44 92 01

Fax:  ++ 49/9 41/9 44 92 02

Email: agamulescu@web.de