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[Imaging of the anterior eye chamber with optical coherence tomography].

BACKGROUND: Optical coherence tomography (OCT) represents a high-resolution diagnostic method which can be used to precisely image the anterior eye segment. Further developments in scanning technology and data evaluation allowed to visualize the entire anterior eye segment in one image, and the purpose of this study was to clinically evaluate this new system. PATIENTS AND METHODS: The studied OCT system was adapted to a slit-lamp and allowed us to image the anterior segment with an axial resolution of 10 microm at a scanning rate of 200 Hz with a depth of 7 mm and a maximal width of 15 mm. In selected cases the clinical value of anterior segment OCT was assessed. The reproducibility and level of agreement of anterior chamber depth measurements were assessed during the preoperative examination in 49 cataract surgery patients and compared to ultrasound (US) biometry (10 MHz). RESULTS: The studied anterior segment OCT allowed the cross-sectional imaging of the entire anterior eye segment. Changes of the anterior chamber before and after cataract surgery or surgical iridectomy were visualised. Furthermore, the findings of the anterior chamber after implantation of an iris-fixated intraocular lens (IOL) and an iris prosthetic system could be assessed. The reproducibility of the anterior chamber depth measurement was +/- 22 microm (OCT) and +/- 76 microm (US). The mean difference between optical and acoustic values was 1 microm (0.03 % p = 0.921) and the limits of agreement (95 % confidence interval) were 260 microm (8.58 %). CONCLUSIONS: The anterior segment OCT proved to be a helpful diagnostic method. The cross-sectional visualisation of the entire anterior chamber allowed us to assess important values for the implantation of iris-fixated IOL and other changes after surgical procedures. The resolution and reproducibility were higher than for conventional ultrasound biometry.

Aged↗

Optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a light-based imaging modality that can be used in biological systems to study tissues in vivo with near-histologic, ultrahigh resolution. The rationale for intravascular application of OCT is its potential for in vivo visualisation of the coronary artery microstructure. METHODS AND RESULTS: The principle is analogous to pulse-echo ultrasound imaging; however, light is used rather than sound to create the image. Low-coherent near-infrared light is emitted by a superluminescent diode and reflected by the microstructures within biological tissues. The echo time delay of reflected light waves is converted into a two-dimensional spatial image. The intensity of the reflected light waves is translated into an intensity map. Experimental studies confirmed the ability of intravascular OCT for plaque characterisation and accurate assessment of vascular structures that are close to the luminal surface. Preliminary clinical experience proved in vivo feasibility of intravascular OCT. A variety of atherosclerotic plaque structures including thin cap fibroatheromas can be visualized in vivo. CONCLUSIONS: Intravascular OCT allows for accurate assessment of vessel structures close to the luminal side. Clinical application is feasible. To date, however, the clinical relevance of OCT findings in coronary arteries is unclear and further validation of OCT imaging is mandatory.

Coronary Artery Disease↗

Evaluation of tracheal imaging by optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a new technology capable of generating high resolution cross-sectional images of complex tissue in real time. Analogous to ultrasound, OCT measures backscattered light intensity using coherence interferometery to construct topographical images of complex tissue. Since OCT uses infrared light rather than acoustic waves, its spatial resolution is exceptionally high (2-10 microm). Recent advances in data acquisition, analysis, and processing enable real-time imaging, and make OCT a potentially valuable tool for pulmonary airway diagnostic applications, including assisting directed airway biopsies. OBJECTIVE: This study evaluates feasibility of OCT for delineating proximal airway microstructures in various animal as well as human tracheas. METHODS: Excised trachea samples from New Zealand white rabbits, Duroc pigs, and human trachea were imaged using a compact, 1,300-nm broad-band superluminescent-diode-based prototype fiber OCT device we constructed. The resulting structural OCT images were compared to conventional hematoxilin and eosin (HE) stained histological sections from the same samples. RESULTS: OCT was able to delineate microstructures such as the epithelium, mucosa, cartilage, and glands in all samples. CONCLUSION: These findings suggest that integration of OCT with flexible fiberoptic bronchoscopy could enhance pulmonary diagnostic medicine and detection of pathologic tissue changes in various respiratory diseases.

Animals↗

Relationship of gender, body mass index, and axial length with central retinal thickness using optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) acquires cross-sectional retinal images with high resolution using low-coherence interferometry. Few studies have studied the effect of demographic data and ocular parameters that may affect central retinal thickness. In this study, these factors were used as parameters to analyse if any significant relationship exists with central retinal thickness. METHODS: Volunteers with a best-corrected visual acuity of 6/12 or better and no evidence of ocular abnormalities or interventions were recruited from October 2001 to March 2003. Body mass index (BMI), autorefraction, and keratometry recordings were measured, followed by applanation tonometry and A-scan ultrasonography. The central retinal thickness of the right eye was analysed using a scan length of 3 cm. Another 25 eyes were selected for interobserver reproducibility. RESULTS: In all, 117 normal subjects (60 male and 57 female subjects) were recruited. The mean thickness of the central retina with a diameter of 1 mm was 203+/-23 microm for male and 189+/-20 microm for female subjects. Age, intraocular pressure, and keratometric readings were not significantly correlated with central retinal thickness. Using multiple regression, gender, BMI, axial length, and signal-to-noise ratio (P<0.05) were significantly associated with the central retinal thickness. The intraclass correlation coefficient was 0.98 for interobserver reproducibility. CONCLUSION: OCT has a high interobserver reproducibility. The male gender, larger BMI, and longer axial length are associated with a significantly thicker central retina and these parameters should be considered for assessing retinal thickening and baseline comparisons in future studies.

Adolescent↗

Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography.

PURPOSE: Optical coherence tomography (OCT) is a new technology that uses near-infrared light in an interferometer to produce approximately 10-microns resolution cross-sectional images of the tissue of interest. The authors performed repeated quantitative assessment of nerve fiber layer thickness in individuals with normal and glaucomatous eyes, and they evaluated the reproducibility of these measurements. METHODS: The authors studied 21 eyes of 21 subjects by OCT. Each subject underwent five repetitions of a series of scans on five separate occasions within a 1-month period. Each series consisted of three circular scans around the optic nerve head (diameters, 2.9, 3.4, and 4.5 mm). Each series was performed separately using internal (fixation with same eye being studied) and external (fixation with contralateral eye) fixation techniques. The eye studied and the sequence of testing were assigned randomly. RESULTS: Internal fixation (IF), in general, provides a slightly higher degree of reproducibility than external fixation (EF). Reproducibility was better in a given eye on a given visit than from visit to visit. Reproducibility as measured by intraclass correlation coefficients were as follows: circle diameter (CD), 2.9 mm, 0.51/0.57 (normal/glaucoma) (IF), 0.43/0.54 (EF); CD, 3.4 mm, 0.56/0.52 (IF), 0.43/0.61 (EF); CD, 4.5 mm, 0.53/0.43 (IF), 0.42/0.49 (EF). CONCLUSIONS: Nerve fiber layer thickness can be reproducibly measured using OCT. Internal is superior to external fixation; each circle diameter tested provides adequate reproducibility.

Aged↗

Optical biopsy in human gastrointestinal tissue using optical coherence tomography.

OBJECTIVES: Optical coherence tomography (OCT) is a new technique for performing high-resolution, cross-sectional tomographic imaging in human tissue. OCT is somewhat analogous to ultrasound B mode imaging except that it uses light rather than acoustical waves. OCT has over 10 times the resolution of currently available clinical high-resolution imaging technologies. In this work, we investigate the capability of OCT to differentiate the architectural morphology of gastrointestinal tissue with the long-term objective of extending OCT to endoscopic based diagnostics. METHODS: Normal and diseased gastrointestinal tissues were taken postmortem and imaged using OCT. Images were compared with corresponding histology to confirm tissue identity and suggest the mechanisms that produce tissue contrast. RESULTS: Microstructure was delineated in different tissues, including the esophagus and colon, at 16 +/- 1 microns resolution, higher than any clinically available cross-sectional imaging technology. Differentiation of tissue layers, such as the mucosa, submucosa, and muscularis were achieved because of their different optical properties. CONCLUSIONS: The ability of OCT to provide high-resolution in situ imaging of gastrointestinal microstructure, without the need for excisional biopsy, suggests the feasibility of using OCT as a powerful diagnostic imaging technology, which can be integrated with conventional endoscopy.

Biopsy↗

High-resolution endoscopic imaging of the GI tract using optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) has demonstrated the microscopic structure of the gastrointestinal (GI) tract mucosa and submucosa in vitro. We evaluated a prototype OCT system and assessed the feasibility of OCT in the human GI tract. METHODS: The 2.4 mm diameter prototype OCT probe, inserted through an endoscope, provides a 360-degree radial scan. Images (6.7 frames/sec) are displayed on a television monitor. Tissue contact is not required. In patients undergoing elective endoscopy, OCT images were obtained of normal mucosa (confirmed by biopsy). RESULTS: Seventy-two sites were imaged (38 patients): esophagus (21), stomach (12), duodenum (11), terminal ileum (4), colon (15), and rectum (9). Varying the distance between the probe and the mucosal surface produced images of the GI wall of varying depth. When held about 1 mm above the mucosal surface, the images consisted of mucosal structures such as colonic crypts, gastric pits, and duodenal villi. With the probe held against the wall, the OCT image comprised several layers interpreted as mucosa, muscularis mucosae, and submucosa. Structures including blood vessels were evident within the submucosa. A probe with a 0.5 mm working distance to the focal point provided the best images. Reducing the frame rate to 4.0 per second facilitated image interpretation. CONCLUSIONS: OCT is feasible in the human GI tract and provides interpretable high-resolution images of mucosa and submucosa.

Adult↗

Limitations of imaging choroidal tumors in vivo by optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) produces two-dimensional cross-sectional images with a longitudinal resolution of 10 microns. Its capacity for imaging retinal structure has been shown in a variety of diseases. There are no reports on its capacity and limitations in imaging choriocapillary and choroidal structures. METHODS: Twenty-two patients with the diagnosis of malignant melanoma of the choroid were submitted to OCT. We used a prototype and a commercial device, both with an 850-nm superluminescent diode with a band-width of 30 nm (reported longitudinal resolution 10 microns). The images were evaluated for retinal thickness, changes in retinal pigment epithelium, subretinal fluid accumulation and changes in choriocapillary or choroidal reflectivity. RESULTS: Retinal edema and detachment found on biomicroscopic examination for fluorescein angiography was detected by OCT in all such cases. In 2 of 22 cases small retinal detachments were detected only by OCT. Tumor extension through the retinal pigment epithelium was not seen in this series, either by biomicroscopy or by OCT. The pattern of choroidal or choriocapillary reflectivity was nonspecifically lower than that of normal choroid, but did not yield any additional information about tumor histology. When normal retina was present, the OCT appearance of a malignant melanoma resembled that of normal choroid. CONCLUSION: OCT may provide information about the retinal structure overlying prominent tumors and the extent of adjacent retinal detachment. In its present state of development, OCT is of little value in the differential diagnosis of choroidal tumors. Its potential value for the follow-up of shallow tumors needs further investigation.

Adult↗

High resolution in vivo intra-arterial imaging with optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a new method of catheter based micron scale imaging. OCT is analogous to ultrasound, measuring the intensity of backreflected infrared light rather than sound waves. OBJECTIVE: To demonstrate the ability of OCT to perform high resolution imaging of arterial tissue in vivo. METHODS: OCT imaging of the abdominal aorta of New Zealand white rabbits was performed using a 2.9 F OCT imaging catheter. Using an ultrashort pulse laser as a light source for imaging, an axial resolution of 10 micrometer was achieved. RESULTS: Imaging was performed at 4 frames/second and data were saved in either super VHS or digital format. Saline injections were required during imaging because of the signal attenuation caused by blood. Microstructure was sharply defined within the arterial wall and correlated with histology. Some motion artefacts were noted at 4 frames/second. CONCLUSIONS: In vivo imaging of the rabbit aorta was demonstrated at a source resolution of 10 micrometer, but required the displacement of blood with saline. The high resolution of OCT allows imaging to be performed near the resolution of histopathology, offering the potential to have an impact both on the identification of high risk plaques and the guidance of interventional procedures.

Animals↗

Identification of occlusal sealants using optical coherence tomography.

OBJECTIVE: Optical coherence tomography (OCT) is a new imaging technique that uses light to image dental structures interferometrically. OCT creates cross-sectional images that have potential diagnostic value for dental applications. When used in epidemiological studies, OCT offers a safe, non-invasive technique to discriminate occlusal sealants and composite restorations. This paper summarizes a study in which dentists were asked to interpret and discriminate between OCT images. METHODOLOGY: Twenty-one dentists were asked to interpret OCT images of nine extracted premolars that were either not restored, contained an occlusal sealant or were restored with a composite restoration. RESULTS: Although the dentists were previously unfamiliar with OCT images, they adapted well and felt confident in their diagnoses using this new technology. The sensitivity of OCT to discriminate composite and sealants was > 0.92, while the specificity of discrimination was > 0.94. The capacity of OCT to discriminate sealants from non-restored occlusal surfaces was slightly less (sensitivity 0.88; specificity 0.86), but still within a clinically acceptable level. Inter- and intra-rater reliability, as measured by the kappa statistic, also revealed excellent performance by dentists using this new imaging technology. Intra-rater reliability was very good, ranging from 0.82 to 1.0. Inter-rater reliability was also high, predominately in the "Good" to "Very Good" agreement range. CONCLUSION: This preliminary study indicates OCT imaging may be an important new technology for discriminating occlusal sealants and composite restorations.

Bicuspid↗

[Macular imaging with optical coherence tomography].

PURPOSE: Optical Coherence Tomography (OCT) is a novel noninvasive and noncontact imaging technique providing cross-sectional representations of the eye structures. OCT is analogous to Ultrasound B-scan, except that it analyzes the reflection of a 850 nm light wave. The aim of this study was to assess the potential of ocular coherence tomography for diagnosing and monitoring macular diseases. METHODS: Cross-sectional images were performed with the Zeiss-Humphrey OCT. Over one year period, we examined approximately 300 patients with idiopathic full thickness macular hole, lamellar hole, cystoid macular edema, choroidal new vessels, epiretinal membrane, diabetic maculopathy, and central serous chorioretinopathy. RESULTS: OCT can provide new information concerning the posterior pole diseases mentioned above. OCT can also be useful in thickness measurements. CONCLUSION: OCT allows tomographic analysis of macular diseases. The information obtained is different from that obtained by histologic study which is sometimes hard to interprete. OCT is mostly useful in studying internal layers of the retina. Further applications may be developed.

Choroid Diseases↗

Heidelberg retina tomography and optical coherence tomography in normal, ocular-hypertensive, and glaucomatous eyes.

PURPOSE: To evaluate optic disc and retinal nerve fiber layer (RNFL) appearance in normal, ocular-hypertensive, and glaucomatous eyes undergoing confocal scanning laser ophthalmoscopy and optical coherence tomography (OCT). DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Seventy-eight eyes of 78 consecutive normal (n = 17), ocular-hypertensive (n = 23), and glaucomatous subjects (n = 38) were enrolled. METHODS: Each patient underwent complete ophthalmic examination, achromatic automated perimetry, confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomography [HRT]), and OCT. Topographic HRT parameters (disc area, cup-disc ratio, rim area, rim volume, cup shape measure, mean RNFL thickness, and cross-sectional area) and mean OCT-generated RNFL thickness were evaluated in each group. MAIN OUTCOME MEASURES: OCT and HRT assessment of optic disc and RNFL anatomy. RESULTS: OCT RNFL thickness showed no difference between normal and ocular-hypertensive eyes (P = 0.15) but was significantly less in glaucomatous eyes (P < 0.001). HRT measurements of rim area, cup-disc ratio, cup shape measure, RNFL thickness, and RNFL cross-sectional area were significantly less in glaucomatous eyes (all P < 0.005) and were correlated with mean OCT RNFL thickness (all P < 0.02). RNFL thickness using OCT or HRT was highly correlated with visual field mean defect during achromatic perimetry (P < 0.0001). CONCLUSION: Both HRT and OCT can differentiate glaucomatous from nonglaucomatous eyes. RNFL thickness measurements using OCT correspond to disc topographic parameters using HRT.

Adult↗

Relation between optical coherence tomography and optical pachymetry measurements of corneal swelling induced by hypoxia.

PURPOSE: To determine the relation between optical coherence tomography (OCT) and optical pachymetry (OP) measurements of corneal swelling induced by hypoxia. DESIGN: Experimental study. METHODS: One randomly selected eye of 20 noncontact lens wearers (10 males and 10 females, age 35.6 +/- 9.6 years) was patched during 3 hours of soft contact lens (SCL) wear while the contralateral eye acted as control. Central corneal thickness of both eyes was measured before and after SCL wear using OCT and OP in randomized order. RESULTS: Baseline central corneal thickness was 523.6 +/- 33.0 microm (mean +/- standard deviation [SD]) measured with OCT and 490.6 +/- 25.5 microm with OP. Immediately after contact lens removal, corneal thickness measured with OCT increased by 13.8 +/- 2.3% compared with 12.1 +/- 1.8% (paired t test: P <.001) measured with OP. Thereafter, corneal thickness decreased at the rate of 5.6% per hour for OCT and 5.4% per hour for OP. The difference in thickness between instruments before lens insertion, which was 33 microm compared with the difference after lens removal (edematous cornea), which ranged from 46 to 41 microm. The difference between instruments decreased during the corneal deswelling period after lens removal. The correlation coefficient between OCT and OP was 0.914 before lens insertion and 0.932 after lens removal. CONCLUSION: This study has demonstrated the difference of corneal thickness measured with OCT and OP. Although both instruments are correlated highly in all conditions tested, OCT may overestimate corneal thickness in normal and edematous corneas.

Adult↗

Optical coherence tomography for optical biopsy. Properties and demonstration of vascular pathology.

BACKGROUND: Optical coherence tomography (OCT) is an recently developed medical diagnostic technology that uses back-reflected infrared light to perform in situ micron scale tomographic imaging. In this work, we investigate the ability of OCT to perform micron scale tomographic imaging of the internal microstructure of in vitro atherosclerotic plaques. METHODS AND RESULTS: Aorta and relevant nonvascular tissue were obtained at autopsy. Two-dimensional cross-sectional imaging of the exposed surface of the arterial segments was performed in vitro with OCT. A 1300-nm wavelength, superluminescent diode light source was used that allows an axial spatial resolution of 20 microns. The signal-to-noise ratio was 109 dB. Images were displayed in gray scale or false color, Imaging was performed over 1.5 mm into heavily calcified tissue, and a high contrast was noted between lipid- and water-based constituents, making OCT attractive for intracoronary imaging. The 20-microns axial resolution of OCT allowed small structural details such as the width of intimal caps and the presence of fissures to be determined. The extent of lipid collections, which had a low backscattering intensity, also were well documented. CONCLUSIONS: OCT represents a promising new technology for imaging vascular microstructure with a level of resolution not previously achieved with the use of other imaging modalities. It does not required direct contact with the vessel wall and can be performed with a catheter integrated with a relatively inexpensive optical fiber. The high contrast among tissue constituents, high resolution, and ability to penetrate heavily calcified tissue make OCT an attractive new imaging technology for intracoronary diagnostics.

Arteriosclerosis↗

Optical coherence tomography study of tilted optic disk associated with macular detachment.

PURPOSE: To describe the macular findings by optical coherence tomography in both eyes of a patient with tilted optic disk and visual decrease. METHODS: A 35-year-old woman with bilateral tilted optic disk and serous macular detachment was examined by slit-lamp biomicroscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography (OCT). RESULTS: Fluorescein angiography demonstrated staining of the temporal rim of the staphyloma adjacent to the optic disk and hyperfluorescence of the diffuse pigmentary changes in the papillomacular area. Leakage points and serous macular detachment were not observed. The existing neurosensory detachment at the fovea became evident only by OCT. CONCLUSIONS: The existence of subretinal fluid, which became evident only by OCT, supports the view that OCT could further contribute to the study of the asymptomatic pigmentary lesions of the macula that are present in 11% of eyes with tilted optic disk. The reason for the localized macular detachment remains unclear. Dysfunction of the retinal pigment epithelium (RPE) or leakage of the optic disk staphyloma rim could possibly explain the cause of fluid accumulation in the macula.

Adult↗

Criteria for the diagnosis of dysplasia by endoscopic optical coherence tomography.

BACKGROUND: Endoscopic optical coherence tomography provides images of the GI mucosa and submucosa in microscopic detail. It is unknown whether endoscopic optical coherence tomography can reliably detect dysplasia. Colon polyps were used as a model to determine whether dysplasia in GI tissue has characteristic optical coherence tomography imaging features. METHODS: Endoscopic optical coherence tomography images of colon polyps and normal colon tissue were obtained at colonoscopy. In real time, endoscopists compared tissue organization and light scattering for polyps and normal mucosa with endoscopic optical coherence tomography. Imaged polyps were removed and evaluated histopathologically. Organization and light scattering, as assessed by endoscopic optical coherence tomography at colonoscopy, were compared for adenomas versus hyperplastic polyps. A computer program also quantified and compared the degree of light scattering for hyperplastic polyps and adenomas. RESULTS: A total of 44 polyps were imaged in 24 patients (30 adenomas, 14 hyperplastic polyps). Endoscopic optical coherence tomography images of adenomas had significantly less structure (p = 0.0005) and scattered light to a lesser degree than hyperplastic polyps (p = 0.0007). Hyperplastic polyps were significantly closer in organization (p = 0.0003) and light scattering (p = 0.0006) to normal mucosa as compared with adenomas. By digital image analysis, the light-scattering property of hyperplastic polyps was closer to normal mucosa compared with adenomas (14.86 vs. 45.81; p = 0.0001). CONCLUSIONS: Real-time endoscopic optical coherence tomography imaging differentiated adenomas, hyperplastic polyps, and normal colon tissue. By using the colon adenoma as a model, the endoscopic optical coherence tomography characteristics of dysplasia are loss of tissue organization and reduced light scattering.

Adenoma↗