Dr. P V Prasad, P19855, Dr. Padmamalini Mahendradas, Dr. Rohit Shetty, Dr. Ashwin Mohan, Dr. Ankush Kawali
Abstract:
Aim:
To assess the clinical application of multi colour imaging in posterior uveitis
Methods:
This was a prospective observational study of patients attending the Uveitis clinic at Narayana Nethralaya. All eligible patients underwent Color fundus photo (CFP), multicolored imaging (Spectralis) and OCT and OCT angio when indicated
Results:
Serpigenous choroiditis lesions extending along inferior vascular arcades were better appreciated in infrared spectrum of Multicolur image compared to colour fundus photography. ILM folds are better appreciated on blue reflectance. Scar involvementof different layers in the retina is better appreciated in multicolour images.
Conclusion:
Multicolour imaging offers better visualization of some specific pathologies than Conventional CFP and is less affected by media opacities.
Introduction
Multicolourimaging (MCI) developed in spectral domain Optical coherence Tomography SD-OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany) uses the cSLO to capture three simultaneous reflectance images using three monochromatic laser sources.Blue reflectance (BR: 488 nm),Green reflectance (GR: 515 nm) and Infrared reflectance (IR: 820 nm). Penetrates surface the retina at different depths to give details at the various layers of the retina.1
Materials and Methods
Prospective observational cross – sectional case study. Patients diagnosed with Uveitis coming to Outpatient department of Narayana Nethralaya – Uvea and Ocular immunology services were included in this study.
Patients underwent for Comprehensive Ophthalmic examination
- Best corrected visual Acuity
- Detailed Anterior segment Examination with slit lamp
- Slit lamp Biomicroscopy with 90 D examination
- Indirectophthalmoscopy with 20 D lens.
- Fundus images taken by Colour Fundus photography (CFP) and also by Multi Colour Imaging (MCI)
- SD –OCT and OCT Angio whenever required
- High speed combined and simultaneous cSLO imaging was performed with a SPECTRALIS OCT including Multi Color imaging using the multicolor mode on area of central 55 degree (Heidelberg Engineering).
Analysis
The images captured through MCI and CFP was analysed separately by two observers.
Differences in the appearance of various lesions and pathologies in different cases were tabulated and analysed.
Sensitivity, specificity and the agreement between the two methods Kappa statistics was calculated.
Results
Figure1: Grapical representation of sex distribution in the study
Figure 2: Graphical representation of the laterality in the study
Figure 3: Graphical representation of etiological diagnosis of various cases included in the study
Case example:
Case1:
A 45y female with left eye serpigenous choroiditis with aetiology of Toxoplasmosis having visual acuity 6/6 OU.
On imaging with colour fundus photograph and multicolour image in which serpigenous choroiditis lesions extending along inferior vascular arcades are better appreciated in infrared spectrum of Multicolur image compared to colour fundus photography.
Case 2:
A 28y female with left eye multifocal choroiditis with aetiology of tuberculosis having visual acuity 6/6 OD, 6/9 OS.
On imaging with colour fundus photograph and multicolour image which shows multifocal choriditis lesions inferotemporal to optic disc are better appreciated in multicour images ILM folds on blue reflectance and choroiditis on infrared reflectance. In colour fundus photography ILM folds are not appreciated.
Case 3:
A 8 y female child with right eye toxoplasmic scar having visual acuity 6/6 in both eyes.
On imaging ,Colour fundus photograph and multicolour image showingretinochoroidaltoxoplasmic scar at macula in Right eye. Scar involvementof different layers in the retina is better appreciated in multicolour images.
Statistics:
Each pathology graded from 0 (absent) to 2(clearly visible) for each of the 4 multi colour images.
Total score was compared for each of the pathologies among the 4 multi colour images.
Inter-rater agreement (kappa) was calculated to evaluate agreement between the 2 observers
Inter-rater agreement was strong (weighted kappa = 0.875).
Results
Superficial pathologies like ERM, ILM folds, retinitis and macular edema were best appreciated on blue reflectance;
NVEs, exudates and hemorrhages were best appreciated in green reflectance;
Deeper pathologies like RPE changes and choroidal lesions were best appreciated in infrared reflectance
Disc edema and PEDs were equally visible in all the 4 images
Figure 4: Graphical representation of visibility of various pathologies in colour fundus photograph and all types of multicolor images.
Discussion:
Multicolour imaging offers better visualization of some specific pathologies than Conventional CFP and is less affected by media opacities. MCI can be used as a tool in investigating posterior ocular disease as it shows surface retinal disease, retinal vascular disease, and optic nerve disease more clearly than color fundus photography.2
Conclusion:
MCI is a novel diagnostic tool to localize the level of pathology in posterior uveitis compared to CFP. As the use of MCI become more widespread, further studies are needed to validate various details seen on multicolor imaging with conventional CFP and other imaging modalities.
References:
1.Alten F, Clemens CR, Heiduschka P, Eter N: Characterisation of reticular pseudodrusen and their central target aspect in multi-spectral, confocal scanning laser ophthalmoscopy. Graefes Arch ClinExp Ophthalmo2014; 252:715–721.)
2.Joseph T Nezgoda, Natalia Camacho, Dirk-Uwe G Bartsch, Glenn Currie, William R Freeman; Multicolor Imaging Compared with Color Fundus Photography for Retinal, Choroidal and Optic Nerve Pathology. Invest. Ophthalmol.Vis.Sci.2014;55(13):248. )
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