Michelle T. Cabrera

Choroid Development and Feasibility of Choroidal Imaging in the Preterm and Term Infants Utilizing SD-OCT

PURPOSE To determine whether choroidal imaging is feasible in preterm and term infants using an 840-nm portable spectral domain optical coherence tomography (SD-OCT) system without the use of enhanced-depth imaging techniques and to assess choroidal development by comparing choroidal thickness of preterm infants, term infants, and adults. METHODS SD-OCT images were obtained from 86 preterm infants, 59 term infants, and nine adults using a portable SD-OCT system plus nine adults using a tabletop system. An unprocessed image across the macula from one randomly selected eye of each participant was selected for determination of whether the choroidal-scleral junction (CSJ) could be visualized and for measurement of choroidal thickness. RESULTS Subfoveal CSJ was visualized in 96% of young-preterm infants (imaged from 30-36 weeks postmenstrual age [PMA]); 78% of term-aged preterm infants (imaged from 37-42 weeks PMA); 49% of term infants; and 39% of adult subjects. Racial pigmentation did not affect CSJ visibility in young-preterm infants (P = 0.57). Subfoveal choroidal thickness (SFCT) in young-preterm infants, term-aged preterm infants, term infants, and adults was 176 ± 53 μm, 289 ± 92 μm, 329 ± 66 μm, and 258 ± 66 μm, respectively, and these were all statistically significantly different from one another except term-aged preterms to adults. CONCLUSIONS Infant choroid can be imaged with a portable SD-OCT system without enhanced depth imaging. Melanin in the RPE and choroid does not hinder outer choroidal imaging in young-preterm infants without advanced retinopathy of prematurity (ROP). In preterm infants, choroidal thickness increased with age but was thinner when compared to term infants suggesting delayed development due to ROP.

Exploratory Dijkstra forest based automatic vessel segmentation: applications in video indirect ophthalmoscopy (VIO).

We present a methodology for extracting the vascular network in the human retina using Dijkstra’s shortest-path algorithm. Our method preserves vessel thickness, requires no manual intervention, and follows vessel branching naturally and efficiently. To test our method, we constructed a retinal video indirect ophthalmoscopy (VIO) image database from pediatric patients and compared the segmentations achieved by our method and state-of-the-art approaches to a human-drawn gold standard. Our experimental results show that our algorithm outperforms prior state-of-the-art methods, for both single VIO frames and automatically generated, large field-of-view enhanced mosaics. We have made the corresponding dataset and source code freely available online.

Racial variation in optic nerve head parameters quantified in healthy newborns by handheld spectral domain optical coherence tomography

PURPOSE To characterize optic nerve head (ONH) morphology and parameters, including vertical disk diameter, vertical cup diameter, and vertical cup/disk ratio in healthy, full-term newborns using a handheld spectral domain optical coherence tomography (SD-OCT) device. METHODS In this prospective observational case series, healthy white, black, and Hispanic full-term newborns delivered at the Duke Birthing Center between August 2010 and May 2011 underwent dilated fundus examination and SD-OCT imaging of the optic nerve in each eye. OCT parameters were calculated and compared for each group of infants. RESULTS A total of 58 consecutive newborns of white (n = 22), black (n = 15) and Hispanic (n = 21) ethnicity were included. Mean vertical disk diameter in white, black, and Hispanic newborns was 1.29 ± 0.15 mm (standard deviation), 1.38 ± 0.14 mm, and 1.38 ± 0.14 mm, respectively (white versus Hispanic, P = 0.02; white versus black, P = 0.07). Mean vertical cup diameter in white, black, and Hispanic newborns was 0.44 ± 0.15 mm, 0.56 ± 0.23 mm, and 0.46 ± 0.30 mm, respectively (white versus black, P = 0.03). Mean vertical cup/disk ratio was 0.34 ± 0.10 for white, 0.40 ± 0.17 for black, and 0.33 ± 0.20 for Hispanic newborns (P = 0.07 for white versus black). CONCLUSIONS Handheld SD-OCT is an effective means of imaging the ONH in newborns. Racial differences in cup/disk ratio are present at birth. These data may serve as the beginning of a normative dataset for characterizing development of the ONH as well as for comparison to the neonatal ONH in disease states.

Macular Findings in Healthy Full-term Hispanic Newborns Observed by Hand-held Spectral-Domain Optical Coherence Tomography

BACKGROUND AND OBJECTIVE To enhance understanding of ethnically diverse normal newborn retinal morphology, the authors report spectral-domain optical coherence tomography (SD-OCT) macular findings in healthy Hispanic newborns. PATIENTS AND METHODS In this IRB-approved prospective, observational case series, 20 full-term Hispanic newborns had dilated retinal examinations and imaging by hand-held SD-OCT without sedation at the Duke Birthing Center. RESULTS Of 20 newborns imaged (35% male; median gestational age: 39 weeks; range: 36 to 40 weeks), two (10%) had bilateral subfoveal fluid, including one case of bilateral double subretinal fluid pockets. Three eyes of two infants (10%) had retinal macular cystoid structures (one enlarged at 1.5 months, with resolution by 3 months). These SD-OCT findings were not visible by indirect ophthalmoscopy. CONCLUSION Some Hispanic newborns have subretinal fluid or macular cystoid structures on SD-OCT. This study expands our understanding of findings seen by SD-OCT in healthy full-term newborns of various races.

Sub-tenon triamcinolone acetonide injections for topical medication intolerance in chronic blepharokeratoconjunctivitis.

Purpose: To report the efficacy of sub-Tenon triamcinolone acetonide (TA) injections for chronic blepharokeratoconjunctivitis (BKC) in 2 patients who were intolerant to topical therapies. Methods: In this retrospective observational case series, the records of 2 patients with chronic BKC who received sub-Tenon TA injections were reviewed. Results: Both patients, a 4-year-old girl and a 21-year-old developmentally delayed man, were managed successfully with sub-Tenon TA injections. The treatment resulted in resolution of symptoms, diminished corneal haze, reduced conjunctival injection, and improved visual acuity without complications. Conclusions: This case series illustrates the potential benefit of using sub-Tenon TA injections for chronic BKC in patients who are intolerant to topical corticosteroid therapy. Therefore, sub-Tenon TA injections may be considered for patients with vision-threatening BKC and nonadherence to topical therapies.

Isolated Horner syndrome and syringomyelia in a child

Horner syndrome can be caused by a variety of etiologies that interrupt the sympathetic innervation of the eye, including but not limited to central mass lesions. Recently, it has been debated whether neuroimaging has a place in the diagnostic algorithm of isolated pediatric Horner syndrome given the low incidence of neuroblastoma. We present a case of a 19-month-old girl with an isolated Horner syndrome, likely caused by a lower cervical syrinx, that was diagnosed by magnetic resonance imaging.

The Characteristics and Short-term Refractive Error Outcomes of Cystoid Macular Edema in Premature Neonates as Detected by Spectral-Domain Optical Coherence Tomography

BACKGROUND AND OBJECTIVE To explore characteristics associated with cystoid macular edema (CME) in neonates screened for retinopathy of prematurity (ROP). PATIENTS AND METHODS In this institutional review board-approved, prospective, observational study, premature neonates underwent imaging with handheld spectral-domain optical coherence tomography. RESULTS Of 73 included infants (median gestational age [GA]: 28 weeks, range 23-33 weeks; birth weight: 966 g, range 506 g-1695 g), 28 (38%) had CME and 17/28 (61%) had ROP. CME was associated with ROP (P=.03) and younger GA (P=.04), but not associated with sex, race, birth weight, postmenstrual age at imaging, ROP severity, or myopia at median 6 months corrected age. CME resolved in three cases after bevacizumab treatment for type 1 ROP and in five cases without treatment. CME appeared in two cases several weeks following injections. CONCLUSION CME was associated with ROP and younger GA, but not with myopia. Intravitreal bevacizumab for type 1 ROP has inconclusive effects on CME.

Further support for first-trimester disruption causing the oromandibular-limb hypogenesis spectrum of anomalies

School of Medicine, Department of Ophthalmology, UNC Center for Maternal and Infant Health, Departments of Pediatrics and Pediatrics and Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Correspondence to Arthur S. Aylsworth, MD, University of North Carolina CB# 7487 UNC Campus at Chapel Hill, Chapel Hill, NC 27599-7487, USA Tel: +1 919 966 5756; fax: +1 919 966 3025; e-mail: asayls@med.unc.edu

Rapidly Progressive, Isolated Subretinal Leukemic Relapse: A Case Report

Purpose: The aim of this paper is to describe a case of relapsed pediatric acute lymphoblastic leukemia (ALL) presenting as a rapidly progressive subretinal infiltrate, as diagnosed by ultrasound-guided fine needle aspiration (FNA). Methods: We conducted a clinical pathological retrospective chart review. Results: Eleven months after documented remission of T-cell ALL while on maintenance therapy, this 17-year-old patient presented with acute open angle glaucoma in the right eye. B-scan ultrasonography suggested total retinal detachment. Eight weeks later, based on routine cerebrospinal fluid analysis, the patient was diagnosed with central nervous system relapse of T-cell ALL. Repeat B-scan 1 week later showed a new hyperechoic subretinal mass. FNA of the mass confirmed leukemic infiltrate. The involved eye was enucleated, demonstrating leukemic cells throughout the subretinal space, choroid, and the optic nerve. Following hematopoietic stem cell transplant, the patient continues to maintain bone marrow remission 5 months after enucleation without involvement in the opposite eye. Conclusion: Retinal detachment in any patient with a history of leukemia should raise the possibility of relapse and may warrant aspiration/biopsy if other means of diagnosing relapse are inconclusive. Subretinal infiltrate may progress rapidly and prompt diagnosis is paramount to tailoring therapy and preserving vision.