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Tomografa Optica CoherenteDr. Jos Roberto Brito NavarroFebrero 2017

Al momento de analizar un OCT, se pueden obtener diferentes imgenes con informacin diferente, relevante en distintas enfermedades.

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Clasico corte de alta definicin es el ms til.Ha sido comparado con un corte casi histolgico de la retina.3

Clsicamente se han diferenciado las capas de la retina como lneas hiper o hiporeflectantes, sin embargo an en situaciones normales, no exista consenso en algunas de estas capas, diferentes textos y artculos mostraban discordancias.4

MLE ES HIPERREFLECTIVA POR LAS BARRAS TERMINALES DE LAS CELULAS DE MULLER.7

OCT EN DMRE

TIPOS DE DRUSENDRUSEN PEQUEOSDRUSEN GRANDESDEPOSITOS SUBRRETINIANOSDUROSCUTICULARESBLANDOSPSEUDODRUSEN RETICULARESMENOS DE 63 MICRASNUMEROSOS MS DE 50 ENTRE 25 Y 75 MICRASGRANDES ARRIBA DE 125 MICRASDIAMETRO VARIABLE.PEQUEOS DEPOSITOS SUB-EPRHIPERREFECTIVOS.A VECES MENOS DISCERNIBES QUE EN A FOTOGRAFIA A COLORSUB-EPR FORMA ALARGADA.MODERADA HIPERREFLECTIVIDADCONFIGURACIN DENTADA O SIERRADRUSEN MAS GRANDES ERODAN EN LA MONOCAPA DE EPR. DEPOSITOS MS GRANDES SUB-EPRHIPERREFECTIVOSDEPOSITOS ENTRE EL EPR Y ZONA ELIPSOIDES. PUEDEN ROMPER LA ZONA ELIPSOIDE.

DRUSEN BLANDOS

Large soft drusen. A. Color photograph. The black arrows indicate the scan lines for the opticalcoherence tomographic (OCT) sections. B. The near-infrared reflectance scanning laserophthalmoscopic (SLO) picture shows decreased brightness in the region of the soft drusen.C. There is a subtle increase in autofluorescence at the outer edges of several drusen. D.Representative OCT scans showing the deposition of material under the retinal pigmentepithelium (RPE). Note that drusen color in A is not related to the thickness of sub-RPE materialseen in D.11

Drusen

DRUSEN BLANDOS

CUTICULARES

CUTICULARESDrusen cuticulares, patrn de sierra.

Penetracin de la luz

Penetration of light through cuticular drusen revealed by OCT. A. Each druse shows thinningof the overlying RPE at its apex (red arrow) and RPE thickening at its base (open arrows).Penetration of light into the underlying choroid is blocked at sites adjacent to the drusen (bodiesof the arrowheads) while transmission of light is increased in the center of each druse (at thepoints of the arrowhead). B, C. The transmission of light into the deeper layers thus varies notaccording to the thickness of the druse material, but by the thickness of the RPE.16

Pseudodrusen reticulares (RPD) Depsitos drusenoides subretinianos (SDD)

Desprendimiento de Epitelio Pigmentario

CategoriasSerosos, vascuarizados o mixto18

DMRE HUMEDA

This is an example of type 1 neovascularization.There is a vascularized PED with secondary elevation of the overlying retina and subretinal hemorrhage.Early in the fluorescein angiogram, there is an indistinct area of subpigment epithelial staining (top row, middle image). In the late stage of the angiogram, there is staining of the subpigment epithelial neovascular complex and leakage into the neurosensory detachment (top row, right image). The OCT shows that neovascularization is confined to the subpigment epithelial space with an overlying area of subretinal fluid.The vascularized PED may appear irregular in height and shape, as shown here.There may be varying degrees of sub-RPE hyper-reflective material comprised of neovascular tissue, exudation and hemorrhage.19

OCT visualizes the components of the neovascular membrane, a retinal pigment epithelial detachment (PED), detachment of the neuroepithelium (NED), intraretinal fluid, and subretinal hemorrhage. D: Drusenoid RPE detachments (), subrretinal hemorrhage (*), dense particles present in the subrretinal fluid (), intrarretinal migration of RPE cells (>).20

Spectral-domain optical coherence tomography at presentation demonstrated an intraretinal hyper-reflective focus and intra-retinal cysts (white arrow) at the area corresponding to intraretinal haemorrhage, subretinal fluid (green arrow) and a large pigment epithelial detachment (red arrow).21

DEP VASCULARIZADO

The OCT shows a vascularized PED with heterogeneous sub-RPE signals and subretinal fluid.22

RIP O DESGARROS DE EPR

Subretinal fluid and dense subretinal hemorrhage adjacent to an area of "scrolled" retinal pigment epithelium (RPE) temporally to nasally; long white arrows point to the temporal edge of a well-demarcated area that lacks RPE, as a result of it curling nasally (white arrow heads) toward the optic nerve24

OCT, Right eye. Red arrow points to an area where the RPE ends abruptly. White arrow points to an area of "scrolled" RPE adjacent to moderate subretinal fluid.25

TUBULACIONES EXTERNAS RETINIANAS (OTR)

Tubulaciones: alteracin de los fotorreceptores disrupcin de la capa, invaginando clulas remanentes, 27

Tubulaciones Retinianas Externas

Proliferacin Angiomatosa RetinianaRAP

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VASCULOPATIA POLIPOIDEA

La vasculopata coroidea polipoidea (VCP) es una red de grandes vasos sanguneos anormales, de paredes delgadas, que se originan en coroides. Se discute si la VCP es una entidad propia o es una variante de neovascularizacin coroidea(NVC) tipo 1, con una clara diferencia: los vasos terminan en lesiones polipoideas32

Fig. 1 Marked reduction of treatment-nave polyp after 6 months of intravitreal aflibercept. a. EPIC study baseline ICG angiogram (left) withcorrelated OCT study (right). Note the hyperfluorescent polyp with hypofluorescent ring on ICG angiogram. On the OCT, an inverted U-shaped polyp(arrow) is seen with surrounding serous detachment. b. ICG angiogram (left) following 6 months of intravitreal aflibercept with corresponding OCT(right) reveals marked reduction in the polyp (arrow)33

Vasculopata Polipoidea

las lesiones carac-tersticas de la VCP estn por encima de la membrana deBruch. La VCP es una neovascularizacin tipo 1 con caracte-rsticas patognomnicas: 1) los DEP atpicos con morfologaen M y complejo QRS; 2) los plipos que se observan comocavidades ovaladas adheridas al EP, y 3) la NVC que se apreciacomo hiperreflectividad debajo del EP. Alshahrani et al.12, conSD-OCT, consideran que las lesiones en la VCP no estn loca-lizadas en la coroides interna, sino entre el EP y su membranabasal. Khan et al.13, estudiaron 18 casos de VCP con OCT, loca-lizando sus lesiones en el espacio sub-EP. Otros estudios hanindicado una localizacin similar de las lesiones en la VCP34

DISTROFIA FOVEOMACULAR viteliforme del adulto

La distrofia foveomacular viteliforme del adulto es un fenotipo macular pleomrfico de aparicin tarda caracterizado por un depsito central amarillo entre la retina neurolgica y el epitelio pigmentario retiniano (2). Este acmulo da lugar funduscpicamente a una lesin subretiniana amarillenta, oval, nica y levemente elevada de la zona central macular. Fue descrita por primera vez por Adams en 1883, en un paciente que demostraba unos cambios peculiares en la mcula. Posteriormente fue individualizada por Gass en 1974 (3). En un principio se incluy dentro de las distrofias en patrn del epitelio pigmentado. Hoy se la considera como una entidad nosolgica propia36

ATROFIA

LESIONES FIBROVASCULARES

Fig. 3.20 Fibrovascular retinal pigmented epithelium detachment (PED). Cross-sectional B-scan of the right eye of an 87-year-old woman with a fibrovascular PED. The space below the retinal pigment epithelium is filled with solid layers of medium reflectivity separated by hyporeflective clefts. A small amount of subretinal fluid can be identified over the PED (arrow). 39

GRACIAS