Three-dimensional imaging of macular holes with high-speed optical coherence tomography

Objective: To demonstrate the advantages of 3-dimensional imaging of macular hole pathology using new-generation high-speed optical coherence tomography (OCT). Design: Prospective observational case series. Participants: Twenty-one eyes from 20 consecutive patients diagnosed with a macular hole. Methods: A prototype high-speed OCT system was built based on a Fourier-domain OCT (FD OCT) technology for patient examination. The system has achieved sensitivity of similar to 98 decibels, axial resolution of similar to 4.3 mu m in tissue, and an acquisition rate of similar to 18 700 axial scans per second. Three-dimensional imaging of macular hole pathology was performed based on a raster scan protocol consisting of 256X256 axial scans. All patients were imaged with 3-dimensional OCT, Stratus OCT, and OCT Ophthalmoscope C7. Main Outcome Measures: Images of macular hole pathologies obtained by 3-dimensional OCT and standard OCT instruments. Results: The 3-dimensional OCT imaging successfully generated realistic 3-climensional images of the vitreofoveal interface and intraretinal microstructures associated with a macular hole. The 3-climensional overview of the vitreofoveal interface was helpful in gaining an immediate understanding of the dynamic interactions of the vitreous and fovea. Observations of consecutive en face images in combination with conventional longitudinal images and of cross-sectional images in combination with sectioned volume images enabled identification of intraretinal microstructures and their 3-dimensional extension associated with a macular hole, such as subfoveal structural changes after vitreous traction, connection of the flap to intraretinal structures, the external limiting membrane (ELM) and its disruption, and elevated photoreceptor inner and outer segments delineated by the ELM. The appearance of inner-wall images of a macular hole produced by photoreceptor inner and outer segment backreflection varied throughout macular hole stages. Conclusions: Three-dimensional imaging of macular holes with high-speed OCT based on FD OCT technology offers 3-climensional overviews that facilitate understanding of the abnormalities in the vitreofoveal interface. It also provides consecutive orthogonal images that allow much more precise and minute observation of 3-dimensionally extending intraretinal structural changes associated with a macular hole than conventional OCT imaging, especially in the photoreceptor inner and outer segments.