• Written By: Matthew W. Wilson, MD, FACS
    Ocular Pathology/Oncology

    This prospective study demonstrated that fundus autofluorescence (FAF), infrared imaging and spectral-domain optical coherence tomography (SD-OCT) all allowed more sensitive detection of astrocytic hamartomas compared with conventional ophthalmoscopy and color fundus photography. The results indicate that infrared imaging, SD-OCT and FAF are useful adjuncts to clinical examination and fundus photography for the detection of retinal astrocytic hamartomas in patients with tuberous sclerosis complex.

    The authors compared the usefulness of various imaging modalities in four patients (eight eyes) with tuberous sclerosis complex. They report in the May issue of the American Journal of Ophthalmology that infrared imaging and SD-OCT were the most sensitive techniques for detecting small lesions and may aid in the detection of astrocytic hamartomas not visible on clinical examination or color fundus photography. FAF was a useful adjunctive test for obtaining greater contrast between lesions and surrounding retina.

    The results also indicate that high-resolution SD-OCT scans revealed in vivo structural details, such as hyper-reflective dots, not visible with earlier OCT imaging. Additionally, the authors say that the ability to monitor structural changes over time in astrocytic hamartomas using SD-OCT may be beneficial for monitoring the success of systemic chemotherapy in the treatment of various tuberous sclerosis tumors.

    Infrared imaging was particularly helpful for topographic localization of smaller lesions, which were then imaged further with targeted SD-OCT scans. This avoided the need to perform dense SD-OCT scans of the entire posterior pole, which can be both difficult and impractical, especially with limited cooperation in children.