highres anterior segment oct casia ss-1000 case reports...cross sectional view in keratoglobus ......
TRANSCRIPT
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Kirrberger Str. 1 / Geb. 7
66421 Homburg/Saar Tel.: +49 (0) 6841/16-26900
HighRes Anterior Segment OCT
CASIA SS-1000
-
Case Reports
A. Langenbucher, T. Eppig
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Content
• Imaging modalities for the anterior eye segment and
characterization of the CASIA-OCT
• Measurement samples with the Casia 1000
– Corneal pathologies
– Following penetrating keratoplasty + complications
– Anterior segment analysis
– Refractive surgery and IOL implantation + complications
• Conclusions
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Oculus Pentacam HR
• LED with 475 nm UV-
free
• Rotating slit projection
• 100 images in 2 s
• 500 axial points
Ziemer Galilei (Bon Optics)
• Placido-topography+Dual
Scheimpflug-Imaging (rotating slit)
• Merging of Placido & Scheimpflug data
Sonomed UBM
• 35 or 50 MHz
• Resolution (50 MHz) axial/lateral 18/40 µm
• Acquisition time HR/3D 3 s
• No topographic function or image processing
Reichert Reflex UBM • 35 or 50 MHz • Resolution (50 MHz)
axial/lateral 16/45 µm • Acquisition time HR/3D 2
s
• No topographic function or image processing
Zeiss Visante TD-OCT • SLD mit 1310 nm • 2000 Scans/s • Resolution axial/lateral
18/60 µm
• AS scan (16x6 mm) 256 A-scans (.125 s/slice)
• HR cornea scan 512 A-scans (.25 s/slice)
TMS-5 Tomey
• 25 or 31 rings x 256 points
• acquisition time .5 s (n=4)
• 6400 / 7300 datapoints
• 64 frames in 1.0 s
• 40960 measurement points
• Placido and/or Scheimpflug
• Data merging & motion correction
Ro
t. S
lit |
Pla
cid
o
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Tomey SS Casia 1000 (SS-OCT)
• Light source 1310 nm (NIR)
• Spatial resolution axial 10 µm, lateral 30 µm
• Anterior segment analysis (16x16x6 mm)
• Corneal scan (10x10x3 mm)
• 30.000 A scans/s
• Modalities:
– 2D/3D measurement and data analysis
– Corneal topography (anterior and posterior)
– Anterior segment measurement
– Pachymetry mapping
– HR-cornea scan
– Densitometry map
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Optical tomography vs. Ultrasound
• Refractive index of ALL media
must be known
Tissue opacities block light (NIR!!!, e.g. CASIA)
• Deeper structures MUST be corrected by inverse raytracing
through superficial structures!!!!
• Error propagation if superficial
structures are not measured or analyzed appropriately
– 10th order polynomial fit (CASIA)
instead of spherical model in
Pentacam
• Speed of sound of ALL media
must be known (especially in pathologic tissue or
cataractous lenses unrealistic!!!)
• Refraction at interfaces (e.g. at corneal front surface or vacuoles)
• Error propagation for deeper
structures if superficial structures
are measured or interpreted
uncorrectly.
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Measurement samples:
Measurement with corneal
pathologies (e.g. dystrophies and
keratoconus)
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Stromal corneal dystrophy
Granular stromal dystrophy
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Stromal corneal dystrophy
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Keratoconus ante perforationem
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Overview image: Keratoconus
3D display
Automatic surface detection
and characterization 12
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Corneal topography in keratoconus
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Dedicated KC screening software
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Cross sectional view in keratoglobus
Extreme thinning and bulging of the cornea, risk of perforation
„Live“-image 15
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Corneal topography map in keratoglobus
Due to opacification
and uncertain reflex
the corneal back surface
cannot be detected
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Examination of amniotic membrane in situ
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Perforating injury with a steel needle
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Descemet detachment and corneal edema in
bullous keratopathy
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Corneal measurement through a CL
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Topography and size of a CL
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Measurement samples:
Diagnostics after penetrating (PK) or
lamellar (LK) keratoplasty +
complications
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Overview image: following PK
„Live“ image
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Corneal topography following PK
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Graft diameter and CCT profile
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Automatic surface recognition following PK
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Step formation and flat ACD
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Following DSEAK
Descemet stripping endothelial keratoplasty
Measurement of the graft thickness
„Live“ image 29
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Measurement w-t-w and graft diameter
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Measurement samples:
Anterior segment analysis
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Anterior chamber depth measurement
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Anterior chamber analysis
Cross section area and
volume (integration over 180°)
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Angle measurement
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Complete and partial anterior synechiae
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Situation after PK
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Posterior synechia with cyst
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Angle closure glaucoma
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Severe iris defect and Descemet detachment
after ocular trauma
Automatic surface recognition
still works!!!
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Malignant iris tumor
• Measurement of
dimensions and
structure
• Therapy monitoring
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Peripheral iris cyst
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Measurement samples:
Refractive surgery and IOL
implantation
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Corneal topography following LASIK
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Evaluation of flap thickness after LASIK
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LASIK flap 3D video
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Corneal Intacs
3D view
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Connection between
ring segments
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Tilted refractive anterior chamber IOL
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Extreme keratectasia after LASIK – Corneal
topography
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Extreme keratectasia after LASIK –
Meridional cross section
Automatic
surface
detection
works!!!
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Conclusions
• The Casia 1000 is a powerful diagnostic tool which allows for high resolution 2D and 3D-measurements of – Cornea (.2-2.4 s image acquisition time)
– Anterior eye segment (distances, chamber angles, areas,…; 1.2 s acquisition time)
– Crystalline and artificial lens (mainly anterior segment, .5-1.2 s image acquisition time)
• Topography of the anterior and posterior corneal surface including precise full surface pachymetry (0.3 s acquisition time)
• True angles and distances ONLY if superficial surfaces are recognized and corrected properly – optical pathway correction with polynomials (n=10)
– optional manual surface correction
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Conclusions
• In measurement precision the Swept-Source-Technology is equivalent with SE-FD-OCT, but allows significantly shorter acquisition times – lower risk of movement artifacts (SS vs. TD-OCT: 30000 vs. 2000
scans/s)
• Raw data and processed data can be easily exported and postprocessed externally
• Dedicated keratoconus screening module is available with the new software version
• RGP CL fitting software in preparation (spherical, aspherical, multi-curved or toric CLs)
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Experimental Ophthalmology
Saarland University
Kirrberger Strasse / Bldg. 22 66421 Homburg/Saar
Germany
Tel.: +49 (0) 6841 / 16-21218 Fax.: +49 (0) 6841 / 16-24400
Thanks for your kind attention
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TMS-5 Anterior segment analyzer
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Classical topography map of the anterior
corneal surface
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Corneal power evaluation of the anterior
corneal surface (e.g. CL fitting)
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Corneal statistics (qualitative and
quantitative)
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Keratoconus screening based on anterior
corneal topography
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Corneal quad map
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Alternatively with ACD instead of axial
power (e.g. in glaucoma screening)
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Surface detection with the Scheimpflug
AC mode
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Measurement of CCT, ACD and w-t-w
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Matching of data sets originated from
Placido disc and Scheimpflug modes
All optical sections of
Scheimpflug image are shifted
in x-y-z to be aligned to the
Placido disc data set
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Case presentation: Comparison of
different anterior segmant imaging
modalities
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Extreme keratoconus with scarring – slit
lamp overview
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Slit lamp examination – cone profile
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Munson sign – side view
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Casia imaging – cross section
Diffuse back surface configuration
Extreme cone configuration
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Comparison of different anterior
segment imaging modalities
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Casia imaging – 3D view
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Casia imaging – topography map
Realistic values for surface elevation,
axial power and pachymetry 70
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Pentacam HR imaging – topography map
Realistic values only for axial power, but not
for surface elevation or pachymetry 71
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TMS-5 imaging – corneal topography
and Klyce statistics
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TMS-5 imaging – corneal topography
and Klyce keratoconus screening
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