Dhaivat Shah » Imaging marvels

  • ONH-Drusen

    Mar 16 2018 by Dhaivat Shah

    ONH-drusen

    Condition/keywords: drusen, optic nerve

  • ONH-Drusen

    Mar 16 2018 by Dhaivat Shah

    ONH-drusen

    Condition/keywords: drusen, hypopyon, optic nerve

  • Outer Retinal Tubulation

    Mar 27 2018 by Dhaivat Shah

    Outer retinal tubulation (ORT) is a feature of photoreceptor rearrangement after chronic retinal damage due to refractory cme, long standing CNVM or old trauma. Photoreceptors lose adhesions to surrounding structures, resulting in outward folding and formation of new lateral contact between photoreceptors to form round structure. They generally remains stable over time. It is important to recognize ORT on OCT because it indicates a refractory state of the pathological condition and poor visual prognosis, and likely not to benefit from any treatment. Here is a case of 62-year-old female with history of 4 previous anti-VEGF injection in left eye for CNVM, with the recent OCT showing formation of ORT with subfoveal scarred membrane.

    Photographer: Dr Dhaivat Shah

    Condition/keywords: choroidal neovascular membrane (CNVM), outer retinal tubulation

  • Cystoid Macular Edema Multicolor imaging

    Mar 31 2018 by Dhaivat Shah

    This is a case of a 50-year-old female presenting with right eye IT BRVO with ME. Unarguably, the first modality of investigation would be an OCT along with a fundus photograph. Instead of using a conventional fundus photo, a multicolor image was captured. It beautifully highlighted the cystic pattern of macular edema, hemorrhages and sclerosed vessel, which corresponded well with the OCT findings. Multi-color scanning laser imaging uses three laser wavelengths simultaneously to provide diagnostic images that show distinct structures at different depths within the retina. The high-resolution, detailed MultiColor images can highlight structures and pathologies not visible on ophthalmoscopy and fundus photography. This imaging modality has the potential to replace conventional color fundus photography in the near future.

    Photographer: Dr Dhaivat Shah

    Imaging device: Heidelberg Spectralis

    Condition/keywords: cystoid macular edema (CME), multicolor

  • Morning Glory Syndrome

    Apr 14 2018 by Dhaivat Shah

    7-year-old male patient presented to our OPD when the mother noticed that the child is not able to see clearly through the left eye. BCVA OD 6/6 OS 6/60. OU anterior segment normal. Fundus OD was normal, OS showed an enlarged, funnel-shaped excavation that incorporated the optic disc. The disc itself was enlarged, pink in color and had a surrounding area of peripapillary chorioretinal pigmentary changes which was sparing the fovea. MRI orbit/brain came out to be normal. OS diagnosed to be Morning glory syndrome. The child was prescribed full-time glasses to correct the anisometropia and occlusion/patching of the right(normal) eye 2 hours per day and guarded visual prognosis was explained.

    Photographer: Miss Marina Parvin

    Condition/keywords: Morning Glory Syndrome

  • Foveal Thinning Post Blunt Trauma

    Aug 25 2018 by Dhaivat Shah

    28-year-old male. Post blunt trauma with tennis ball. Fundus color photo shows large area of retinal thinning. Multi color image shows dull red color over fovea, depicting thinning. SD-OCT shows inner retinal ischemia and foveal thinning with early macular hole formation.

    Imaging device: Spectralis

    Condition/keywords: blunt trauma

  • ERM

    Aug 30 2018 by Dhaivat Shah

    55-year-old female presented with left eye BCVA 6/24 N18, early cataract changes on slit lamp, fundus showing ERM with retinal thickening. Multi-color image (MCI) depicting an ERM (green hue) with retinal thickening. Note how beautifully the extent of ERM is captured, which can help the surgeon to decide the area of surgical peeling. The BR particularly provides details of the inner retina and the vitreoretinal interface, hence showing the ERM. This platform utilizes confocal technology and thus has unique advantages over CFP. MCI provides good image quality in hazy media and in small pupil. It does not use bright white light and thus is not discomforting to the patient. Images obtained with MCI have better contrast and sharper borders as compared to CFP. Definitely the new tech in for the next generation!

    Photographer: Miss Moupiya Das

    Imaging device: SPECTRALIS

    Condition/keywords: blue reflectance, epiretinal membrane (ERM)

  • Polypoidal Chroidal Vasculopathy

    Sep 21 2018 by Dhaivat Shah

    A 40-year-old female presented with sudden onset decreased vision in right eye. BCVA: CF 1 mt. Fundus showed massive subretinal exudation with haemorrhage. EDI OCT showed notched PEDs with shallow SRF and exudation with back-shadowing. FFA shows leak with window defects. ICG shows hotspot in late phase. Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized by the presence of aneurysmal polypoidal lesions in the choroidal vasculature, resulting in damage to the overlying retina and loss of retinal pigment epithelium. The aneurysmal dilatations, also known as polyps, may be found subfoveal, juxtafoveal, extrafoveal, peripapillary or even peripheral regions. The polypoidal lesions are best detected on indocyanine green angiography as hotspots in late phase. The presence of choroidal polyps can lead to recurrent episodes of exudative retinal detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage and exudation. Treatment is available in form of laser/PDT along with Anti VEGF injection.

    Photographer: Miss Moupiya Das

    Condition/keywords: polypoidal choroidal vasculopathy (PCV)

  • Gyrate Atrophy

    Oct 31 2018 by Dhaivat Shah

    50-year-old male came in with complaint of daytime vision loss for a year and nighttime vision loss for more than 20 years, gradually increasing day by day. Fundus showed paving-stone like areas of atrophy of the RPE involving the macula which coalesces to form a characteristic scalloped border at the junction of normal and abnormal RPE. Gyrate atrophy is an autosomal recessive dystrophy caused by tenfold elevations of plasma ornithine, which is toxic to the RPE and choroid. Patients with gyrate atrophy have hyperpigmented fundi, with lobular loss of the RPE and choroid, normally sparing the fovea. The finding of generalized hyperpigmentation of the remaining RPE helps to clinically distinguish gyrate atrophy from choroideremia. Affected patients usually develop night blindness during the first decade of life and experience progressive loss of visual field and visual acuity later in the disease course. Early diagnosis is crucial because treatment in form of Arginine free diet and oral pyridoxine helps in slowing the progression of disease.

    Imaging device: Optos

    Condition/keywords: fundus autofluorescence (FAF), gyrate atrophy