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Choroidal granulomas visualized by enhanced depth imaging optical coherence tomography.

Alessandro Invernizzi1, Chiara Mapelli, Francesco Viola

  • 1*Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation-Ospedale Maggiore Policlinico, Milan, Italy; †Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; ‡Eye Unit, Immunology Ocular Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; and §Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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Summary

Enhanced depth imaging optical coherence tomography (EDI-OCT) effectively visualizes choroidal granulomas (CG), revealing characteristics influenced by lesion size and disease type. Increased signal transmission on EDI-OCT aids in identifying these ocular inflammatory conditions.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Inflammatory Diseases

Background:

  • Choroidal granulomas (CG) are inflammatory lesions that can affect vision.
  • Accurate visualization and characterization of CG are crucial for diagnosis and management.
  • Enhanced depth imaging optical coherence tomography (EDI-OCT) offers high-resolution cross-sectional imaging of the choroid.

Purpose of the Study:

  • To evaluate the capability of EDI-OCT in visualizing choroidal granulomas (CG).
  • To define the characteristic features of CG as seen on EDI-OCT.
  • To correlate EDI-OCT findings with indocyanine green (ICG) angiography and clinical data.

Main Methods:

  • Review of combined ICG angiography and EDI-OCT images from 44 patients with CG (sarcoid, tubercular, Vogt-Koyanagi-Harada).
  • Classification of CG by ICG angiography (full/partial thickness, small/large).
  • Detailed evaluation of EDI-OCT scans for lesion characteristics (thickness, shape, reflectivity, internal pattern, margins, transmission effects) by two independent operators.

Main Results:

  • EDI-OCT visualized 100% of CG detected by ICG angiography.
  • CG appeared more homogeneous with increased signal transmission compared to surrounding choroid on EDI-OCT.
  • Lesion characteristics on EDI-OCT, including thickness, shape, and margins, were influenced by CG size and underlying disease etiology (e.g., tubercular lesions often showed lobulated shapes).

Conclusions:

  • EDI-OCT is a suitable imaging modality for visualizing and characterizing choroidal granulomas.
  • The appearance of CG on EDI-OCT is significantly influenced by lesion size and the specific disease causing the granuloma.
  • Increased transmission effect observed on EDI-OCT can be a valuable indicator for identifying CG.