Method for determining boundaries and area of hidden peripheral retinal break

Abstract

FIELD: ophthalmology.SUBSTANCE: used to determine the boundaries and area of a hidden peripheral retinal break. First, a linear segmental wide-field OCT scan is performed and a hidden peripheral retinal tear is identified. Using targeted OCT angiography, the scanning lines of two structural B-scans are aligned horizontally and vertically in the rupture zone. Points are identified along the border of the retinal break, these points are transferred and marked on the frontal OCTA image in the “Draw” mode of the Angio Retina program. The boundaries of the hidden gap are determined and the gap area is automatically calculated using the Angio Analytics program.EFFECT: ability to dynamically monitor the size of a hidden retinal tear, including before and after laser exposure, for timely prevention of the development of rhegmatogenous retinal detachment due to objective visualization of the hidden boundaries of the defect and automated high-precision measurement of its area in real time.1 cl, 3 ex

Description

[0001] The invention relates to medicine, namely to ophthalmology, and can be used to determine the boundaries and area of ​​a hidden peripheral retinal break.

[0002] The relevance of timely detection of occult peripheral retinal breaks is due to the fact that occult breaks in acute posterior vitreous detachment (PVD) can pose a significant risk of developing retinal detachment and require rapid diagnosis and treatment [2025-2026 Basic and clinical science course, section 12: Retina and vitreous. San Francisco: American Academy of Ophthalmology, 2025].

[0003] According to a number of authors, in 68.8-78.8% of cases of acute symptomatic PVD, the peripheral retinal tear is valvular [Sharma MC, Determination of the incidence and clinical characteristics of subsequent retinal tears following treatment of the acute posterior vitreous detachment-related initial retinal tears / / American Journal of Ophthalmology. - 2004. - Vol. 138, No. 2. - P. 280-284. - DOI: 10.1016 / j.ajo.2004.03.009; Karahan E., Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment / / International ophthalmology. 2018. Vol. 38. Is. 1. P. 257-263. DOI: 10.1007 / s10792-017-0455-0], which requires immediate laser intervention [2025-2026 Basic and clinical science course, section 12: Retina and vitreous. San Francisco: American Academy of Ophthalmology, 2025].However, treatment of hidden retinal breaks is difficult due to reduced visualization of the defect, which limits the determination of its exact location on the fundus, borders and area.

[0004] Difficulty in diagnosing occult peripheral breaks is associated with changes in the anterior and / or posterior segment of the eye, with lens opacities and IOL implantation [Gupta D., Clinically undetected retinal breaks causing retinal detachment: A review of options for management. / / Surv Ophthalmol. 2018. Vol. 63 Is. 4. P. 579-588. DOI: 10.1016 / j.survophthal.2017.08.002].

[0005] A method for diagnosing prognostically dangerous forms of peripheral retinal dystrophies (patent RU 2538930 C1 dated June 16, 2013) is based on optical coherence tomography (OCT) of peripheral retinal dystrophies. This method involves peripheral OCT scanning in 5 Raster Lines mode, consisting of five parallel scans spaced equally (0.2 mm) apart, each 6 mm in size, along and across the retinal dystrophy zone to detect vitreoretinal tractions.

[0006] The disadvantage of this method is the lack of the ability to diagnose, determine the boundaries and area of ​​different forms of hidden peripheral ruptures.

[0007] The “gold standard” for diagnosing peripheral retinal breaks is binocular indirect ophthalmoscopy with the scleral indentation technique [2025-2026 Basic and clinical science course, section 12: Retina and vitreous. San Francisco: American Academy of Ophthalmology, 2025]. Biomicroscopy using a slit lamp and non-contact high-diopter diagnostic lenses is also widely used in clinical practice [Cheung R., Ly A., Katalinic P., Coroneo MT, Chang A., Kalloniatis M., Madigan MC, Nivison-Smith L. Visualization of peripheral retinal degenerations and anomalies with ocular imaging / / Seminars in Ophthalmology. 2022. Vol. 37, No. 5. P. 554-582. DOI: 10.1080 / 08820538. 2022.2039222.]. However, these methods provide a diagnostic error (3-15%), and some breaks may be missed [Nixon TJ, Meyer CH, Lois N. Incidence and detection of retinal breaks in acute posterior vitreous detachment / / Eye. - 2023. - Vol. 37, No. 3. - P. 510-516.- DOI: 10.1038 / s41433-022-02154-3].

[0008] Patent RU 2850599, 12.11.25 [Shaimova V.A. Method for Predicting Occult Retinal Break in Patients with Symptomatic Acute Posterior Vitreous Detachment] describes a method for predicting occult retinal breaks in patients with symptomatic acute PVD. The method is based on the use of optical coherence tomography (OCT) with analysis of the vitreoretinal interface both in the macular zone and at the periphery of the retina. The key diagnostic feature is the presence of preretinal hyperreflective points in the vitreous body, considered as a marker of pathological vitreoretinal changes. The method calculates the occult retinal break prognostic coefficient (CRPC), which is the ratio of the reflectivity index of the vitreoretinal interface at the periphery of the retina to a similar indicator in the macular zone. If the PCSR value is equal to or greater than 1.5, a high probability of the presence of a hidden peripheral retinal tear is predicted.This quantitative approach allows us to move from subjective interpretation of OCT signs to a standardized assessment of the risk of developing a hidden retinal tear.

[0009] The advantage of this method is the ability to early predict occult peripheral retinal breaks in acute PVD for subsequent detection. A disadvantage of this method is the lack of ability to define the boundaries and calculate the area of ​​occult peripheral retinal breaks.

[0010] A method for detecting hidden peripheral retinal valvular break is known using wide-field OCT scanning by the "sliding" method from the central to the peripheral parts of the retina in symptomatic acute PVD [Shaimova V.A., Islamova G.R., Trubilin V.N., Dmukh T.S., Kuchkildina S.Kh., Shaimov T.B., Shaimov R.B., Kravchenko T.G., Fomin A.V. Wide-field optical coherence tomography is an effective method for detecting retinal valvular break (clinical observation). Bulletin of ophthalmology. 2023;139(1):93-98. doi.org / 10.17116 / oftalma202313901193].

[0011] The advantage of this method is the detection of an occult peripheral tear in acute symptomatic PVD and the presence of rupture predictors such as retinal and vitreous hemorrhages, "tobacco dust"-like pigment epithelial cells in the anterior vitreous, and hyperreflective dots. A disadvantage of this method is the inability to determine the boundaries and area of ​​the occult tear.

[0012] In the available literature, we did not find any sources of information describing the determination of the boundaries and area of ​​hidden peripheral retinal breaks.

[0013] The objective of the proposed invention was to develop a method for determining the boundaries and area of ​​a hidden retinal break based on optical coherence tomography angiography (OCTA).

[0014] The technical result of the proposed method is the possibility of dynamic control over the size of a hidden retinal tear, including before and after laser exposure, for timely prevention of the development of rhegmatogenous retinal detachment.

[0015] The technical result is achieved by performing targeted OCT angiography in Angio Retina mode after determining the location of the rupture, determining the boundaries using the algorithm of the manual adjustment function "Draw" and measuring the area using the Angio Analytics software.

[0016] Determining the boundaries and area of ​​the hidden rupture is necessary for the accuracy of laser treatment by superimposing an image from an OCT angiogram on a photograph of a digital navigation laser or by the method of traditional laser coagulation of the retina using a single-point laser mounted on a slit lamp.

[0017] Our studies of OCT angiography of the vitreoretinal interface in a group of patients with hidden breaks (96 eyes) allowed us, using the techniques we found, to determine the topography and area of ​​the defect in 95% (91 eyes), and to evaluate them dynamically after prophylactic laser coagulation of the retina in the immediate and late postoperative periods.

[0018] The method is carried out as follows.

[0019] First, a linear, segmental, wide-field OCT scan is performed to identify a hidden peripheral retinal break. Using targeted OCT angiography, the horizontal and vertical scan lines of two structural B-scans are aligned in the break area. Points are identified along the retinal break border, transferred, and marked on the en face OCTA image in the "Draw" mode of the Angio Retina software. The boundaries of the hidden break are determined from these points, and the break area is automatically calculated using the Angio Analytics software.

[0020] The method is illustrated by the following clinical examples:

[0021] Clinical example 1.

[0022] Patient Z., 53, presented to the clinic with complaints of flashes and a floating opacity in front of her right eye for 3 days. Vis OD = 1.0; P0 = 17 mmHg. The anterior sections are unchanged. A retinal examination was performed using a traditional method - a 60 D non-contact lens.

[0023] Fundus examination: the optic disc is pale pink, with clear borders. The course and caliber of the vessels are unchanged. The macular area is without visible pathology. The periphery of the fundus is unchanged. To identify a hidden retinal break, a segmental wide-field OCT scan of the retina from the macula to the periphery was performed, which revealed a hidden peripheral retinal break in the superotemporal segment. Using targeted OCT angiography, the scan lines of two structural B-scans were aligned horizontally and vertically in the area of ​​the break. The boundaries of the retinal break were identified on the en face OCTA image, these points were marked in the "Draw" mode of the Angio Retina program, and the area of ​​the peripheral break was automatically calculated using the Angio Analytics program, which was 1.245 mm2.After the diagnosis of an occult peripheral retinal tear in the superotemporal segment was established, the patient was interviewed, where the retinal condition, the diagnosis, and the potential risk of developing retinal detachment were explained in detail. Laser treatment was proposed. The patient declined laser treatment for the occult tear. When the patient returned a week later complaining of increasing photopsies and floaters in her right eye, a repeat examination was performed. This revealed progression of the occult tear, the appearance of hyperreflective spots in the macular region and in the superotemporal segment, widening of the margins, and an increase in the tear area to 2.914 mm². The patient underwent urgent laser treatment for the peripheral tear. Follow-up examinations after 2 weeks and 3 months showed stabilization of the retina.

[0024] Clinical example 2.

[0025] Patient Zh., 27 years old. Consulted an ophthalmologist at the clinic with complaints of photopsia in front of the left eye for 4 weeks. Vis OS = 0.09 sph - 3.5 = 1.0; P0 = 16 mmHg. The anterior sections are unchanged. A traditional retinal examination was performed - biomicroscopy with a non-contact 60 D lens.

[0026] Fundus: The optic disc is pale pink, with clear borders. The course and caliber of the vessels are unchanged. The macular area is unchanged. Periphery of the fundus: a zone of hyperpigmentation is detected along the course of a vessel in the temporal segment.

[0027] To detect a occult retinal break, a segmental wide-field OCT scan of the retina from the macula to the periphery was performed. A occult break was detected in the temporal segment, and targeted OCT angiography was performed in the area of ​​the break. Using targeted OCT angiography, the scan lines of two B-scans were aligned horizontally and vertically in the break area. This allowed us to identify the boundaries of the retinal break on the structural en face OCTA image. These points were marked in the "Draw" mode of the Angio Retina software, and the area of ​​the peripheral break was automatically calculated using the Angio Analytics software, which was 1.513 mm2. The patient underwent laser treatment of the break. A follow-up examination after 2 weeks and 3 months showed stabilization of the retinal condition. The area of ​​the break remained unchanged and amounted to 1.513 mm2.

[0028] Clinical Example 3

[0029] Patient G., 56 years old. Consulted an ophthalmologist at the clinic with complaints of photopsia, floating opacities in front of the left eye for 5 days after intense physical activity (chopping wood). Vis OS = 0.2 sph + 2.0 = 1.0; P0 = 16 mmHg. Anterior sections are unchanged. A traditional retinal examination was performed - biomicroscopy with a non-contact lens of 60 D. Fundus: optic disc is pale pink, borders are clear. The course and caliber of the vessels are unchanged. The macular area is visible. Periphery of the fundus - a punctate hemorrhage was detected in the superonasal segment. In order to identify a hidden break, segmental OCT scanning of the retina from the macula to the periphery was performed. A hidden retinal tear was detected in the superonasal segment in the area of ​​hemorrhage, along with a flat neurosensory retinal detachment. Targeted OCT angiography of the associated tear in the superonasal segment was performed.Using targeted OCT angiography, the scanning lines of two B-scans were aligned horizontally and vertically in the area of ​​the combined retinal break. This allowed us to identify the boundaries of the combined retinal break on the structural en face OCTA image. These points were transferred and marked in the "Draw" mode of the Angio Retina software. The area of ​​the combined peripheral break was automatically calculated using the Angio Analytics software, which amounted to 1.985 mm². The patient underwent laser treatment for the combined break. He was warned about the possible progression of localized planar retinal detachment and was recommended to change his lifestyle (cease strenuous physical activity). A follow-up examination after 2 weeks showed a decrease in the area of ​​the combined break to 1.432 mm² due to a decrease in localized planar retinal detachment, as well as the absence of pinpoint hemorrhage. A follow-up examination after 3.6 months showed a stable retinal condition.

[0030] Thus, the method allows determining the boundaries and area of ​​hidden peripheral retinal breaks to assess the dynamics and evaluate the therapeutic effect of laser coagulation.

Claims

A method for determining the boundaries and area of ​​a hidden peripheral retinal break, characterized in that linear segmental wide-field OCT scanning is first performed and a hidden peripheral retinal break is detected, then, using targeted OCT angiography (OCT-A), the scanning lines of two structural B-scans are combined horizontally and vertically in the break zone, points are identified along the border of the retinal break, these points are transferred and marked on the frontal OCT-A image in the "Draw" mode of the Angio Retina program, the boundaries of the hidden break are determined based on them, and the area of ​​the break is automatically calculated using the Angio Analytics program.