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OCT helps in diagnosis, follow-up of pediatric retinal disorders
A new portable system allows for rapid and accurate diagnosis as well as greater comfort for young patients during examination.
ROME — Optical coherence tomography is a valid means in the diagnosis and follow-up of pediatric retinal dysfunctions, according to a surgeon at the Bambin Gesù pediatric clinic here.
“In our clinical practice, diagnosis has always had limitations due to the lack of cooperation of very young patients and to the need to perform invasive examinations under general anesthesia. OCT was not normally used because it required a half-sitting position and the fixation of the laser light,” Michele Fortunato, MD, said.
A new, portable OCT system can be configured to provide imaging independent of the orientation of the subject. It can be moved to different locations and used with the child lying in the supine position.
“It is a precious new tool in our diagnostic armamentarium. It can be used in children, infants and newborns, including premature babies, who are often at risk for a host of chronic diseases, including retinopathy of prematurity, that typically require careful diagnosis and management. There is also a wide range of potential applications in many congenital malformations or genetic disorders, and in traumatic damage following accidents or shaken-baby syndrome,” he said.
As a complement of fluorescein angiography and indocyanine green angiography, OCT can be used to explore the retinal layers, as well as the choroid and optic nerve. The direct, detailed view of the ocular structures often leads to a more accurate diagnosis, unveiling otherwise invisible anomalies.
An emblematic case in the practice of Dr. Fortunato and Dr. Angela Turtoro was that of a 12-year-old child who was treated with photodynamic therapy for a subretinal membrane that did not seem to improve.
“OCT examination showed the presence of vitreoretinal traction, very rare in children, due to wrinkling and contraction of the [internal limiting membrane]. This created an edema in the posterior pole of the macula. The child was highly myopic, and the cause of the edema was therefore not visible on [fluorescein angiography]. OCT was crucial in formulating a diagnosis in this case. This particular condition of the [internal limiting membrane] was likely the consequence of blunt ocular trauma, quite common in children who play football,” Dr. Fortunato explained.
Children and teenagers represent 50% of all patients with ocular trauma. Often they undergo repeated examinations under general anesthesia, prolonged treatments, extenuating rehabilitation programs and several surgical operations to address the most common consequence of pediatric ocular trauma: amblyopia. Reducing the interval between the trauma and the treatment is mandatory in order to achieve a good functional recovery.
“OCT is a great help in these cases. It is easy to perform and allows for an early and accurate diagnosis, avoiding the consequences of delayed treatment,” Dr. Fortunato said.
Various forms of maculopathy, such as Best’s disease, Leber-Coats’ disease and Stargardt’s disease, can be monitored during treatment to see the extension and progressive reabsorption of retinal exudates.
“We performed the first PDT treatment worldwide in a child with Best’s disease, and since then we have treated many cases of Best’s and Coats’ diseases using the same technique. We are now using the OCT routinely in the diagnosis and follow-up of these patients,” Dr. Fortunato said. – by Michela Cimberle
- Michele Fortunato, MD, can be reached at Via Polibio 4, 00136 Rome, Italy; +39-06-39742614; e-mail: micfortunato@hotmail.com.