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Binarization of enhanced depth imaging optical coherence tomographic images of an eye with Wyburn-Mason syndrome: a case report.

Iwata A, Mitamura Y, Niki M, Semba K, Egawa M, Katome T, Sonoda S, Sakamoto T - BMC Ophthalmol (2015)

Bottom Line: The luminal area of the 1,500-μm-wide subfoveal choroid was computed to be 307,165.6 μm(2) in the right eye and 545,780.7 μm(2) in the left eye.The EDI-OCT images showed a thicker choroid, and binarization of the EDI-OCT images showed that the luminal areas were significantly larger in the affected eye, suggesting a dilatation of the choroidal vessels.The results demonstrated that conversion of EDI-OCT images to binary images was a useful method to quantify the choroidal structure.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan. rtpgg803@yahoo.co.jp.

ABSTRACT

Background: To report a thicker choroid and larger choroidal luminal area in an eye with Wyburn-Mason syndrome. To the best of our knowledge, this is the first report demonstrating an increase in the choroidal thickness and the luminal area in a case of Wyburn-Mason syndrome. In addition, we report the changing appearance of retinal arteriovenous malformations over a 16-year period.

Case presentation: A 27-year-old woman, who was diagnosed with Wyburn-Mason syndrome at age 11 years, visited our clinic. Her best-corrected visual acuity was 20/12.5 in the right eye and light perception in the left eye. Severely dilated, tortuous vascular loops were distributed from the optic disc over all four quadrants of the left fundus. The vascular loops in some areas were more dilated and tortuous than 16 years earlier. Optical coherence tomography (OCT) showed retinal edema with cystic changes and enlarged choroidal vessel lumens in the left eye. The subfoveal choroidal thickness was manually measured by the caliper function in the enhanced depth imaging OCT (EDI-OCT) images. Binarization of the EDI-OCT images was performed with publicly accessible ImageJ software. The examined area of the subfoveal choroid was 1,500 μm wide, and the dark areas representing the luminal areas were traced by the Niblack method. After determining the distance of each pixel, the luminal area was automatically calculated. The subfoveal choroidal thickness was 250 μm in the right eye and 462 μm in the left eye. The luminal area of the 1,500-μm-wide subfoveal choroid was computed to be 307,165.6 μm(2) in the right eye and 545,780.7 μm(2) in the left eye.

Conclusions: The EDI-OCT images showed a thicker choroid, and binarization of the EDI-OCT images showed that the luminal areas were significantly larger in the affected eye, suggesting a dilatation of the choroidal vessels. The results demonstrated that conversion of EDI-OCT images to binary images was a useful method to quantify the choroidal structure.

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Related in: MedlinePlus

Fundus photographs,fluorescein angiographic(FA)image, and enhanced depth imaging optical coherence tomographic(EDI-OCT) images. A: Fundus photograph at age 27 years. Markedly dilated tortuous vascular loops consistent with retinal arteriovenous malformations are distributed from the optic disc over four quadrants in the left eye. Arteries are directly connected to veins without passing through any capillaries. The optic disc is obscured by very large vascular loops. Numerous anastomosing vessels make it difficult to separate the arterial and venous components. B: At age 27 years, wide-field fluorescein angiography in early phase shows fluorescein throughout the vascular loops without an intervening capillary bed and leakage from the loops, indicating a direct arteriovenous communication. Red arrow indicates the fovea (center of the foveal avascular zone), and green arrows indicate the direction of the OCT scans in ‘E’ and ‘F’. C: Fundus photograph at age 11 years. The vascular loops in some areas are less dilated and tortuous than at 27 years in the left eye (see ‘A’). D-F: EDI-OCT images in the healthy right eye (D) and the affected left eye (E, F) at age 27 years. Choroidal thickness of the left eye is thicker than that of the fellow eye. ‘E’ indicates a horizontal scan, and ‘D’ and ‘F’ indicate vertical scans through the fovea. OCT images in the left eye (E, F) demonstrate retinal edema with cystic changes and oval-shaped lesions corresponding to cross sections of abnormal retinal vessels. White arrow indicates cystoid macular edema (F).
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Fig1: Fundus photographs,fluorescein angiographic(FA)image, and enhanced depth imaging optical coherence tomographic(EDI-OCT) images. A: Fundus photograph at age 27 years. Markedly dilated tortuous vascular loops consistent with retinal arteriovenous malformations are distributed from the optic disc over four quadrants in the left eye. Arteries are directly connected to veins without passing through any capillaries. The optic disc is obscured by very large vascular loops. Numerous anastomosing vessels make it difficult to separate the arterial and venous components. B: At age 27 years, wide-field fluorescein angiography in early phase shows fluorescein throughout the vascular loops without an intervening capillary bed and leakage from the loops, indicating a direct arteriovenous communication. Red arrow indicates the fovea (center of the foveal avascular zone), and green arrows indicate the direction of the OCT scans in ‘E’ and ‘F’. C: Fundus photograph at age 11 years. The vascular loops in some areas are less dilated and tortuous than at 27 years in the left eye (see ‘A’). D-F: EDI-OCT images in the healthy right eye (D) and the affected left eye (E, F) at age 27 years. Choroidal thickness of the left eye is thicker than that of the fellow eye. ‘E’ indicates a horizontal scan, and ‘D’ and ‘F’ indicate vertical scans through the fovea. OCT images in the left eye (E, F) demonstrate retinal edema with cystic changes and oval-shaped lesions corresponding to cross sections of abnormal retinal vessels. White arrow indicates cystoid macular edema (F).

Mentions: A 27-year-old woman, who was diagnosed with Wyburn-Mason syndrome at age 11 years, visited our clinic for a regular examination. At age 11 years, her best-corrected visual acuity (BCVA) was 20/500 in the left eye, and cerebral angiography demonstrated AVMs along the course of the left ophthalmic artery. There was no history of systemic diseases. On a regular examination at age 27 years, she was in the 8th month of pregnancy, and her obstetrician consulted us on the risk of hemorrhaging from the retinal AVMs at the time of parturition. Her BCVA was 20/12.5 in the right eye and light perception in the left eye. Exophthalmos was not found, and the ocular motility was normal. The intraocular pressures were 16 mmHg OD and 17 mmHg OS. The anterior segments and ocular media of both eyes and fundus of the right eye were within normal limits. However, severely dilated tortuous vascular loops consistent with retinal AVMs were distributed from the optic disc over all four quadrants of the left eye (Figure 1A). The arteries were directly connected to the veins without passing through any capillaries. The optic disc was obscured by the large vascular loops. Numerous anastomosing vessels made it difficult to separate the arterial and venous components. The vascular loops in some areas were more dilated and tortuous than 16 years earlier (Figure 1C). Magnetic resonance imaging revealed orbital and retro-orbital AVMs including canalicular segments of the optic nerve on the left side. Prominent serpiginous vessels could be detected in the left orbit, including the apex which encased the optic nerve. Neurologic examinations were unremarkable, and no changes were found in the facial skin.Figure 1


Binarization of enhanced depth imaging optical coherence tomographic images of an eye with Wyburn-Mason syndrome: a case report.

Iwata A, Mitamura Y, Niki M, Semba K, Egawa M, Katome T, Sonoda S, Sakamoto T - BMC Ophthalmol (2015)

Fundus photographs,fluorescein angiographic(FA)image, and enhanced depth imaging optical coherence tomographic(EDI-OCT) images. A: Fundus photograph at age 27 years. Markedly dilated tortuous vascular loops consistent with retinal arteriovenous malformations are distributed from the optic disc over four quadrants in the left eye. Arteries are directly connected to veins without passing through any capillaries. The optic disc is obscured by very large vascular loops. Numerous anastomosing vessels make it difficult to separate the arterial and venous components. B: At age 27 years, wide-field fluorescein angiography in early phase shows fluorescein throughout the vascular loops without an intervening capillary bed and leakage from the loops, indicating a direct arteriovenous communication. Red arrow indicates the fovea (center of the foveal avascular zone), and green arrows indicate the direction of the OCT scans in ‘E’ and ‘F’. C: Fundus photograph at age 11 years. The vascular loops in some areas are less dilated and tortuous than at 27 years in the left eye (see ‘A’). D-F: EDI-OCT images in the healthy right eye (D) and the affected left eye (E, F) at age 27 years. Choroidal thickness of the left eye is thicker than that of the fellow eye. ‘E’ indicates a horizontal scan, and ‘D’ and ‘F’ indicate vertical scans through the fovea. OCT images in the left eye (E, F) demonstrate retinal edema with cystic changes and oval-shaped lesions corresponding to cross sections of abnormal retinal vessels. White arrow indicates cystoid macular edema (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359503&req=5

Fig1: Fundus photographs,fluorescein angiographic(FA)image, and enhanced depth imaging optical coherence tomographic(EDI-OCT) images. A: Fundus photograph at age 27 years. Markedly dilated tortuous vascular loops consistent with retinal arteriovenous malformations are distributed from the optic disc over four quadrants in the left eye. Arteries are directly connected to veins without passing through any capillaries. The optic disc is obscured by very large vascular loops. Numerous anastomosing vessels make it difficult to separate the arterial and venous components. B: At age 27 years, wide-field fluorescein angiography in early phase shows fluorescein throughout the vascular loops without an intervening capillary bed and leakage from the loops, indicating a direct arteriovenous communication. Red arrow indicates the fovea (center of the foveal avascular zone), and green arrows indicate the direction of the OCT scans in ‘E’ and ‘F’. C: Fundus photograph at age 11 years. The vascular loops in some areas are less dilated and tortuous than at 27 years in the left eye (see ‘A’). D-F: EDI-OCT images in the healthy right eye (D) and the affected left eye (E, F) at age 27 years. Choroidal thickness of the left eye is thicker than that of the fellow eye. ‘E’ indicates a horizontal scan, and ‘D’ and ‘F’ indicate vertical scans through the fovea. OCT images in the left eye (E, F) demonstrate retinal edema with cystic changes and oval-shaped lesions corresponding to cross sections of abnormal retinal vessels. White arrow indicates cystoid macular edema (F).
Mentions: A 27-year-old woman, who was diagnosed with Wyburn-Mason syndrome at age 11 years, visited our clinic for a regular examination. At age 11 years, her best-corrected visual acuity (BCVA) was 20/500 in the left eye, and cerebral angiography demonstrated AVMs along the course of the left ophthalmic artery. There was no history of systemic diseases. On a regular examination at age 27 years, she was in the 8th month of pregnancy, and her obstetrician consulted us on the risk of hemorrhaging from the retinal AVMs at the time of parturition. Her BCVA was 20/12.5 in the right eye and light perception in the left eye. Exophthalmos was not found, and the ocular motility was normal. The intraocular pressures were 16 mmHg OD and 17 mmHg OS. The anterior segments and ocular media of both eyes and fundus of the right eye were within normal limits. However, severely dilated tortuous vascular loops consistent with retinal AVMs were distributed from the optic disc over all four quadrants of the left eye (Figure 1A). The arteries were directly connected to the veins without passing through any capillaries. The optic disc was obscured by the large vascular loops. Numerous anastomosing vessels made it difficult to separate the arterial and venous components. The vascular loops in some areas were more dilated and tortuous than 16 years earlier (Figure 1C). Magnetic resonance imaging revealed orbital and retro-orbital AVMs including canalicular segments of the optic nerve on the left side. Prominent serpiginous vessels could be detected in the left orbit, including the apex which encased the optic nerve. Neurologic examinations were unremarkable, and no changes were found in the facial skin.Figure 1

Bottom Line: The luminal area of the 1,500-μm-wide subfoveal choroid was computed to be 307,165.6 μm(2) in the right eye and 545,780.7 μm(2) in the left eye.The EDI-OCT images showed a thicker choroid, and binarization of the EDI-OCT images showed that the luminal areas were significantly larger in the affected eye, suggesting a dilatation of the choroidal vessels.The results demonstrated that conversion of EDI-OCT images to binary images was a useful method to quantify the choroidal structure.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan. rtpgg803@yahoo.co.jp.

ABSTRACT

Background: To report a thicker choroid and larger choroidal luminal area in an eye with Wyburn-Mason syndrome. To the best of our knowledge, this is the first report demonstrating an increase in the choroidal thickness and the luminal area in a case of Wyburn-Mason syndrome. In addition, we report the changing appearance of retinal arteriovenous malformations over a 16-year period.

Case presentation: A 27-year-old woman, who was diagnosed with Wyburn-Mason syndrome at age 11 years, visited our clinic. Her best-corrected visual acuity was 20/12.5 in the right eye and light perception in the left eye. Severely dilated, tortuous vascular loops were distributed from the optic disc over all four quadrants of the left fundus. The vascular loops in some areas were more dilated and tortuous than 16 years earlier. Optical coherence tomography (OCT) showed retinal edema with cystic changes and enlarged choroidal vessel lumens in the left eye. The subfoveal choroidal thickness was manually measured by the caliper function in the enhanced depth imaging OCT (EDI-OCT) images. Binarization of the EDI-OCT images was performed with publicly accessible ImageJ software. The examined area of the subfoveal choroid was 1,500 μm wide, and the dark areas representing the luminal areas were traced by the Niblack method. After determining the distance of each pixel, the luminal area was automatically calculated. The subfoveal choroidal thickness was 250 μm in the right eye and 462 μm in the left eye. The luminal area of the 1,500-μm-wide subfoveal choroid was computed to be 307,165.6 μm(2) in the right eye and 545,780.7 μm(2) in the left eye.

Conclusions: The EDI-OCT images showed a thicker choroid, and binarization of the EDI-OCT images showed that the luminal areas were significantly larger in the affected eye, suggesting a dilatation of the choroidal vessels. The results demonstrated that conversion of EDI-OCT images to binary images was a useful method to quantify the choroidal structure.

Show MeSH
Related in: MedlinePlus