Infrared imaging and optical coherence tomography reveal early-stage astrocytic hamartomas not detectable by fundoscopy.
OBJECTIVE
To describe and correlate the features of astrocytic hamartomas using multimodal imaging.


METHODS
Prospective, noncomparative, observational case series.


METHODS
This was a single-center study of 4 patients (8 eyes) with tuberous sclerosis complex. A complete ophthalmologic examination, fundus photography, fundus autofluorescence (FAF), infrared imaging, and spectral-domain optical coherence tomography (SD-OCT) were performed for each patient. Images from each modality were analyzed and compared.


RESULTS
In 2 patients, infrared imaging and SD-OCT detected occult retinal astrocytic hamartomas that were not observed on clinical examination or color fundus photography. FAF demonstrated the greatest contrast between lesions and surrounding retina but failed to identify 1 occult lesion that was detected with infrared imaging and SD-OCT. SD-OCT revealed lesions arising from the retinal nerve fiber layer with overlying vitreous adhesions, hyperreflective dots, and optically empty spaces at all depths of the tumor. Hamartomas were hyporeflective on infrared imaging and hypoautofluorescent on FAF. FAF of some lesions demonstrated hyperautofluorescent spots.


CONCLUSIONS
Infrared imaging and SD-OCT aid in the detection of astrocytic hamartomas that are not visible on clinical examination or color fundus photography. SD-OCT enhances visualization of structural details. FAF is a useful adjunctive test to obtain greater contrast between lesions and surrounding retina. The ability to monitor structural changes over time in astrocytic hamartomas using SD-OCT may be beneficial for monitoring the success of systemic chemotherapy in the treatment of various tuberous sclerosis tumors.
Bernard and Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York, USA.
Luna
L
Xu
Tomas R
TR
Burke
Jonathan P
JP
Greenberg
Vinit B
VB
Mahajan
Stephen H
SH
Tsang
D000293:Adolescent; D001253:Astrocytes / Q000473:pathology*; D002648:Child; D003952:Diagnostic Imaging; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007259:Infrared Rays; D008297:Male; D019721:Ophthalmoscopes; D011446:Prospective Studies; D019572:Retinal Neoplasms / Q000175:diagnosis*; D041623:Tomography, Optical Coherence; D014402:Tuberous Sclerosis / Q000175:diagnosis*