Heidelberg spectralis sd oct

This retrospective, longitudinal study evaluated children 18 years old or younger who presented to the Children's Hospital of Philadelphia between January 2016 and December 2020. The study adhered to the tenets of the Declaration of Helsinki and was approved with waiver of informed consent by the Institutional Review Board at the Children's Hospital of Philadelphia.
Subjects were included if they (1) were aged 18 years or younger, (2) underwent treatment for diagnosed or suspected papilledema in the setting of idiopathic intracranial hypertension (IIH) (i.e., primary pseudotumor cerebri syndrome), secondary pseudotumor cerebri syndrome, or papilledema secondary to a tumor, and (3) completed traditional cpRNFL and enhanced depth imaging raster scan protocol of the ONH using Heidelberg Spectralis SD-OCT (Heidelberg Engineering Inc., Heidelberg, Germany) on at least two separate visits in the first 4 months of treatment, including a pretreatment visit and one showing resolving papilledema, defined as a 10% or greater decrease in mean cpRNFL relative to pretreatment in an eye. The exclusion criteria were (1) worsening papilledema (i.e., >10% increase in mean cpRNFL relative to the pretreatment visit) before the first resolving visit and (2) poor quality OCT images precluding appropriate segmentation of the internal limiting membrane (ILM) and/or BM.

All OCT measurements were performed using SD-OCT (Heidelberg Spectralis SD-OCT; Heidelberg Engineering; Spectralis software version 5.3.2) after pupillary dilation. Scans with quality score of less than 20 were excluded from the analysis. We also excluded scans with inadequate quality as determined by poor quality fundus images, interruption of the RNFL segmentation, or those in which the posterior border of the choroid could not be delineated (Fig. 1).Fig. 1

An optical coherence tomography (OCT) image shows the manual segmentation of Bruch's membrane (upper red line) and sclerochoroidal border (lower red line) in a raster line of macula. Choroidal map and volume measured in nine sectors of the Early Treatment Diabetic Retinopathy Study (ETDRS) layout profile across the central 3.45 mm zone in the macula after manual segmentation of choroidal thickness.

Fig. 1

Macular scans were performed with Heidelberg Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany). Horizontal high-resolution transfoveal line scans were obtained using automated real-time tracking with an average of nine images. Each volume scan was composed of 25 horizontal b-scans in high-resolution mode with 256 µm distance between b-scans and 512 a-scans per b-scan. The EZA was measured using vendor software (Heidelberg Eye Explorer Version 1.10.2.0). The observers marked the locations of the two most distant temporal and nasal points that the EZ layer could be distinguished from the adjacent layers using the “arrow tool” at each scan (Supplementary Fig. S2b). The dots were connected to generate a circle using the “draw region” tool of the software, and the circle's area was automatically calculated by software (Supplementary Fig. S2a). The EZA was measured by three observers (YT, AH, JK) and the mean of the three measurements was used for analysis.