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Photo Essay: Hyperpigmented Macules | Consultant360

When a patient presents with a hyperpigmented macule, one of the first conditions that comes to mind is neurofibromatosis. However, a variety of normal and pathologic conditions are associated with hyperpigmented macules. Here we present a selection of such lesions and their associated conditions. The collection is by no means comprehensive. For example, patients with Silver-Russell syndrome or Bloom syndrome may have multiple café au lait macules, but photographs of such patients are not included.

We hope this Photo Essay will serve as a reminder that hyperpigmented macules may appear in a wide variety of conditions—both benign and pathologic.

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Becker Nevus

This 13-year-old boy has a Becker nevus–also called Becker melanosis, because the lesions do not contain nevus cells. This common lesion is characterized by the abrupt onset of hyperpigmentation that gradually expands; it appears at or before adolescence. The male-to-female ratio is approximately 5:1.Becker nevi are usually unilateral and are commonly located on the shoulder or upper chest.

Half of Becker nevi are associated with hypertrichosis. The hairs usually become coarser and darker with time.A variety of bone and tissue abnormalities have been reported in patients with Becker nevi (eg, arm hypoplasia, pectus excavatum, absent pectoralis major muscle), albeit in a minority of those affected.

Becker nevus is not a true nevus. The risk of melanoma developing within the lesion is the same as that for uninvolved skin.

 

Solitary and Multiple Café au Lait Macules

The 12-year-old boy in Figure A has one large and one small café au lait macule and a single hypopigmented macule. Solitary café au lait macules may be present in as many as 30% of newborns. They vary in size from a few millimeters to several centimeters. The macules may be inconspicuous until the affected area is exposed to the sun.

Parents frequently ask about these lesions. Fortunately, the vast majority of solitary café au lait macules have no clinical significance. This patient enjoys robust good health.

In contrast, the 9-year-old girl in Figure B shows classic features of neurofibromatosis type 1 (NF-1) with axillary freckling and multiple café au lait macules.

NF-1 may be diagnosed when any 2 of the following are present:

1. Six or more café au lait macules over 5 mm in diameter in prepubertal persons or over 15 mm in postpubertal persons.

2. Axillary or inguinal freckling.

3. Two or more iris Lisch nodules.

4. Two or more neurofibromas or one plexiform neurofibroma.

5. A distinctive osseous lesion.

6. Optic gliomas.

7. A first-degree relative with NF-1.

Café au lait macules are present in 100% of patients with NF-1; these are usually scattered over the trunk and extremities. Their size, number, and pigmentation increase with age.

Neurofibromas–like the one shown in Figure C in a 19-year-old woman–are small, rubbery lesions with a purplish discoloration overlying the skin. They may also be situated along peripheral nerves and blood vessels within viscera. Plexiform neurofibromas may appear as larger, more hyperpigmented café au lait macules. These lesions result from thickening of nerve trunks and are usually located in the orbital or temporal region.

 

Fanconi Anemia

This is an autosomal recessive syndrome characterized by chromosomal breakage, pancytopenia, and various congenital abnormalities. It is a heterogeneous condition clinically and has been linked to defects in at least 8 different genes. Fifty percent to 65% of affected persons demonstrate areas of hyper- or hypopigmentation. Café au lait macules, like those shown in Figure A in a 9-year-old boy, are seen in approximately 25% of those affected.

Skeletal abnormalities are another hallmark of Fanconi anemia: hypoplasia of the thumbs and radii are the most common findings. Figure B demonstrates hypoplasia of the thenar eminence in the same 9-year-old boy. Other skeletal abnormalities include hip dislocation, scoliosis, and vertebral anomalies. Low birth weight and subsequent short stature, microphthalmia, microcephaly, developmental delay, renal and genital anomalies, GI defects, and cardiac defects also have an increased association with this condition. However, 1 out of 3 affected persons demonstrates no obvious congenital deformities.

 

Urticaria Pigmentosa

This 4-year-old boy has urticaria pigmentosa–one of a group of disorders in which mast cells group together in the skin. Patients may have solitary mastocytomas or (rarely) diffuse infiltration of the skin with mast cells.

The lesions shown here are typical of urticaria pigmentosa. They are hyperpigmented macules that are mostly uniform in size and are distributed mainly on the trunk. They differ from lentigines, nevus cell nevi, and café au lait spots in one striking way. When one of the lesions of urticaria pigmentosa is rubbed or stroked, the mast cells contained therein release their contents (histamine, prostaglandins, leukotrienes, etc), with a resultant local hive or blister. This phenomenon–the Darier sign–is not demonstrated by nevi or café au lait macules.

Other varieties of mastocytosis may be associated with systemic symptoms related to the release of a large amount of mediators from a large number of mast cells (eg, episodic flushing, palpitations, or syncope). Patients may also have extracutaneous aggregates of mast cells in the bone, lungs, kidneys, or intestinal wall.

 

McCune-Albright Syndrome

McCune-Albright syndrome is classically described as a triad of polyostotic fibrous dysplasia, café au lait macules, and precocious puberty. The syndrome may also be accompanied by various other endocrinopathies including hyperthyroidism, acromegaly, hyperprolactinemia, Cushing syndrome, and hypophosphatemic rickets. Some patients may also exhibit hepatic, cardiac, and GI dysfunction.

The syndrome is more common in girls than boys, but both sexes are affected. It is caused by a mutation in the alpha subunit of a G protein. This mutation results in increased signal transduction along the cAMP pathway, which stimulates growth and function of the gonads, adrenal cortex, specific pituitary cell populations, osteoblasts, and melanocytes.

The hyperpigmented lesions in McCune-Albright syndrome are classically described as “coast of Maine” macules with broad, irregular borders. The 14-year-old patient pictured here demonstrates a characteristic macule. These lesions are typically larger than macules in other conditions and are often found over the sacrum, buttocks, and upper spine. As a rule, fewer than 6 lesions are present. About half of the time, they are unilateral and follow the lines of Blaschko (see case on page 322). If the lesions are unilateral, they are usually found on the same side on which the skeletal abnormalities are more prominent. *

 

Segmental Café au Lait Macule

This 11-year-old boy has a segmental café au lait macule in a zosteriform distribution. Because the presence of such a lesion may signify somatic mosaicism, a careful review of systems and physical examination of affected patients is indicated. The same cautions apply to patients with large (10-cm) café au lait macules. This patient is vigorously healthy.

Lines of Blaschko

There are several disorders of hyperpigmentation that follow the lines of Blaschko–and this distribution can aid in their diagnosis. The lines of Blaschko were originally described by Alfred Blaschko in 1901. He recognized the pattern as distinct from dermatomes and Langer lines. The lines of Blaschko form a “V” shape over the spine, “S” shapes over the lateral and anterior aspects of the trunk, and a linear pattern over the extremities. It is thought that these lines represent normal embryonic movements of the skin during embryogenesis. The manifestation of certain diseases along these lines is believed to represent somatic mosaicism, with abnormal skin surrounded by normal skin clearly showing the distinction. Several of the diseases of hyperpigmentation we present here follow these lines–as evidenced in the following photos.

Pigmentary mosaicism. The patient in Figure A, a 6-month-old girl, demonstrates the phenomenon of pigmentary mosaicism. The areas of hyperpigmentation follow the lines of Blaschko. The phenomenon of pigmentary mosaicism was first described by Ito in 1952. Since that time, there has been an expanding recognition of a group of disorders that affect both sexes in which chromosomal mosaicism is always suspected and frequently demonstrated–albeit sometimes with great difficulty. Case reports and series describe patients with a wide variety of other abnormalities that may involve the hair, teeth, eyes, heart, and CNS. Often patients have no other abnormalities. Disorders of pigmentary mosaicism differ from incontinentia pigmenti in that both sexes are affected, and the pigmentary changes with mosaicism–which may be hyper- or hypopigmentation–are not preceded by vesicular or verrucous lesions as they are in incontinentia pigmenti.

Proteus syndrome. This rare disorder is characterized by overgrowth of multiple tissues in a mosaic pattern. The term “proteus” is derived from the Greek sea god of the same name, who had the ability to appear in the form of any creature to avoid being captured. The same is true of this heterogeneous disorder that can involve the skin, subcutaneous tissue, connective tissue, CNS, and the viscera. The most common clinical manifestations are epidermal pigmented nevi, nevi on the palms and soles, hyperostosis, local gigantism, hemihyperplasia, and multiple lipomas in the subcutaneous tissues and abdominal and pelvic cavities. The nevi typically follow the lines of Blaschko.

Figure B shows an epidermal nevus in the axilla of a 4-year-old girl with this disorder. Figure C demonstrates gigantism of this girl’s fingers.

Description of Skin Lesions – Dermatologic Disorders

Macules are flat, nonpalpable lesions usually 10 mm in diameter. Macules represent a change in color and are not raised or depressed compared to the skin surface. A patch is a large macule. Examples include freckles, flat moles, tattoos, and port-wine stains Capillary Malformations Capillary malformations are present at birth and appear as flat, pink, red, or purplish lesions. Port-wine stains are capillary vascular malformations that are present at birth and that manifest… read more , and the rashes of rickettsial infections Overview of Rickettsial and Related Infections Rickettsial diseases (rickettsioses) and related diseases (anaplasmosis, ehrlichiosis, Q fever, scrub typhus) are caused by a group of gram-negative, obligately intracellular coccobacilli. All… read more , rubella Rubella (See also Congenital Rubella. ) Rubella is a contagious viral infection that may cause adenopathy, rash, and sometimes constitutional symptoms, which are usually mild and brief. Infection during… read more , measles Measles Measles is a highly contagious viral infection that is most common among children. It is characterized by fever, cough, coryza, conjunctivitis, an enanthem (Koplik spots) on the oral mucosa… read more (can also have papules and plaques), and some allergic drug eruptions Drug Eruptions and Reactions Drugs can cause multiple skin eruptions and reactions. The most serious of these are discussed elsewhere in THE MANUAL and include Stevens-Johnson syndrome and toxic epidermal necrolysis, hypersensitivity… read more .

Papules are elevated lesions usually 10 mm in diameter that can be felt or palpated. Examples include nevi, warts, lichen planus Lichen Planus Lichen planus is a recurrent, pruritic, inflammatory eruption characterized by small, discrete, polygonal, flat-topped, violaceous papules that may coalesce into rough scaly plaques, often accompanied. .. read more , insect bites, seborrheic keratoses Seborrheic Keratoses Seborrheic keratoses are superficial, often pigmented, epithelial lesions that are usually warty but may occur as smooth papules. The cause of seborrheic keratosis is unknown, but genetic mutations… read more , actinic keratoses Actinic keratoses Chronic affects of sunlight include photoaging, actinic keratoses, and skin cancer. (See also Overview of Effects of Sunlight.) Chronic exposure to sunlight ages the skin (photoaging, dermatoheliosis… read more , some lesions of acne Acne Vulgaris Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying… read more , and skin cancers Overview of Skin Cancer Skin cancer is the most common type of cancer and commonly develops in sun-exposed areas of skin. The incidence is highest among outdoor workers, sportsmen, and sunbathers and is inversely related. .. read more . The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided.

Urticaria Urticaria Urticaria consists of migratory, well-circumscribed, erythematous, pruritic plaques on the skin. Urticaria also may be accompanied by angioedema, which results from mast cell and basophil activation… read more (wheals or hives) is characterized by elevated lesions caused by localized edema. Wheals are pruritic and red. Wheals are a common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight. The typical wheal lasts 24 hours.

Scale is heaped-up accumulations of horny epithelium that occur in disorders such as psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including… read more , seborrheic dermatitis Seborrheic Dermatitis Seborrheic dermatitis is a common inflammatory condition of skin regions with a high density of sebaceous glands (eg, face, scalp, sternum). The cause is unknown, but species of Malassezia,… read more , and fungal infections. Pityriasis rosea Pityriasis Rosea Pityriasis rosea is a self-limited, inflammatory disease characterized by diffuse, scaling papules or plaques. Treatment is usually unnecessary. Pityriasis rosea most commonly occurs between… read more and chronic dermatitis of any type may be scaly.

Erosions are open areas of skin that result from loss of part or all of the epidermis. Erosions can be traumatic or can occur with various inflammatory or infectious skin diseases. An excoriation is a linear erosion caused by scratching, rubbing, or picking.

Petechiae are nonblanchable punctate foci of hemorrhage. Causes include platelet abnormalities (eg, thrombocytopenia, platelet dysfunction Overview of Platelet Disorders Platelets are cell fragments that function in the clotting system. Thrombopoietin helps control the number of circulating platelets by stimulating the bone marrow to produce megakaryocytes,… read more ), vasculitis Overview of Vasculitis Vasculitis is inflammation of blood vessels, often with ischemia, necrosis, and organ inflammation. Vasculitis can affect any blood vessel—arteries, arterioles, veins, venules, or capillaries… read more , and infections (eg, meningococcemia, Rocky Mountain spotted fever Rocky Mountain Spotted Fever (RMSF) Rocky Mountain spotted fever (RMSF) is caused by Rickettsia rickettsii and transmitted by ixodid ticks. Symptoms are high fever, severe headache, and rash. (See also Overview of Rickettsial… read more , other rickettsioses).

Purpura is a larger area of hemorrhage that may be palpable. Palpable purpura is considered the hallmark of leukocytoclastic vasculitis. Purpura may indicate a coagulopathy. Large areas of purpura may be called ecchymoses or, colloquially, bruises.

Telangiectases are foci of small, permanently dilated blood vessels that may occur in areas of sun damage, rosacea Rosacea Rosacea is a chronic inflammatory disorder characterized by facial flushing, telangiectasias, erythema, papules, pustules, and, in severe cases, rhinophyma. Diagnosis is based on the characteristic… read more , systemic diseases (especially systemic sclerosis Systemic Sclerosis Systemic sclerosis is a rare chronic disease of unknown cause characterized by diffuse fibrosis and vascular abnormalities in the skin, joints, and internal organs (especially the esophagus… read more ), or inherited diseases (eg, ataxia-telangiectasia Ataxia-Telangiectasia Ataxia-telangiectasia results from a DNA repair defect that frequently results in humoral and cellular deficiency; it causes progressive cerebellar ataxia, oculocutaneous telangiectasias, and… read more , hereditary hemorrhagic telangiectasia Hereditary Hemorrhagic Telangiectasia Hereditary hemorrhagic telangiectasia is a hereditary disorder of vascular malformation transmitted as an autosomal dominant trait affecting men and women. (See also Overview of Vascular Bleeding… read more ) or after long-term therapy with topical fluorinated corticosteroids.

Cafe Au Lait Spots: Background, Pathophysiology, Etiology

Author

Nazanin Saedi, MD Assistant Professor, Director of Laser Surgery and Cosmetic Dermatology, Department of Dermatology and Cutaneous Biology, Jefferson Medical College of Thomas Jefferson University

Nazanin Saedi, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

Raj D Sheth, MD Chief, Division of Pediatric Neurology, Nemours Children’s Clinic; Professor of Neurology, Mayo Clinic Alix School of Medicine; Professor of Pediatrics, University of Florida College of Medicine

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, Child Neurology Society

Disclosure: Nothing to disclose.

Disseminated gonococcal infection presenting as the arthritis-dermatitis syndrome

Clin Med (Lond). 2019 Jul; 19(4): 340–341.

, dermatology residentA and , dermatology physicianB

Chi-Hui Wang

AChang Gung Memorial Hospital, Taoyuan, Taiwan

Chun-Wei Lu

BChang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

AChang Gung Memorial Hospital, Taoyuan, Taiwan

BChang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

Address for correspondence: Dr Chun-Wei Lu, Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, 5 Fushin Street, Taoyuan, Taiwan. Email: [email protected] © Royal College of Physicians 2019. All rights reserved.This article has been cited by other articles in PMC.

Case

A 47-year-old man presented with multiple tender, erythematous-to-violaceous macules and pustules on his palms and lower legs (Fig ). Spike fever, malaise and arthralgia in wrists and right ankle were noted for 3 days. There was no history of urogenital symptoms. Laboratory surveillance showed leucocytosis of 17.3 × 103/μL and increased C-reactive protein of 30.74 mg/dL. Skin biopsy demonstrated leucocytoclastic vasculitis. Remarkably, blood culture was positive for Gram-negative diplococci, subsequently identified as Neisseria gonorrhoeae. Under a focused history-taking concerning sexually transmitted infections (STIs), the patient reported having had unsafe sexual behaviours with female prostitutes 2 weeks ago. Screening tests of syphilis, chlamydia and HIV were all negative. On commencement of intravenous ceftriaxone, 2 g, and oral azithromycin, 1 g, daily for disseminated gonococcal infection (DGI), he became afebrile with marked resolution of skin rash and polyarthralgia 6 days later.

Disseminated gonococcal infection. (a) Discrete, tender, erythematous macules and vesicles on the right palm and middle finger. (b) Right calf with haemorrhagic rash and pustules formation. (c) Dermoscopic image showing the purpuric macule with dusky centre and peripheral erythema.

Discussion

The incidence of DGI has been reported to be very low (0.5–3% of all gonococcal infections).1 Historically, DGI occurred more frequently in woman with occult cervical infections; however, rising cases were observed among HIV-infected males recently. DGI results from the bloodstream dissemination of N gonorrhoeae, typically developing within 3 weeks of primary mucosal infection.

Clinical suspicion of DGI should arise in patients with a classic triad of skin rash, polyarthralgia and tenosynovitis, termed ‘arthritis-dermatitis syndrome’.2 Characteristic cutaneous lesions are scattered small-sized purpuric macules on palms and soles, which can evolve into vesicopustules with hemorrhage.3 Histologically, epidermal and perivascular neutrophilic infiltrates with vasculitis may be seen. Asymmetric polyarticular pain and tenosynovitis involving small joints are distinctive features. DGI is mainly confirmed by culturing gonococci from blood, synovial fluid or skin lesion. Cultures of synovial fluid and skin lesion are mostly negative, but positive blood cultures are identified in 50% of patients with arthritis-dermatitis syndrome of DGI. Differential diagnosis includes infective endocarditis, meningococcemia and Reiter syndrome.

With the rapid emergence of antimicrobial-resistant N gonorrhoeae, the Centers for Disease Control and Prevention recommends dual antibiotic therapy (ceftriaxone plus azithromycin) for DGI.4 To date, STIs including gonorrhoeal infection are growing global health concerns. Timely identification of DGI and initiation of appropriate treatment are mandatory to prevent potential complications and transmission.

References

1. Beatrous SV, Grisoli SB, Riahi RR, Matherne RJ, Matherne RJ.
Cutaneous manifestations of disseminated gonococcemia. Dermatol Online J
2017;23. [PubMed] [Google Scholar]2. Brogadir SP, Schimmer BM, Myers AR.
Spectrum of the gonococcal arthritis-dermatitis syndrome. Semin Arthritis Rheum
1979;8:177–83. [PubMed] [Google Scholar]3. Ghosn SH, Kibbi A-G.
Cutaneous gonococcal infections. Clin Dermatol
2004;22:476–80. [PubMed] [Google Scholar]4. Workowski KA, Bolan GA.
Sexually transmitted diseases treatment guidelines, 2015. Morbidity and mortality weekly report: Recommendations and reports
2015;64:1–137. [PMC free article] [PubMed] [Google Scholar]

Types, Symptoms, Causes, Treatment & Recovery

Overview

What is vitiligo?

Vitiligo (vit-il-EYE-go) is a skin disorder that causes the skin to lose its color. Smooth white areas (called macules if less than 5mm or patches if 5mm or larger) appear on a person’s skin. If you have vitiligo in a place that has hair, the hair on your body may also turn white.

The condition occurs when melanocytes (the skin cells that produce melanin, the chemical that gives skin its color, or pigmentation) are destroyed by the body’s immune system.

How does vitiligo progress?

Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Vitiligo typically begins on the hands, forearms, feet, and face but can develop on any part of the body, including the mucous membranes (moist lining of the mouth, nose, genital, and rectal areas), the eyes, and inner ears.

Sometimes the larger patches continue to widen and spread, but usually they stay in the same place for years. The location of smaller macules shifts and changes over time, as certain areas of skin lose and regain their pigments. Vitiligo varies in the amount of skin affected, with some patients experiencing few depigmented areas and others with widespread loss of skin color.

What are the types of vitiligo?

Vitiligo can be:

  • Generalized, which is the most common type, when macules appear in various places on the body.
  • Segmental, which is restricted to one side of the body or one area, such as the hands or face.
  • Mucosal, which affects mucous membranes of the mouth and/or the genitals.
  • Focal, which is a rare type in which the macules are in a small area and do not spread in a certain pattern within one to two years.
  • Trichome, which means that there is a white or colorless center, then an area of lighter pigmentation, and then an area of normally colored skin.
  • Universal, another rare type of vitiligo, and one in which more than 80% of the skin of the body lacks pigment.

How common is vitiligo?

Vitiligo occurs in about 1% or slightly more of the population throughout the world. Vitiligo affects all races and genders equally; however, it is more visible in people with darker skin. Although vitiligo can develop in anyone at any age, it most commonly appears in people ages 10 to 30 years. Vitiligo rarely appears in the very young or very old.

Symptoms and Causes

What causes vitiligo?

Although the causes of vitiligo aren’t completely understood, there are a number of different theories:

  • Autoimmune disorder: The affected person’s immune system may develop antibodies that destroy melanocytes.
  • Genetic factors: Certain factors that may increase the chance of getting vitiligo can be inherited. About 30% of vitiligo cases run in families.
  • Neurogenic factors: A substance that is toxic to melanocytes may be released at nerve endings in the skin.
  • Self-destruction: A defect in the melanocytes causes them to destroy themselves.

Vitiligo may also be triggered by certain events, such as physical or emotional stress. Because none of the explanations seem to completely account for the condition, it’s possible that a combination of these factors is responsible for vitiligo.

Is vitiligo painful?

Vitiligo is not painful. However, you can get painful sunburns on the lighter patches of skin. It is important to protect yourself against the sun with measures like using sunscreen, staying out of the sun during the hours that it is strongest, and wearing protective clothing. Some people with vitiligo have reported having itchy skin sometimes, including before the depigmentation starts.

Can I inherit vitiligo?

Vitiligo is not necessarily inherited. However, about 30% of people who have vitiligo do have at least one close relative who also has vitiligo.

What are the signs and symptoms of vitiligo?

Signs and symptoms of vitiligo include the following:

  • Patches of skin lose color. This can include the eyes and/or the mucous membranes in your mouth or nose.
  • Patches of hair on your head or face turn prematurely gray or white.

What problems are associated with vitiligo?

Although vitiligo is mainly a cosmetic condition, people with vitiligo may experience a variety of problems:

  • Because they lack melanocytes, macules are more sensitive to sunlight than the rest of the skin, so they will burn rather than tan.
  • People with vitiligo may have some abnormalities in their retinas (the inner layer of the eye that contains light-sensitive cells) and some variation of color in their irises (the colored part of the eye). In some cases, there is some inflammation of the retina or iris, but vision is usually not affected.
  • People with vitiligo may be more likely to get other autoimmune diseases (in which the body’s immune system causes it to attack itself), such as hypothyroidism, diabetes, pernicious anemia, Addison’s disease, and alopecia areata. Also, people with autoimmune diseases are more at risk for developing vitiligo.
  • People with vitiligo may feel embarrassed or anxious about their skin. Sometimes people are rude – they may stare or say unkind things. This could cause a person with vitiligo to develop low self-esteem. This in turn could create anxiety or depression issues and make someone want to isolate. If this happens, you should talk to your healthcare provider or your family and friends to help you find a solution.

Diagnosis and Tests

How is vitiligo diagnosed?

Usually the white patches are easily visible on the skin, but healthcare providers can use a Wood’s lamp, which shines ultraviolet (UV) light onto the skin to help differentiate from other skin conditions.

What other conditions resemble vitiligo?

There are other conditions that make the skin change or lose pigmentation. These include:

  • Chemical leukoderma: Exposure to some industrial chemicals cause damage to the skin cells, resulting in linear or splotchy white areas of skin
  • Tinea versicolor: This yeast infection can create dark spots that show on light skin, or light spots that show on darker skin.
  • Albinism: This genetic condition means that you have lower levels of melanin in the skin, hair and/or eyes.
  • Pityriasis alba: This condition starts off with red and scaly areas of skin, which fade into scaly lighter patches of skin.

Management and Treatment

How is vitiligo treated?

There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation). Common treatments include camouflage therapy, repigmentation therapy, light therapy and surgery. Counseling may also be recommended.

Camouflage therapy:

  • Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA). Use of sunscreens minimizes tanning, thereby limiting the contrast between affected and normal skin.
  • Makeups help camouflage depigmented areas. One well-known brand is Dermablend®.
  • Hair dyes if vitiligo affects the hair.
  • Depigmentation therapy with the drug monobenzone can be used if the disease is extensive. This medication is applied to pigmented patches of skin and will turn them white to match the areas of vitiligo.

Repigmentation therapy:

  • Corticosteroids can be taken orally (as a pill) or topically (as a cream put on the skin). Results may take up to 3 months. The doctor will monitor the patient for any side effects, which can include skin thinning or striae (stretch marks) if used for a prolonged period.
  • Topical vitamin D analogs.
  • Topical immunomodulators such as calcineurin inhibitors.

Light therapy:

  • Narrow band ultraviolet B (NB-UVB) requires two to three treatment sessions per week for several months.
  • Excimer lasers emits a wavelength of ultraviolet light close to that of narrow band UVB. This is better for patients who do not have widespread or large lesions since it is delivered to small, targeted areas.
  • Combining oral psoralen and UVA (PUVA) is used to treat large areas of skin with vitiligo. This treatment is said to be very effective for people with vitiligo in the areas of the head, neck, trunk, upper arms and legs.

Surgery:

  • Autologous (from the patient) skin grafts: Skin is taken from one part of the patient and used to cover another part. Possible complications include scarring, infection or a failure to repigment. This might also be called mini grafting.
  • Micropigmentation: A type of tattooing that is usually applied to the lips of people affected by vitiligo.

Counseling:

  • Vitiligo can cause psychological distress and has the ability to affect a person’s outlook and social interactions. If this happens, your caregiver may suggest that you find a counselor or attend a support group.

Prevention

How can I prevent vitiligo?

Since no one knows for certain what causes vitiligo, no one can tell you how to prevent it. In general, it is smart for everyone to practice safe sun exposure habits and to take good care of your skin.

Outlook / Prognosis

What is the outlook for people with vitiligo?

About 10% to 20% of people who have vitiligo fully regain their skin color. People with the best chance of regaining skin color are those who are young, whose vitiligo reaches its peak in less than six months and is located mainly on the facial area. People who are less likely to regain their color are those who get vitiligo later in life on their lips and limbs, especially the hands.

Is vitiligo fatal?

No. And it is not in any way contagious, either.

Living With

What should I know about living with vitiligo?

In reading about vitiligo, you might find this thought showing up in many places, that ‘vitiligo is not life-threatening, but it is life-altering.’ The fact that vitiligo develops over time is one reason for this. Another factor is that many societies believe that appearance is very important, and that being different is to be avoided. This is often very true for women.

It is important for everyone to take ownership of their health. Educating yourself about vitiligo and finding a doctor who really knows about the disease and treatment options is key. If you develop any new symptoms that cause you worry, or if you have questions, make sure your voice is heard.

Resources

Are there resources for people with vitiligo?

Here are the names of some organizations that might be helpful to you.

Pathology Outlines – Café-au-lait spot

Lentigines, melanotic macules and melanocytic hyperplasia

Café-au-lait spot

Topic Completed: 1 April 2013

Minor changes: 3 November 2020

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PubMed Search: Café-au-lait spot

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Cite this page: Hale CS. Café-au-lait spot. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumormelanocyticcafeaulait.html. Accessed October 9th, 2021.

Definition / general

  • Pigmented macule 0.5 mm+, flat, round / oval, sharply demarcated with even pigmentation; long axis is along cutaneous nerve tract
  • May have irregular borders
  • Pigment histologically restricted to basal layer of epidermis
  • Usually present at birth (Wikipedia)

Terminology

  • Café au lait is French for “coffee with milk”, referring to light brown color of lesions
  • Often abbreviated as “CALM”

Epidemiology

  • If solitary, usually nonsyndromic
  • In U. S. study of children under 5 years, 19% had one, 0.75% had > 2; more present in African Americans (Arch Dis Child 1966;41:316)
  • If solitary, usually nonsyndromic; multiple associated with neurofibromatosis type 1 – any person with 6+ lesions should be presumed to have neurofibromatosis until proven otherwise
  • Also associated with McCune-Albright syndrome and other syndromes (eMedicine)

Clinical images

Images hosted on other servers:

Axillary freckling

Lesion of face

Neurofibromatosis type I patient

Microscopic (histologic) description

  • Basal hyperpigmentation of epidermis, no deeper pigmentation
  • Increased amount of pigment in melanocytes, some have giant pigment granules (Tohoku J Exp Med 1976;118:255)
  • Melanophages are rare
  • Adnexal epithelium has no increased pigment
  • Syndromic patients: more DOPA+ melanocytes in lesional skin contrasted to sporadic patients with decreased DOPA+ melanocytes within lesion (Arch Dermatol 1970;102:442)

Electron microscopy description

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File:Macule.

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Summary[edit]

This file was moved to Wikimedia Commons from en.wikipedia using a bot script. All source information is still present. It requires review. Additionally, there may be errors in any or all of the information fields; information on this file should not be considered reliable and the file should not be used until it has been reviewed and any needed corrections have been made. Once the review has been completed, this template should be removed. For details about this file, see below. Check now!
DescriptionMacule.jpg

English: A Macule is a small, circular, flat spot less than [frac25] in (1 cm) in diameter. Macules are seen but not felt. The color of a macule is not the same as that of nearby skin. Macules come in a variety of shapes and are usually brown, white, or red. Examples of macules include freckles and flat moles. A macule more than [frac25] in (1 cm) in diameter is called a patch.
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90,000 Macular degeneration – Latvijas Amerikas acu centrs

What does macular degeneration mean?
When the eye looks straight, the macula is the focal point of the retina, where the light rays are bent through the cornea and the lens. Just like a camera lens, the image enters the retina through a lens similar to a camera lens. If changes have occurred in the macula, the central part of the image disappears, with the appearance of a blurred spot. The rest of the image can be kept clear.

What causes macular degeneration?

Macular degeneration is caused by changes or damage to the macula. The eye can still see lateral objects well, since the “peripheral” vision is intact. That is why macular degeneration by itself does not cause complete blindness. But it becomes burdensome or even impossible to read or work closely at close quarters.

The retina is a very sensitive and sensitive tissue layer that covers the inner surface of the eyeball.Macula is a very small field in the center of the retina, which can be compared to the big O in a newspaper article. Without this small field, our “straight ahead” vision, which is used for reading and other precise work, is impossible. Macular degeneration is more common in older patients, but the loss of central vision is not always due to aging of the eye – eye trauma, infection or inflammation cause macular degeneration.

What are the types of macular degeneration?
The most common type of macular degeneration is involutionary macular degeneration.This type occurs in about 70% of cases and is associated with aging of the eye. This is due to the destruction or separation of the macular tissue. The tissues become thinner. Exudative macular degeneration occurs in about 10% of cases. Usually the macula is protected by a thin layer of tissue that separates the macula from the eye with thick and very thin blood vessels. Sometimes these vessels rupture or bleed, resulting in scarring. Very often, new blood vessels that are unnecessary for the eye appear and grow in these scars.These vessels are very thin and often rupture and bleed. The blood destroys the macula and causes further scarring. Vision is distorted and blurred, and dense scars block the central vision of the eye.

There are types of macular degeneration that occur in young patients (adolescent / juvenile macular degeneration) that are not caused by aging. Sometimes, injuries, infections, or inflammation are the causes of damage to the fine tissues of the macula.

What are the symptoms of macular degeneration?
If macular degeneration occurs in only one eye, it may be difficult to notice at first if the other eye is in normal condition.This often happens, and it takes a long time before changes in vision become noticeable. The symptoms of macular degeneration vary from patient to patient. Sometimes only one eye loses vision, while the other retains good vision for many years. When both eyes are affected, reading and performing precision work can become especially problematic.

Macular degeneration by itself does not cause complete blindness. Since peripheral vision is usually preserved, the majority of patients are able to serve themselves reasonably well.

Symptoms of macular degeneration may include an unclear color image, blurry letters when reading, straight lines appear curved, and sometimes the central part of the image appears more distorted than the sides. A dark or unclear spot appears in the center of the image.

How to diagnose macular degeneration?
Many patients do not even realize that macular degeneration has affected them until there is a major change in vision. An eye doctor can detect macular degeneration at an early stage.

During the visit, the doctor ascertains the patient’s complaints, collects data on diseases acquired throughout life, as well as on family diseases. A complete diagnosis of the condition of the eyes and vision is performed, during which the doctor determines the functions of vision, as well as examines all the structures of the eyes.

The doctor conducts an examination – OCT (optical coherence tomography), which determines the form and degree of the disease. This is a painless, non-contact method of examination, as a result of which an enlarged image of the retina of the eye can be obtained.

In addition, fluorescence angiography can be performed. During this method, a dye, fluorescein, is injected into a blood vessel, which enters the blood vessels of the retina through the bloodstream, and the retina and blood vessels are photographed using a special camera.

Timely diagnostics can sometimes prevent further changes in the macula or help to choose optical aids to improve vision.

How is macular degeneration treated?
At a very early stage of the formation of exudative macular degeneration, an ophthalmic laser can be used to treat it.With the help of a laser light beam, bleeding membranes are cauterized and newly formed blood vessels are destroyed, thus reducing the possibility of loss of vision, which causes progressive scarring of the macula and retina.

Age-related macular degeneration (AMD)
Age-related macular degeneration (AMD) is the most common form of macular degeneration associated with aging of the eye, which permanently damages the back of the eye.

AMD usually affects both eyes, but symptoms may initially appear in one eye. If age-related macular degeneration progresses, severe and irreversible vision loss may develop in the later stages of the disease.

Most often, vision loss occurs gradually and damages the center of the eye, which means that each of the patient’s eyes can still see from the sides.

http://cv-eye.com/procedures/retina/macular-degeneration/

Vecuma mākulas deģenerācijas (VMD) progresija – Progression of age-related macular degeneration (AMD)
Normāla redze – normal vision
Mitrā VMD forma – wet form of AMD
Amslera tīkls – Amsler mesh

Risk Factors
AMD is a common cause of poor vision in older people – the older the age, the greater the risk of the disease.Age-related macular degeneration is an inherited disease of the eye. Increased risk of disease in relatives of patients with AMD. Also, smoking and eating a diet that is lacking certain essential nutrients significantly increase the risk of degeneration.

Types of VMD

Early AMD – metabolic waste products accumulate under the macula, forming clots known as drusen. There may not be any complaints of visual impairment, but at this stage of the disease, dietary and lifestyle changes can help slow the progression of the disease.
Late stage of AMD – the disease progresses, vision is impaired. There are two late forms of AMD:
1. Dry form of AMD – most often develops slowly and gradually over many years. Macular cells die in small areas, images may become blurry and pale, and image details are lost.
2. Wet form of AMD – new, pathological blood vessels grow from the side of the choroid (back of the eye) into the macula or under it. These blood vessels bleed and rupture.Scar tissue forms in or around the macula. Wet AMD develops faster and can cause significant visual impairment in a week, day, or even hours. Signs are visual deformation of objects, empty or blurry areas in the central field of view. In two thirds of cases, late stage AMD is caused by the wet form of age-related macular degeneration.

http://healthlifemedia.com/healthy/wp-content/uploads/2016/12/Wet-and-Dry-AMD.jpg

Mitrā VMD forma – wet form of VMD
Sausā VMD forma – dry form of VMD

Identifying the early form of the disease
If you are 50 years old, it is recommended to schedule an eye doctor visit every year or every other year to detect an early stage of AMD when vision is still intact.AMD detected early has a greater chance of preventing visual impairment.

You can monitor your AMD by performing the Amsler test daily, using suitable reading glasses as needed. If you find a change in vision, see a doctor immediately.

If you have AMD and have no eye complaints, daily use of the Amsler test cannot replace regular visits to your eye doctor.

If you have been diagnosed with AMD, it is important to understand the disease, its development and treatment plan with your eye doctor.

Treatment of wet AMD
The goal of treatment of wet AMD is to prevent worsening of the condition. Treating an early stage of the disease can keep your vision in better condition. Treatment includes:

• Anti-VEGF (Vascular Endothelial Growth Factor) therapy that reduces the secretion of new blood vessels or bleeding in the macula.

• Photodynamic therapy – photosensitive drug and laser eliminate abnormal blood vessels.
• Laser photocoagulation – the use of laser beams near pathological blood vessels.

Treatment of early and dry AMD
Treatment includes dietary changes, smoking cessation and, in some cases, supplementation.

What can I do?
• If you smoke, stop immediately. Smoking significantly increases the risk of developing AMD, the risk of developing advanced AMD, and late AMD may start earlier.
• If you are 50 years old, see your ophthalmologist every year or every two years when AMD can be found early.
• Tell your eye doctor that a relative has AMD.
• Do an Amsler test (grid) every day to watch for early signs of AMD. If your vision suddenly changes, see your eye doctor right away.
• Eat fruits, green leafy vegetables every day, fish two to three times a week, a handful of nuts per week, low glycemic index carbs (low GI).Limit your use of fats and oils.
• Talk with your doctor if the use of dietary supplements would be beneficial.
• Maintain a healthy weight by exercising regularly.

Given the fact that AMD is an inherited condition, genetic testing (also for young people) can be done to determine the potential lifetime risk of AMD.

http://whatislowvision.org/2014/02/19/february-is-national-age-related-macular-degeneration-and-low-vision-awareness-month/

VMD riska faktori – Risk factors for AMD
Vecums 50+ – Age 50+
Smēķēšana – Smoking
Baltā rase – White race
VMD gadījumi ģimenē – Cases of AMD in the family

Samazini VMD risku – Reduce the risk of AMD
Izvairies no smēķēšanas – Avoid smoking
Bieži sporto – Exercise more often
Uzturi normālu asinsspiedeinu un holesterīna līmenī asinīs – Maintain normal blood pressure and veneers 5 Uzturā lietojot zaļos lapu dārzeņus un zivis – Eat right! Eat green leafy vegetables and fish.

For more information on what age-related macular degeneration is, watch the video!

90,000 SPECTRUM OF OPERATIONS – Augentagesklinik am Kapellenberg in Potsdam

Traditionally, in terms of accessibility and functionality, it is customary to divide the eye into two segments – front and back. In a simplified form, this can be described as follows.

The anterior segment of the eye begins in the place that you see when you look at your eye from front to back: transparent mucous membrane of the eye, transparent sensitive cornea, as a result of bending, forming a small cavity in the front of the eye (anterior chamber of the eye), behind them is located what you know as an individual eye pigment (blue, green, brown eyes): an iris with a pupil in the middle: a black movable hole through which light enters the eye, and behind it is the lens – a rounded natural lens.

Eye model

Cornea

Iris with pupil

Lens

The posterior segment of the eye begins behind the lens. This segment cannot be seen with the naked eye. Behind the pupil and the lens is a jelly-like mass that fills the eye (the vitreous, in the eye model it looks like a large removable transparent ball), and at the very end, in the back of the round eye, there is a retina, like a wallpaper lining the back hemisphere of the eye, with visible to the doctor during examination with the retinal vessels (shown here in the model), with typical light reflexes of orange color.In this case, the macula is simply a specific area of ​​the retina with special cellular properties and functions. At the posterior pole of the eyeball is the optic nerve, which covers all nerve fibers of the retina and leaves the eye from the back, connecting it to the brain. With the help of the brain, we recognize and relate what we see to what our eyes perceive.

Vitreous body

Retina

Macula

Optic nerve

Roughly simplifying, we can say: in the front part of the eye, the light flow is adjusted and it is ensured that an image can be projected on the retina in the back of the eye on the retina.We see only if the stream of light penetrates in such a way that the light falls directly on the retina, and not in front of it, and it is not directed too far. If the posterior segment of the eye is healthy and the light incidence is not perfect, the “auxiliary lenses / glasses” of the glasses and contact lenses adjust the light flux, and we can see well again, since the lenses in the auxiliary devices ensure that the light falls exactly on the retina again. A natural lens (crystalline lens), which tends to gradually grow cloudy at an older age (cataract), can make it difficult for light to penetrate the front of the eye, but if it is replaced with an artificial lens (cataract surgery), the person can see well again.Thus, vision itself is not yet affected here, since in the anterior segment of the eye only the fall of the luminous flux can be limited.

BACK EYE OPERATIONS ARE HIGHER PILOT IN OPHTHALMOLOGY

After all, it is the posterior segment of the eye, namely the region of the retina and macula, that is responsible for whether we can see at all, whether an image can be created. The posterior segment of the eye, namely the region of the retina and macula, is responsible for the quality of the image, for whether we see colors, whether we see a distorted image, etc.p. Makula, which is the place of the sharpest sight. is responsible for whether we can purposefully focus in order to read, for example. If deposits, neoplasms of blood vessels, hemorrhages, holes or blockages of blood vessels form on the retina, in particular on the macula, vision is often severely affected. The operations and techniques listed in the “Posterior segment of the eye” section are necessary in order to preserve vision or visual acuity in case of diseases. Thus, the requirements and responsibilities of a surgeon operating on the posterior segment of the eye are not the same as in an operation on the anterior segment of the eye.Accordingly, there are not so many experts specializing in the posterior segment of the eye among operating ophthalmologists.

COMBINED OPERATIONS

In our clinic, operations are routinely performed on both the anterior and posterior segments of the eye. The ability to carry out combined surgeries, that is, carrying out surgeries on the anterior and posterior segments of the eye within the same intervention, is a specialty of our clinic, and only a small number of ophthalmological surgeons can do such surgeries.Most surgeons are not qualified to perform operations on the posterior segment of the eye, except for the administration of medication into the vitreous humor. See also: The difference is that our competence extends to the entire eye.

OUR RANGE OF OPERATIONS ON THE BACK EYE:

    • Intravitreal injections (medication, injections into the vitreous body) for macular degeneration and other macular diseases (Lucentis, Makugen, Avastin, Triamcinolone, Eilea, etc.)
    • Operations to indent the retina for retinal detachment and the formation of holes in the retina
    • Vitrectomy with and without endotamponade (gas, oil, heavy fluids) for simple and complex retinal detachments (vitreous / retinal surgery)
    • Surgery of the epi- and subretinal membrane (removal of membranes / hemorrhages on and under the retina)
  • Translocation of the macula (inversion of the entire retina)
  • Intraoperative laser correction and cryotherapy of the retina in vitrectomy
  • Combined interventions: vitrectomy and cataract surgery

OUR RANGE OF OPERATIONS ON THE FORWARD EYE:

In addition to our specialization in the posterior segment of the eye, we also continually offer patients the latest innovations and operating techniques for the anterior segment of the eye.

  • Cataract surgery (surgical treatment of lens opacities). Along with the standardized surgical treatment for lens opacities (cataract surgery) using a wide variety of anesthesia methods, you can also choose the lens that optimally corrects your visual acuity (avoiding glasses for cataract surgery) to at the same time change glasses for lenses. We are one of the first 10 centers in Germany to offer alongside monofocal, multifocal (multifocal lenses) and cylindrical lenses (toric lenses) the latest innovation – Light Adjustable Lens (LAL).At the same time, after the operation, the thickness of the lens can be adjusted and optimally corrected with the help of simple ultraviolet irradiation of the eye, which does not have side effects, as a result of which you no longer need to use glasses for distance.
  • ICL – Glasses-free intraocular contact lens
  • Penetrating / lamellar keratoplasty (corneal transplant)
  • Reconstructive surgery of the anterior segment of the eye after trauma
  • The latest innovation: implantation of a special lens for progressive macular degeneration – with the help of an auxiliary lens system (VIP-IOL), the stream of light, usually falling on the affected areas of the retina, which the person can no longer see, changes direction and thereby is projected onto healthy areas of the retina.
  • Operations to reduce intraocular pressure in glaucoma (surgical treatment of glaucoma) using various operating techniques
  • Since 2012, we have been performing operations to reduce intraocular pressure using the laser technique ECP
  • Crosslinking. Crosslinking is a new treatment for keratoconus, a progressive change in the cornea that results in decreased visual acuity.
  • Frequently combined interventions: e.g. cataract surgery and ECP (lowering intraocular pressure in glaucoma)

LASER SURGERY

  • Laser coagulation for diabetic and other changes in the retinal vessels or the formation of holes in the retina
  • YAG laser capsulotomy for secondary cataract after cataract surgery
  • Laser trabeculoplasty for glaucoma
  • Laser iridotomy for glaucoma
  • Laser polishing of the artificial lens after inflammation
  • PDT (photodynamic therapy) for age-related macular degeneration

GLASSAGE RELEASE – SUPPORTING LENS IMPLANTS FOR HEALTHY SUSTAINABLE GLASSES FAILURE

The desire to give up glasses is extremely common.From an ophthalmic point of view, an eye that has achieved 100% visual acuity through correction with glasses or contact lenses is still a healthy eye. Any intervention in a healthy eye must be weighed with particular care, since the risks, although they are minimal today, still exist. If you want to be free from glasses, we offer you, from our point of view, the best method available today – an auxiliary lens implant. These auxiliary lenses are similar to contact lenses, however, they are not located externally, on the mucous membrane of the eye and the cornea, but inside the eye (= intraocularly) in front of the lens.Their advantage is that they can be removed at any time and thus restore the original natural situation again. Implantation of intraocular contact lenses (ICL) is a complex (as opposed to laser correction methods, for example, LASIK), a completely reversible approach to the correction of visual impairments, which allows maintaining the integrity of the eyeball and adapting to new life situations (changes in visual acuity, the development of cataracts or other eye diseases in older age), and therefore we recommend this method when striving for a healthy, reversible and sustainable eyewear rejection.Correction of visual impairments with a laser (LASIK, etc.), from our professional point of view, is undesirable on the basis of many arguments, primarily due to the irreversibility of the changes carried out on the cornea, although technically this is a simple intervention, which is nevertheless missing from our offer.

Contact us, we will be happy to advise you. For more details about this, as well as about the holding of information events, we inform you on our website.

Research and treatment of the retina

For us, as specialists, it is not enough to have knowledge about the normal or abnormal state of the macula, it is not enough to be able to identify such disorders as retinal rupture, as well as the presence of an internal boundary membrane (IPM), epiretinal membrane (EM), vitreomacular traction syndrome (VMTS), cystoid macular edema (TSOM) or subretinal fluid (SRF). Currently, we must also be able to determine their functional state, and for this we need to determine the state of vascular perfusion and retinal pigment epithelium.Although it is still important for any professional to have the most advanced biomicroscopic technique available. We are now seeing two other methods gaining popularity – optical coherence tomography (OCT) and fluorescence angiography (FA). OCT allows examining the anatomical features of the eye, and owing to fundus autofluorescence, the state of the visual receptors can be observed. The use of fluorescence angiography, in turn, allows visualization of the peripheral perfusion of the retina.Let’s take a closer look at these research methods.

Popular research methods

Optical coherence tomography (OCT, OCT)

Between 1997 and 2007, the quality of the examination of the OCT area improved significantly, and with the help of improved technologies during our research, we could easily recognize the layers of the retina. Other improvements include an increase in the number of possible A-scans per second. If earlier they could be made no more than a hundred, now – up to 50,000-100,000 thousand, and with this there was a significant increase in the contrast of the image.

In 2007, Topcon launched the world’s first 3D Fourier Transform Optical Coherence Tomograph (FD-OCT). With the help of FD-OCT, we can not only recognize even more layers of the retina, we can also see the connection between the inner and outer segments of the optic receptors, and this feature can be used as a guide to localize pathology. On a good clear picture, taken with a modern tomograph, we can even see the vascular bed and the scleral membrane of the eye.We worked hard in the late 90s to bring the optical coherence tomograph into service in UK clinics. At that time, we used photodynamic therapy (PDT) to treat age-related macular degeneration. We have convincingly demonstrated that O CT is a step forward, since it has radically and for the better changed the direction that we have chosen to treat such diseases. We have proven that O-CT can detect retinal abnormalities in 50 percent of cases when the same abnormalities went unnoticed during medical examinations using fundus biomicroscopy.

Autofluorescence (FAF)

We use this method to determine the state of the retinal pigment epithelium (RPE), visual receptors, as well as to study their interaction. In vivo data from FAF can help diagnose as well as get an objective view of disease progression. It is a non-invasive and relatively fast way to assess the state of the central visual function.

Autofluorescence can be determined using two imaging systems: a fundus camera system and a scanning laser or ophthalmoscope.Unsurprisingly, the scan results differ from one another.

The

FAF is becoming an increasingly important part of our diagnostic arsenal and is now widely used to establish anatomical baseline in clinical trials using drug therapy for the treatment of geographic atrophy of RPE (GA). The FAF is arguably an indispensable tool for fully assessing the extent of a disease. RPE atrophy as well as the spread of geographic atrophy can be displayed with overtime use of the FAF.Areas of increased FAF in areas of geographic atrophy indicate areas of risk associated with progression of atrophy over time. The FAF is now an integral part of research in diabetes clinics. We have shown that the FAF can accurately display coagulation points during laser coagulation, which, when using a slit lamp with a special lens, can be detected or unnoticed. With the help of the FAF, we can also assess the condition of the posterior pole of the eyeball, and also recognize the quadrant distribution of the vorticose veins.We use FAF in order to avoid re-treating areas that have already been healed, thus avoiding unnecessary loss of visual receptors in the future, and to identify alternative therapies (ie, pharmacotherapy).

DIAGNOSTICS AND TREATMENT OF CHOROIDAL NEOVASCULARIZATION (CNV) MAKULA AND RETINAL DYSTROPHY.

Benefits of Using the Topcon 3D OCT-2000 in Your Daily Medical Practice. Dr. Leila El Matri

I have used Topcon 3D OCT-2000 for two years, and 3D OCT-2000 F A for about six months and I can confidently say that these devices have high performance and provide high quality images.They are also simple and easy to use and can be learned quickly by any practitioner. Next, I would like to consider the benefits of working with these devices in my daily ophthalmic practice.

High-quality rendering

3D OCT-2000 allows you to simultaneously record up to 50,000 A-scans per second. With this machine, specialists can now view tissue and other areas of interest in a cross-section. In addition, the specialist can conduct studies of the anterior segment, the optic nerve head and the macula.

The software of the 3D OCT-2000 FastMap device allows simultaneous viewing of images in 2D, 3D formats and images, and the obtained images from the fundus camera. Later, we will look at the use of the apparatus with examples of choroidal neovascularization (CNV) and retinal dystrophy to illustrate some of its many benefits.

Fundus camera images

Topcon’s 3D OCT-2000 is the world’s first and only Spectral Optical Coherence Tomography (FD-OCT) scanner that includes a high-resolution, non-myadric camera and a wide 45-degree field of view.The camera also allows for stereo photography, which is accessible to practitioners and boasts the ability to accurately record fundus OCT data (Figure 1).

Figure 1. Color fundus image of a 58-year-old patient with progressive visual impairment. Note the slight hemorrhage in the foveola area, soft drusen, pigment changes in the area of ​​retinal pigment atrophy

Near-infrared autofluorescence and fluorescence angiography (FA).This optical coherence tomograph allows comparison of autofluorescence and fluorescence angiography (Figure 2).

Figure 2. Fundus autofluorescence with near-IR and PAH. Dark points correspond to areas of atrophy of the retinal pigment epithelium (RPE). Areas of the autofluorescence image correspond to latent CNV and RPE detachment.

Near-infrared fundus autofluorescence imaging provides more detailed information than conventional imaging techniques.Fluorescence angiography shows heterogeneous hyperfluorescence with a delayed gap in the macular region, which allows the detection of latent CNV.

Inhomogeneous filling of pigment epithelial detachment (OPES)

During the examination with the F D-OCT, physicians can view both OCT and retinal images at the same time. After scanning the macula, they can position the OCT scanning line in the required areas visualized in the fundus image.The four OCT images shown in Figure 3 were taken from the same patient, but at different positions of the scanning line. The green line indicates the B-type OCT scan area. Figure 3a shows a hidden OPES. Figure 3b shows latent CNV, which is difficult to identify in a clinical setting, as well as by fluorescence angiography, but which was detected by OCT. In addition, the B-type horizontal scan in Figure 3d reveals serous retinal detachment, which is a hallmark of CNV.

Figure 3. Results of OCT scanning at different positions of the scanning line in the same patient.

OCT allows the detection of choroidal neovascularization in various situations, such as age-related macular degeneration (AMD), myopia or angioid retinal stripes. The device also helps to determine their size and their location in the layers of the retina. Choroidal neovascularization can occur in the epithelial layer of the retina or under the pigment epithelium.Serous retinal detachment is a typical sign of CNV. The presence of subretinal fluid may be a more or less important indicator, but in any case it indicates the activity of the choroidal neovascular membrane (CNVM).

F D-OCT HD

High-definition F D-OCT HD spectral tomography allows you to clearly identify the various layers of the retina and analyze many other important features. F D-OCT HD also allows you to detect and localize various minor violations.Topcon’s patented FastMap computer system with 3D OCT visualization provides clinical results in a completely different format, thereby providing better insight and understanding of complex pathologies. The “compare” function allows ophthalmologists to compare the scan results for each patient taken over several sessions.

Follow-up of the patient’s eye movements quantifies changes in retinal thickness using graphical imaging.The OCT device itself makes it possible to carry out accurate measurements during the post-treatment observation of the patient.

Case from medical practice

This patient was diagnosed with a deterioration in the visibility of the left eye and as a result she could not read. Her maximum corrected visual acuity (MAVA) was 0.1, and OCT showed a high RPE score in accordance with serous detachment of the retinal pigment epithelium on both sides. The patient was treated with intravitreal injection and 6 months later her visual acuity was 0.4, a OCT showed that the foveolar contour returns to its normal state with a decrease in RPE vascular detachment. However, a month later, the results of the examination showed that her vision had decreased (counting the fingers on the face). OCT revealed a detachment of the pigment epithelium.

And now let’s move on to the advantages of using the 3D OCT-2000 device in the daily diagnosis and treatment of retinal dystrophy, in particular pigmentary dystrophy (PD).

Investigation and treatment of retinal dystrophy (retinal dystrophy)

Spectral optical coherence tomography (SOCT) allows the assessment and measurement of various retinal thicknesses and is currently the gold standard of research to localize and evaluate macular edema.In particular, with the help of SOCT, a specialist can record the presence of a cyst or traction of the vitreous body. This method allows us to distinguish several forms of cystic macular edema. With OCT, ophthalmologists can also measure the area of ​​cystic macular edema: vertical length, transverse length, and cavity size. With regard to the epiretinal membrane, here OCT shows the presence of hyperreflexia on the inner surface of the retina using irregularities under the surface of the retina, indicating epiretinal fibrosis (ERF), which can be more accurately determined using SOCT.

SOCT allows you to analyze structural changes in particular affecting the visual receptors and their inner surface, thereby providing the necessary information about these tissues. With retinal pigmentary dystrophy, you can also analyze the connection of the outer and inner segments. His condition can be normal, abnormal, or invisible. These features are playing an increasingly important role in medical practice. On the other hand, we can also reveal the thickness of the retina around the macula and highlight the layers (the nerve fiber layer and the inner and outer plexiform layers).In addition, when detecting a macular cyst, SOCT is more sensitive than fluorescence angiography. With fundus autofluorescence in patients with retinal pigmentary dystrophy, an increase in the density of the vitreous body is often observed. The results obtained using OCT reflect the presence of structural changes in the retina.

Conclusion

Optical Coherence Tomograph 3D OCT-2000 from Topcon is a simple and convenient device for use in everyday medical practice, equipped with a built-in fundus camera with high resolution (18.0 megapixels), as well as the innovative FastMap software, which allows you to simultaneously view 2D, 3D and images, as well as images obtained from the fundus camera. I think that in the future this method could become a unified method for determining changes in the macula, optic nerve head, and also for identifying pathologies of the anterior retinal segment.

Acknowledgments: Dr. A. Chebil, Dr. F. Court, Dr. M. Buladi, Dr. S. Tuati.

Prof. El Matri is the head of the Hedi Rais Institute of Ophthalmology in Tunisia.She is also Professor of Ophthalmology at the Faculty of Medicine in Tunisia (University of Tunis el Manar)

Epiretinal Macular Membrane | Institut de la Màcula

What is the epiretinal macular membrane?

The retina is a thin layer that covers the inner part of the back wall of the eye, on which images are focused, which are then sent to the brain.In the center of the retina is the macula, or macula – the part responsible for central vision – the kind of vision we use for reading, watching TV, or recognizing faces.

Epiretinal membrane is a contraction of tissue on the surface of the retina that forms a fold and contributes to further deterioration and loss of vision. In many cases, it is necessary to remove it using microsurgery to avoid irreversible visual impairment.

Reasons

Overgrowth of tissue (membrane) in the macular zone can begin in healthy eyes and be associated with detachment of the vitreous humor (a jelly-like substance that fills the inside of the eye) of the retina.Such membranes can also form after any ocular inflammation, after surgery or inflammatory diseases, as well as intraocular infections.

Main risk factors

Age is the first risk factor, but there are other factors to consider.

  1. Patients undergoing ocular surgery.
  2. Patients with inflammatory intraocular diseases, especially in the back of the eye.
  3. Patients with retinal vascular pathologies.
  4. Patients who already have this pathology in one of the eyes (approximately 20% risk).

Symptoms

Symptoms associated with this pathology usually appear gradually. If the membrane contracts, it can cause distorted vision or cloudiness in the center of the eye. Over time, distorted vision worsens and can make it difficult for the affected eye to read and perform other tasks.

Treatment

It is necessary to conduct an ophthalmological examination, which includes the following tests: retinography, autofluorescence test, optical coherence tomography. In some cases, fluorescence angiography is necessary to determine possible side pathologies.

A relatively high percentage of epiretinial macular membranes tend to stabilize and the symptoms present do not impair the patient’s visual quality.Surgical intervention at these stages is not required, but constant medical supervision is necessary.

In cases where the membrane begins to progress, distortion or progressive loss of vision may appear. In these cases, treatment is carried out by means of vitrectomy, which consists in removing the vitreous humor and draining the membrane that produces traction. The retina is released and thus functions normally. The operation is performed under local anesthesia, after which the patient can return home.

In the months following the operation, vision is gradually restored in 80% of patients. However, in cases where the traction caused by the membrane and the deformation of the retinal tissue is significant, the restoration of vision may be limited.

Risk factors

Occurrence of cataracts in the operated eye. Another extraordinary and rare risk factor for intravitreal surgery is retinal detachment and intraocular infection (the least common complication).

The Macula Institute has the most advanced technologies for the diagnosis and treatment of the epiretinal membrane. Recent advances in vitreoretinal microincisive surgery allow us to treat the epiretinal membrane with the maximum guarantee of success.

Intraocular tumors | IMO

What are eye tumors?

Eye tumors can appear on the eyelids, in the eye (conjunctiva, choroid or retina) and in the orbit (cavity where the eyeball is located).

Given their delicate location, early diagnosis and treatment are essential. Time can be a decisive factor in preserving vision, eyes and even the patient himself in more severe stages of the development of the disease.

The following types of tumors are distinguished:

The most common and usually benign tumors are lids or palpebral tumors. However, in some cases, they can also be cancerous, so it is important to be under medical supervision.

Intraocular tumors:

  • Melanoma is considered the most common type of eye tumor in adults. Choroidal melanoma is most common, but it can also form in the conjunctiva and other intraocular tissues.
  • Retinoblastoma is the most common malignant eye tumor in children, characterized by the rapid growth of retinal cells, therefore it is very important to be diagnosed and treated early.
  • Choroidal hemangioma is a benign tumor (without the risk of metastases), but develops very quickly and aggressively, posing a threat to vision due to damage to the optic nerve (responsible for the transmission of images from the retina to the brain center) and macula (central zone) retina, which reproduces images of objects in detail).

Orbital tumors are less common and are characterized by the appearance of unilateral exophthalmos that develop slowly and progressively (with the exception of certain tumors, which may be bilateral).Orbital tumors are diverse, some of which can have serious consequences.

Melanomas are tumors that can form in the eye and grow without visible symptoms.

Dr. Garcia-Arumi – IMO Barcelona

Why do they appear?

Some tumors are congenital, such as 50% retinoblastoma, which are passed down from generation to generation. 1 in 15,000 babies is born with tumor .

Tumors of the eyelids are directly related to overuse of the sun.

Other tumors, such as melanoma or some orbital tumors, do not have specific risk factors. Some of them may be associated with a syndrome or may spread to neighboring areas or form as a result of a metastatic process.

How to prevent the appearance of ocular tumors?

In the case of tumors of the eyelids, it is recommended to properly protect this area during periods of sun exposure , even from early childhood, as this is the best way to prevent the appearance of a tumor.

Ocular and orbital tumors cannot be prevented . Periodic eye examinations, including a complete fundus examination, are the only form of early detection of the disease.

It is imperative to see an ophthalmologist if symptoms are found. Malignant lesions can recur over time, therefore, at the end of treatment, you should regularly see a doctor.

90,000 treatment and diagnosis of causes, symptoms in Moscow

What is age-related macular degeneration

Age-related macular degeneration is a chronic bilateral degenerative disease of the central area of ​​the retina (macula).It is the most common cause of permanent loss of central vision in patients over 60 years of age. Macular degeneration can be of two forms: dry and wet. In dry form, there is an accumulation of “waste products” of the eye, called druses. This leads to idiopathic and irreversible destruction of the outer layers of the retina, as a result of which the central area of ​​the retina (macula), which is responsible for image detail and central visual acuity, loses its functionality. With a wet form of macular degeneration under the retina, the growth of new pathological blood vessels begins.Their wall is untenable, blood components pass through it, entering the layers of the retina and damaging it, causing retinal edema.

Causes

The causes of age-related macular degeneration are still unknown. However, there are factors that significantly increase the risk of this pathology. These include:

  • over 50 years old
  • smoking
  • presence of this disease in the family
  • genetic predisposition
  • cardiovascular pathology (including arterial hypertension)
  • exposure to aggressive solar radiation
  • race
  • female
  • malnutrition (deficiency of monounsaturated fatty acids, antioxidants)

Symptoms

The main symptoms of dry age-related macular degeneration are:

  • the appearance of curvature of the contours of objects,
  • loss of near visual acuity (loss of letters when reading, which does not go away when using reading glasses).

The above symptoms lead to a gradual loss of central vision. Due to the gradual progression and painless course of this disease, it can remain invisible for a long time. Loss of clarity of objects, blurred vision over time transforms into the appearance of a persistent decrease in visual acuity and the appearance of a gray spot in front of the eye. Retinal lesions are usually bilateral.

Wet form of macular degeneration progresses faster – in a matter of weeks.A decrease in central vision is manifested by a distortion of the shape and size of objects, the appearance of a persistent dark spot in front of the eye. This form of the disease is often one-sided.

Diagnostics

Delay in the treatment of this disease can lead to irreversible consequences.

After clarifying the patient’s complaints, visual acuity (visometry) is determined, violations of the perception of the shape of objects are detected using a special test – the Amsler grid.When performing this test in a patient with a lesion in the central zone of the retina, the lines will be distorted, deformed.

Next, an ophthalmoscopy is performed – an examination of the fundus. This study allows you to diagnose both forms of macular degeneration – dry and wet. If a wet form of the disease is detected, then the following diagnostic research methods are performed.

Newly formed vessels are visualized in detail using fluorescent angiography, which allows you to determine their location, the area of ​​retinal lesion.

However, the most informative technique is optical coherence tomography. With its help, the thickness of various layers of the retina, the presence of fluid in it, the degree of germination of newly formed vessels into the layers of the retina are determined. The coherence tomograph has high clarity and scans the eye at the micrometer level. It is both a scanner and a microscope and makes it possible to detect even the smallest changes in the layers of the retina.

Prevention

Prevention of the appearance of age-related macular degeneration is reduced to the elimination of modifiable risk factors for its development: smoking cessation, normalization of the motor regimen, a balanced diet with a sufficient amount of vegetables and omega-3-unsaturated acids, correction of blood pressure and respect for the eyes.

Treatment

The dry form of macular degeneration is an irreversible degenerative process, therefore, unfortunately, there is no treatment that can restore visual acuity. However, there are ways to slow the progression of the disease. For this, the doctor usually prescribes biologically active additives, vitamins and minerals: zinc, copper, vitamins C and E, carotenoids, omega-3-unsaturated acids.

In case of a wet form of macular degeneration, to prevent neoangiogenesis (the formation of abnormal vessels), intravitreal injections of drugs that block vascular endothelial growth factor (Eilea or Lucentis drug) are performed.This procedure not only stops the process of loss of vision, but also contributes to its improvement in 30% of cases. In some cases, laser or photocoagulation of pathological vessels is used as an alternative, which also leads to a slight improvement in vision.

Patients with wet macular degeneration also need to take dietary supplements, vitamins and minerals to reduce the risk of loss of vision in the second eye.

Optical coherence tomography of the eye – Eye Surgery Center

OCT is a high-precision diagnostic method that allows you to investigate the state of the structural elements of the eye in a cross section and changes in them at the microscopic level with an accuracy of 4 microns.

Principle of the optical coherence tomography method

The principle of the method is close to that in ultrasound diagnostics, when tissues are examined using a reflected sound signal. OCT is based on the properties of tissues of different density to reflect the light signal directed at them in different ways.

OCT uses infrared radiation with a wavelength of 820 nm for scanning. The light beam of the coherent infrared range is focused on the target tissue, partially scattered and partially reflected from internal microstructures.The reflected signal reaches the receiving device, is subjected to computer processing and the result is displayed on the computer screen in the form of a color image. All information obtained during the study is saved in the form of graphic files – images in the database.

To improve perception, the density of tissues on a tomogram is transformed into a color image with different shades that reflect the properties of tissues. For this, a special color scale has been adopted, where media that are transparent to the light beam are indicated by black, and red and white tones correspond to denser structures.

The picture obtained during the study has a very high clarity, the method greatly expands the diagnostic capabilities of the ophthalmologist.

Advantages of the OCT method

  • The main advantage of OCT is the ability to study the finest structures of the organ of vision at the micron level, which ensures high accuracy of the result;
  • OCT allows not only to identify, but also to quantify and record the state of the retina, optic nerve, measure the thickness and determine the transparency of the cornea, examine the state of the iris;
  • Objectively assess the degree of pathological changes in tissues;
  • Precisely establish the localization of pathological foci, their number, size and other characteristics;
  • Light scanning is performed in different directions, which allows obtaining a three-dimensional image of the investigated elements and fixing them with a series of images.
  • The method is non-invasive, which means non-contact, does not require training, has no age restrictions;
  • It has no restrictions on the number of examinations, the possibility of multiple repetitions and saving the results in a computer database allows you to track the dynamics of the disease and control the results of treatment.

Informativeness of the method

As already mentioned, the method of light scanning of the eye, due to the accuracy of its results, opens up wide possibilities in the diagnosis of ophthalmic diseases.In terms of the degree of information content, optical coherence tomography can be compared with a histological examination, only in the case of OCT, a biopsy is not required.

OCT is most informative when examining the following eye structures:

  • Front and rear cameras;
  • Retinas;
  • Cornea;
  • Optic nerve.

Indications for optical coherence tomography

Due to the high sensitivity and accuracy of the method, almost any disease or damage to the organs of vision can be an indication for its appointment.Most often, OCT is prescribed for the diagnosis of the following pathological processes:

  • Macular edema, macular ruptures and pre-ruptures, dystrophic changes in the macula
  • Traction vitreomacular syndrome
  • Various types of retinopathies, retinitis pigmentosa;
  • Various opacities of the cornea, including those after laser vision correction operations;
  • Iridociliary dystrophies;
  • Diseases and injuries of the retina: degenerative processes, detachment, breaks
  • Myopia
  • Neoplasms
  • Acute conditions of retinal vessels: thrombosis, aneurysms, ruptures
  • Glaucoma: in glaucoma, OCT allows assessment of the functioning of the drainage system of the anterior chamber of the eye
  • Atrophy and other diseases of the optic nerve head
  • Diseases of the cornea: keratitis of various etiology; damage;
  • Structural anomalies

Optical coherence tomography is included in the complex of examinations in preparation for operations:

  • Laser vision correction (LASIK, SuperLASIK, FEMTOLASIK and others)
  • Keratoplasty
  • Lens replacement surgery.

Contraindications for carrying out

Since the method is non-invasive and non-contact, no absolute contraindications to it have been identified. In some cases, difficulties may arise when diagnosing OCT:

If the transparency of the media is reduced, it is not possible to obtain a high-quality image;

If the patient is not able to withstand motionless fixation of the gaze for the time required for scanning, this is 2-2.5 seconds.

Preparation for optical coherence tomography procedure

The examination does not imply special training, but for a more detailed study of the structures and obtaining a higher quality image, if necessary, it may be necessary to dilate the pupil with mydriatics.

How is the procedure

Optical coherence tomography is performed according to the following algorithm:

  • Patient registration including last name, first name, age, study number.
  • The patient is positioned in front of the fundus camera lens and is asked to fix his gaze on the mark. If the patient is visually impaired, he is asked to simply stare in front of him.
  • The camera of the device is brought closer to the eye under the control of the retinal image on the monitor. As soon as the image appears, the camera is stopped.
  • The camera is fixed at the found distance and the clarity of the image on the monitor is adjusted.
  • Scanning in progress.
  • Computer processing, alignment and cleaning of the received data from noise is carried out.
  • Measurement of the investigated objects, their optical density is analyzed.
  • Results are saved in the computer memory.

Interpretation of results

When decoding the data obtained, an analysis of the qualitative and quantitative indicators of the objects under study is carried out.

Qualitative (morphological) criteria:

  • Modification of the outer contour of structural elements and tissue layers;
  • Change of their mutual position;
  • Relationship of the study sites with adjacent tissues;
  • Increase or decrease in transparency;
  • Are there pathological inclusions?

Quantitative indicators (measurements):

  • Thinning or thickening of the structures and layers under study;
  • Determination of volume
  • Mapping the surface of interest.

Accounting for the results of optical tomography of the cornea

The identification of structural pathological changes in the cornea and their localization is carried out. The parameters of the found deviations are measured. The thickness of the cornea is calculated. Depending on the results obtained, methods are selected, the tactics of treatment, and tracking of dynamics are determined.In some situations, OCT is the only way to carry out the entire complex of diagnostics, since the method is non-contact.

Optical tomography of the iris

With OCT, the iris is studied:

  • Anterior boundary layer;
  • Stroma;
  • Pigment epithelium.

Optical tomography of the iris allows you to detect diseases at the earliest stages, called preclinical – when there are no obvious clinical symptoms.It is possible to diagnose the following iris abnormalities and diseases:

  • Frank-Kamenetsky syndrome;
  • Pseudoexfoliative syndrome;
  • Pigment dispersion syndrome;
  • Essential mesodermal dystrophy.

Optical computed tomography of the retina

Normal: the macula has the correct profile, the layers of the retina are of uniform thickness, without focal changes. The thickness of the layers is measured; in the area of ​​the fossa, the normal thickness of the retina is about 161-163 microns, at the edge – 234-236 microns.

OCT of the optic nerve

The thickness of the layer of nerve fibers is measured, which directly correlates with deviations in functional indicators, especially with changes in visual fields. Optical scanning of the optic nerve head can be carried out in the annular and radial directions, which makes it possible to study its structure on a cross section and, after computer processing, to obtain both averaged indicators and data on specific segments (on the hour dial) or quadrants (upper, lower, temporal, nasal).The data obtained are compared with the standard indicators of the norm.

Such a depth and accuracy of localization of foci makes it possible to identify both diffuse changes, for example, diffuse atrophy, and local defects of the optic nerve head in neurodegenerative diseases of the retina.