Editorial
Intermediate segment OCT
OCT de segmento intermedio
J.I. Fernández-Vigoa,b,
, L. De-Pablo-Gómez-de-Liañoc, B. Kudsiehb,d, J.Á. Fernández-Vigob,e
Corresponding author
a Servicio de Oftalmología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
b Centro Internacional de Oftalmología Avanzada, Madrid, Spain
c Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
d Servicio de Oftalmología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
e Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
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Fernández-Vigo, L. De-Pablo-Gómez-de-Liaño, B. Kudsieh, J.Á. Fernández-Vigo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" "email" => array:1 [ 0 => "jfvigo@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "De-Pablo-Gómez-de-Liaño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "B." 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"apellidos" => "Fernández-Vigo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro Internacional de Oftalmología Avanzada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "OCT de segmento intermedio" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Optical coherence tomography (OCT) is an imaging technique based on low optical coherence interferometry that produces real-time images of live tissue with high resolution through rapid, non-invasive scanning. The principle of OCT was described by Huang et al. in 1991.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> OCT was first developed in ophthalmology with the aim of evaluating the posterior segment, mainly the macula and the optic nerve. Shortly afterwards, in 1994, Izatt et al. obtained the first image of the anterior segment, broadening its usefulness and focusing the different authors of the time on the study of the cornea, anterior chamber and the iridocorneal angle.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">More recently, due to the great development of this imaging technique, its range of use has been extended to what we call in this editorial "intermediate segment OCT". This intermediate ocular segment (which would paraphrase the term intermediate uveitis) refers to the portion of the ocular wall that extends from the area of the scleral spur and the ciliary body to the <span class="elsevierStyleItalic">ora serrata</span> and extraocular muscles, which is the posterior limit currently visible by this technique. Given the greater speed of acquisition, the high image resolution and the greater penetration into tissues offered by the most modern OCT devices, it is possible to visualise structures that were inaccessible in the first OCT models such as the ciliary muscle, din addition to ifferentiating the conjunctiva, episclera and sclera, observing the <span class="elsevierStyleItalic">lamina fusca</span>, or identifying the extraocular muscles or the transition area of the more peripheral or preequatorial retina to the <span class="elsevierStyleItalic">ora serrate</span>.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The "intermediate segment OCT" has multiple clinical uses that have been described in recent years with the development of this technique and which could be grouped as follows:</p><p id="par0020" class="elsevierStylePara elsevierViewall">Evaluation of the ciliary body (<span class="elsevierStyleSmallCaps">CB</span>) to study its morphology and position, as well as its relationship with the angle opening and with the ciliary sulcus of which it forms part. The first studies to evaluate the ciliary body were carried out using ultrasound biomicroscopy (UBM), but nowadays OCT is increasingly used to study it. Thus, by means of OCT it has been observed that there is a wide range of dimensions of CB in the normal population, being elongated in myopia and decreasing its dimensions with age.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Various studies have evaluated the CB in different types of glaucoma, such as angle closure or malignant glaucoma, and a smaller size has been observed, which produces a more anterior location of the lens.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition, "intermediate segment OCT" is very useful in the case of suspected ciliary detachment<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and can contribute to the study of CB cysts or tumours. Finally, numerous studies have been conducted on the ciliary muscle and its relationship with the uveoscleral pathway, as well as the changes it undergoes during accommodation in an attempt to contribute to the knowledge of the mechanisms involved in presbyopia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study of the extraocular muscles in order to know their position with the aim of planning surgery or reintervention, as well as to study the thickening of the most proximal portion of the muscle in Graves' ophthalmopathy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The evaluation of eye wall involvement in episcleritis and scleritis, analysing the location of the involvement, changes in scleral thickness and response to treatment.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study of the anatomy and changes in the drainage routes of the aqueous humour at a post-trabecular level or in the scleral collectors after different glaucoma treatments such as laser or surgery.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The evaluation of the competence and course of sclerotomies after vitrectomy surgery, as well as of vitreous incarceration, and of the changes that occur after intravitreal injections of anti-angiogenic drugs or pars plana pharmacological implants.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study of intermediate uveitis: assessing the involvement in pars planitis through the presence of cyclic membranes or vitreous condensation, as well as uveal thickening at that level when there is a sarcoid granuloma or in Harada disease.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Evaluation of the position of pre-crystalline or sutured lenses in the ciliary sulcus, to analyse whether they are actually supported in the sulcus or the zonula and sutured in the sulcus or the ciliary processes or the pars plana (UBM being even higher for this purpose).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Also, "intermediate segment OCT" may contribute to improve the knowledge of the physiopathology of some of the most frequent diseases in ophthalmology, such as in central serous chorioretinopathy in which an increased anterior scleral thickness has been recently described which could suggest a generalized scleral stiffness and that this plays a key role in the difficulty of reabsorption of subretinal fluid that typically occurs in this entity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Also very recently the existence of anterior scleral thinning in the lower quadrant has been published, which is more pronounced the greater the degree of myopia. The authors claim this could be a biomarker for the progression of myopia.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Also interestingly, in the field of glaucoma, it has been described that anterior scleral thickness correlates with pachymetry in normotensive glaucoma, but not in open-angle glaucoma.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It should be remembered that OCT still has some limitations and continues to be clearly surpassed by UBM due to its greater penetration for the study of structures such as the posterior chamber, ciliary processes or the zonula, and is therefore superior for the study of the position of intraocular lenses and ciliary body masses.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Due to the continuous progress of this technology, a great development of "intermediate segment OCT" is expected in the coming years leading to a greater and more detailed knowledge of this ocular region, allowing us to improve and expand the current clinical and visual utilities, for example the anterior and posterior insertions of the base of the vitreous, the Salzman hiatus or the anterior and posterior ciliary ligaments, ciliary processes, as well as the distinction between tendon and muscle tissue of the extraocular muscles or the differentiation between scleral vessels vs. collectors of the aqueous drainage system. We are therefore confident that the progress achieved in this technology for the intermediate segment of the eye can contribute to improve the diagnosis and treatment of our patients across the range of ophthalmological disciplines.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">This study has not received any funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Vigo JI, De-Pablo-Gómez-de-Liaño L, Kudsieh B, Fernández-Vigo JÁ. 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