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OCT Tomografia Ottica ad alta definizione (Spectral domain) e tridimensionale
E' una tecnica di diagnosi per immagini che utilizza raggi di luce coerente e che permette l’analisi delle strutture retiniche mediante sezioni tomografiche verticali ad alta risoluzione della retina. Mentre la fluorangiografia e l’angiografia al verde di indocianina permettono di visualizzare gli strati della corioretina (semplificando molto la retina per la fluorangiografia e la coroide per la videoangiografia al verde di indocianina), l’OCT permette di visualizzare delle sezioni della retina.
In breve tempo ha permesso di ampliare in modo notevole le nostre conoscenze sulle malattie retiniche e sul glaucoma. Le esperienze accumulate ed i miglioramenti tecnici (siamo già alla V generazione spectral domain di strumenti OCT) rendono sempre più utile ed affidabile questa tecnica non invasiva, che, data la sua alta precisione, è diventata indispensabile permettendo di completare l’esame fluorangiografico e, in certi casi, di sostituirlo.
A che serve l’OCT?
Permette di diagnosticare e seguire l’evoluzione di numerose affezioni retiniche, decidere se operare e quando, decidere se eseguire iniezioni intravitreali e quando . L’OCT è un esame affidabile, sensibile di altissima precisione, soprattutto con gli ultimi strumenti ad alta definizione. Le immagini mostrano dettagli delle dimensioni di millesimi di millimetri. Le immagini sono riproducibili da diversi strumenti e diversi operatori; l’esecuzione delle scansioni è rapida, semplice e soprattutto non implica la somministrazione di sostanze di contrasto. Le tomografie ottiche della retina sono altamente riproducibili. Dei punti di repere permettono di ritrovare la localizzazione esatta delle tomografie e di confrontare le immagini negli esami successivi, anche a distanza di anni.
Come si esegue?
Le modalità di esecuzione dell’OCT sono similari a quelle dell’esame con ultrasuoni ma con notevoli vantaggi rispetto a questa metodica. Il paziente guarda dentro l’obiettivo di una telecamera, generalmente senza istillazione di gocce per dilatare la pupilla. Vengono eseguite le riprese in pochi minuti , senza abbagliamento. Utilizzando un raggio luminoso, si evita il contatto con il bulbo. Rispetto alle angiografie non è necessaria l’iniezione di sostanze di contrasto. Ogni immagine (sezione ottica ) è ottenuta in una frazione di secondo. L’esame completo dura 10 minuti. Una mappa retinica è ottenuta in pochi secondi. Le immagini ottenute sono precise?
In quali malattie è utile eseguire l’OCT?
La sua utilità è stata dimostrata in numerose patologie:
• degenerazioni maculari senili e giovanili con o senza neovascolarizzazioni sottoretiniche
• retinopatia diabetica
• corioretinopatie acute e croniche
• edemi maculari di varie origini
• distacchi sierosi ed emorragici della retina e dell’epitelio pigmentato
• neovascolarizzazioni intraretiniche e preretiniche
• atrofia retinica
• fori e pseudori maculari
• lesioni dell’interfaccia vitreoretinica. Trazioni vitreoretiniche.
• retinoschisi foveale
• membrane epiretiniche
• glaucoma