Time Domain OCT. Spectral Domain OCT X

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1 Time Domain OCT Spectral Domain OCT X

2 Multiple A-Scans OCT B-Scan Scanning Mirror Raster Scan Multiple B-Scans through Macula Thickness Maps Automated Detection μ μ μ μ μ μ μ

5 * * * * * *

International Nomenclature for OCT Meeting Consensus Normal OCT Terminology

Preretinal Space Nerve Fiber Layer Ganglion Cell Layer Inner Plexiform Layer

OPL) Outer Nuclear Layer Outer Segments Sattler s Layer (inner Choroid) Haller s

RPE/ Bruch s Complex Ellipsoid Zone Interdigitation Zone Choroid Sclera Junction

Layer Layer (Outer Choroid) Abnormal Choriocapillaris RPE/ Bruch s Complex

6 International Nomenclature for OCT Meeting Consensus Normal OCT Terminology Henle s-onl junction (subtle) Formed Vitreous Posterior Cortical Vitreous Preretinal Space Nerve Fiber Layer Ganglion Cell Layer Inner Plexiform Layer Inner Nuclear Layer Outer Plexiform Layer (dendritic) Henle Fiber Layer (axonal OPL) Outer Nuclear Layer Outer Segments Sattler s Layer (inner Choroid) Haller s Layer (Outer Choroid) Choriocapillaris Myoid Zone External Limiting Membrane RPE/ Bruch s Complex Ellipsoid Zone Interdigitation Zone Choroid Sclera Junction International Nomenclature for OCT Meeting Consensus Normal OCT Terminology Henle s-onl junction (subtle) Formed Vitreous Posterior Cortical Vitreous Preretinal Space Normal Nerve Fiber Layer Ganglion Cell Layer Inner Plexiform Layer Inner Nuclear Layer Outer Plexiform Layer (dendritic) Henle Fiber Layer (axonal OPL) Outer Nuclear Layer Outer Segments Sattler s Layer (inner Choroid) Haller s Layer (Outer Choroid) Abnormal Choriocapillaris RPE/ Bruch s Complex Interdigitation Zone Ellipsoid Zone Myoid Zone External Limiting Membrane OPL* ONL ELM RPE Choroid Sclera Junction

7 Premature Infant Retina OPL ONL RPE OPL ONL RPE Normal

8 Central Retinal Thickness Paracentral Acute Middle Maculopathy (Retinal Capillary Ischemia)

Microscope-Integrated Swept-Source OCT Prototype Duke Microscope Integrated OCT prototype system is research system developed by Duke BME (Izatt laboratory).

9 Microscope-Integrated Swept-Source OCT Prototype Duke Microscope Integrated OCT prototype system is research system developed by Duke BME (Izatt laboratory). Use of this system in human subjects was with prior consent and under IRB approved protocols. FULL-THICKNESS MACULAR HOLE Microscope-Integrated Swept-Source OCT Prototype Swept Source OCT (1050 nm) 100 khz A-line rate Peak sensitivity: 99 db, 3.9 mm falloff (- 6dB), up to 7.4 mm axial imaging range, 7.8 µm axial resolution FULL-THICKNESS GPU-based custom software MACULAR HOLE Real-time acquisition, processing, volumetric rendering at 100k A-line rate Stream-saving 4D recording

Myopic Macular Holes Platelet Rich Plasma FULL-THICKNESS MACULAR HOLE Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets.

MYOPIC TRACTION FOVEOSCHISIS Myopic Macular Holes Platelet Rich Plasma FULL-THICKNESS MACULAR HOLE MACULAR HOLE RETINAL DETACHMENT MYOPIC TRACTION FOVEOSCHISIS Adjunctive Therapeutic Options FOR

10 Myopic Macular Holes Platelet Rich Plasma FULL-THICKNESS MACULAR HOLE Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains and releases through degranulation several different growth factors and other cytokines that stimulate healing of tissue. MYOPIC TRACTION FOVEOSCHISIS Myopic Macular Holes Platelet Rich Plasma FULL-THICKNESS MACULAR HOLE MACULAR HOLE RETINAL DETACHMENT MYOPIC TRACTION FOVEOSCHISIS Adjunctive Therapeutic Options FOR MYOPIC MACULAR HOLES Platelet Rich Plasma Internal Maneuvers and Adjuncts Wide ILM peeling 1 Foveolar-sparing ILM peel 2-3 Inverted ILM flap 4-7 Autologous ILM transplantation 8 Lens capsular flap transplantation 9 Autologous neurosensory retinal free flap 10 Autologous blood 11 Autologous platelet-rich plasma 12 Drainage retinotomy 13 Primary silicone oil tamponade External Adjuncts Scleral imbrication Episcleral macular buckling Adjustable macular buckling Posterior scleral reinforcement Suprachoroidal macular buckling Zhang et al. Retina Shimada et al. Am J Ophthalmol Ho et al. Retina Michalewska et al. Retina Kuriyama et al. Am J Ophthalmol Chen & Yang. Am J Ophthalmol Olenik et al. Retina. 2016) 8 Morizane et al. Am J Ophthalmol Chen & Yang. Retina Grewal & Mahmoud. JAMA Ophthalmol Lai et al. Ophthalmology Figueroa et al. Eur J Ophthalmol Jeon et al. Retina Meng et al. Retina Hong et al. BMC Ophthalmol Baba et al. Retina Fujikawa et al. Retina Bured-Jelstrup et al. Br J Ophthalmol Mura et al. Br J Ophthalmol Cacciamani et al. Retina Forlini et al. Retin Cases Brief Rep Zhu et al. Br J Ophthalmol Qi et al. Retina El Rayes. Retina El Rayes. Dev Ophthalmol. 2014

Platelet Rich Plasma Preparation Disappearance of aprp

Successful repair of myopic MHRD was achieved in all 2.

SILICONE OIL BI-MENISCOID PLUG CASE Summary of Key Points

typically observed at POD #1 SILICONE OIL CONDENSED

11 Platelet Rich Plasma Preparation Disappearance of aprp was between POM #1-1.5 Summary of Key Points 1. Successful repair of myopic MHRD was achieved in all 2. aprp can be visualized in vivo using intraoperative OCT SILICONE OIL BI-MENISCOID PLUG CASE Summary of Key Points 3. Resolution of foveoschisis and foveal detachment was typically observed at POD #1 SILICONE OIL CONDENSED BI-MENISCOID PLUG 4. Disappearance of aprp was typically observed between POM 1-1.5

Proposed Biomechanism and Observations OF AUTOLOGOUS PLATELET-RICH PLASMA (aprp) 1.

Fibrin deposition and cross-linking Activated platelets convert fibrinogen to fibrin; fibrin polymerizes Factor XIII cross-links the fibrin polymers

Wound-healing response Serum- and platelet-derived growth factors are elaborated at the site of injury Inflammatory and glial cells phagocytose debris

12 Proposed Biomechanism and Observations OF AUTOLOGOUS PLATELET-RICH PLASMA (aprp) 1. Platelet aggregation Platelet activation is triggered by contact with retinal tissue and/or RPE 2. Fibrin deposition and cross-linking Activated platelets convert fibrinogen to fibrin; fibrin polymerizes Factor XIII cross-links the fibrin polymers into a mesh-like structure Instantenous formation of fibrin plug 3. Wound-healing response Serum- and platelet-derived growth factors are elaborated at the site of injury Inflammatory and glial cells phagocytose debris and repair damaged tissue Gradual remodelling of the extracellular matrix promotes wound contraction Ochakovski et al. Front. Neurosci 2017 Ochakovski et al. Front. Neurosci Bharti et al. IOVS 2014 We successfully acquired live high quality 4D MIOCT images: - en face Summed Voxel Projection (SVP) - B-scans - Volumetric rendering Maneuver 1 SR bleb creation

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