High-resolution optical coherence tomography in pathology of the vitreomacular interface.

Aim: This study investigates the diagnostic capabilities of high-resolution optical coherence tomography (HR-OCT) compared to spectral domain optical coherence tomography (SD-OCT) in detecting detailed microstructural changes in vitreomacular pathology. Methods: This was a prospective cross-sectional study of eyes with vitreomacular interface disease. We included patients with epiretinal membrane (ERM), macular hole (MH), lamellar hole (LH), and vitreomacular traction (VMT). Each patient underwent a comprehensive ophthalmic exam followed by retinal imaging with both SD-OCT and HR-OCT. Images were analyzed for the presence of key biomarkers and the two OCT modalities were compared. Results: The study cohort consisted of 18 patients with a mean age of 66 years (SD 8.9) and (61.1 %) had biological male sex. HR-OCT provided a superior subcellular view, including superior identification of rod cell nuclei in the outer nuclear layer (ONL) and ganglion cell layer (GCL) and enhanced visualization of biomarkers such as the "cotton ball sign" coupled with IZ disruption (33.3 % vs 5.6 % for HR-OCT and SD-OCT groups, respectively, p = 0.0042). Hyporeflective dots in the ONL, indicative of rod cell nuclei, were seen in 88.9 % of HR-OCT cases but were completely undetectable with SD-OCT (p < 0.0001). Inter-grader reliability was strong, with Cohen's Kappa values for most biomarkers ranging from 0.78 to 0.89. Conclusions: HR-OCT significantly improves the detection of subcellular features and biomarkers in vitreomacular interface disorders. This device could enhance early diagnosis and monitoring of vitreomacular diseases, with potential correlations to functional outcomes.