Delhi Journal of Ophthalmology

Multicolour Imaging in Bietti’s Crystalline Dystrophy

Mridhula Sekar, Guruprasad Ayachit, Shrinivas Joshi, Kathyayini S V, Apoorva Ayachit
M M Joshi Eye Hospital, Hosur, Hubballi, Karnataka, India

Corresponding Author:

Apoorva Ayachit
MS, DNB, FVRS, FICO, FAICO(VR)
M M Joshi Eye hospital, Gokul Road,  Hosur, Hubballi - 580021, Karnataka, India
Email id: apoorva.ag@gmail.com

Received: 18-JUN-2019

Accepted: 15-AUG-2019

Published Online: 27-FEB-2020

DOI:http://dx.doi.org/10.7869/djo.513

Abstract
Bietti crystalline dystrophy (BCD) is a rare dystrophy that is characterized by numerous crystals in the peripapillary retina and the posterior pole. Imaging of the crystals has been done on various modalities like autofluorescence, infrared imaging, optical coherence tomography and adaptive optics. To the best of our knowledge, the multicolour (MC) imaging features of BCD have not been described. With our report we demonstrate that MC imaging provides valuable insights about the location of the crystals in the retinal layers.

Keywords :Bietti, Multicolor, OCT, reflectance

We present our experience with multicolour (MC) imaging in a case of Bietti’s crystalline dystrophy (BCD). A 28 year old male presented to us with ocular trauma and was incidentally detected to have ocular findings consistent with BCD. Spectral domain optical coherence tomography showed hyperreflective dots corresponding to the crystals at multiple retinal layers along with fragmented ellipsoid layer and outer retinal tubulations. (Figure 1) Owing to the crystals located at different levels in the retina they were distributed differently in the reflectance images in the MC photographs. Since most crystals were at the level of the outer retina and RPE, they were most numerous in the infrared reflectance photographs and fewer in number in the blue and green reflectance images. (Figure 2)


Figure 1: (Top) - SD-OCT of right eye. Horizontal line scan showing multiple hyperreflective spots (crystals) at various levels of the retina. Outer retinal tabulation also noted. (Yellow solid arrow). (Bottom) - Horizontal line scan of left eye showing similar crystalline deposits in various retinal layers.


Figure 2: (Top- Right eye, Bottom- left eye) - Composite MC Image showing numerous crystals in IR image. GR shows fewer crystals. BR image shows far fewer crystals compared to IR and GR images.

Kumar et al described multimodal imaging of BCD and provided interesting insights into the imaging of crystals. The authors have suggested that red- free photographs and enface OCT help in better visualization of crystals in this rare retinal dystrophy.1 MC photography uses confocal scanning laser ophthalmoscopy (cSLO) and utilizes three different wavelengths of light to capture reflectance images (blue reflectance- BR 488 nm, green reflectance- GR 515 nm, infrared reflectance IR- 820 nm). Details of inner retina are seen best with BR, GR helps in visualization of intraretinal pathologies and IR helps in visualizing structures at outer retina and RPE.2 Various SD-OCT studies have shown BCD crystals concentrated at the inner surface of the RPE.3 This is consistent with better visualization on IR in multicolour imaging.4 To the best of our knowledge, MC imaging features of BCD have not been reported. Our case demonstrates that MC imaging of BCD allows localization of crystals in different retinal layers in a single composite image and adds to its multimodal imaging features.

References
  1. Kumar V, Gadkar A. Multimodal imaging of Bietti's crystalline dystrophy. Indian Journal of Ophthalmology 2018; 66(7):1024.
  2. Tan A, Fleckenstein M, Schmitz-Valckenberg S, Holz F. Clinical Application of Multicolor Imaging Technology. Ophthalmologica 2016; 236(1):8-18.
  3. Kojima H, Otani A, Ogino K, et al. Outer retinal circular structures in patients with Bietti crystalline retinopathy. British Journal of Ophthalmology 2012; 96:390-393.
  4. Y Yanagi, Y Tamaki, and H Fukushima. Fine retinal crystalline deposits observed by confocal scanning laser ophthalmoscopic examination using infrared light. Br J Ophthalmol 2003; 87(4): 509–510.

CITE THIS ARTICLE

Sekar M, Ayachit G, Joshi S, Kathyayini SV, Ayachit AMulticolour Imaging in Bietti’s Crystalline Dystrophy.DJO 2019;30:74-75

CITE THIS URL

Sekar M, Ayachit G, Joshi S, Kathyayini SV, Ayachit AMulticolour Imaging in Bietti’s Crystalline Dystrophy.DJO [serial online] 2019[cited 2020 Apr 7];30:74-75. Available from: http://www.djo.org.in/articles/30/2/Multicolour-Imaging-in-Biettis-Crystalline-Dystrophy.html