The Application of Ultra-wide-field Scanning Laser Ophthalmoscopy in the Detection of Tuberous Sclerosis Complex-associated Retinal Astrocytic Hamartomas

  Objective  To evaluate the clinical value of ultra-wide-field scanning laser ophthalmology(UWF-SLO) in tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartoma (RAH) by comparing the detection rate of RAH lesions between UWF-SLO and traditional color fundus photography (CFP).

  Methods  The clinical data of patients with established TSC-associated RAH diagnosis by the Department of Internal Medicine and Ophthalmology of Peking Union Medical College Hospital from October 2018 to March 2021 were retrospectively reviewed. The detection rate of TSC-associated RAH lesions between 9-fixation-point CFP and UWF-SLO was compared with fundoscopic recordings as the reference standard. The factors that may affect the detection of lesions were analyzed.

  Results  A total of 24 patients with TSC-associated RAH were included in this study. UWF-SLO (composed pseudocolor dual-channel images) performed better than 9-fixation-point CFP in the identification of TSC-associated RAH lesions98.6%(138/140)vs. 65.7%(92/140), P < 0.001, especially for RAH lesions located in the mid and far peripheral retina (P < 0.001). In UWF-SLO, red-channel (633 nm) images showed significantly lower detection rate than green-channel (532 nm) 52.1% (73/140) vs. 98.6% (138/140), P < 0.001 and composed dual-channel images52.1%(73/140) vs. 98.6%(138/140), P < 0.001. Undetected RAH lesions in red-channel UWF-SLO images were all type 1 RAH, and the lession thickness was significantly higher in the detected group than that in the undetected group (527.3±134.7)μm vs. (389.7±76.6)μm, P < 0.001, while the location and retinal involving depth of type 1 RAH were not significantly different(P=0.812, P=1.000).

  Conclusions  Compared to CFP, UWF-SLO may be associated with higher detection rate of TSC-associated RAH and could be applied to the evaluation of TSC-associated RAH.