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• W2774148973 abstract "The choroid has the highest blood flow of any structure in the human body with specific hemodynamic regulatory mechanisms that differ from those of the retinal circulation. It is modulated by a strong autonomic input and is largely insensitive to light stimulation and to differences in blood oxygenation (Kur et al. 2012). Detailed imaging of the choroidal layers has recently been facilitated by the introduction of new imaging modalities such as enhanced depth imaging optical coherence tomography (EDI-OCT) and swept source OCT (SSOCT) (Mrejen & Spaide 2013). One of the more important limitations of routine OCT lies with the two-dimensional (2D) display of static images on a computer screen, hampering characterization of clinically important structural features, such as depth and spatio-anatomical localization. This drawback has been circumvented by the advent of three-dimensional (3D) imaging techniques that provide detailed and problem-oriented information on both the retinal and choroidal compositions, including volume rendering (Spaide 2015). Similar to routine OCT, this technique is restricted to 2D display in computer screens. Recently, a new method has been reported in which printing of OCT data has been described in a patient with an epiretinal membrane (Choi et al. 2016). This study describes for the first time the use of a 3D printing technique, speckle-free 3D choroidal angiography and tumoropsy (Maloca et al., 2016), applied to 3D printing of choroidal vessels and pigmented choroidal tumours. In this study, retrospective 1050 nm OCT volumes were collected from healthy eyes and eyes with pigmented choroidal tumours to evaluate choroidal vessel architecture and tumour 3D printing. Inclusion criteria were age >18 years, adequate media clarity for fundus imaging, good central fixation and visual acuity >20/20. Exclusion criteria were nystagmus, poor cooperation and dry eye syndrome. All subjects underwent a comprehensive baseline ophthalmologic examination to exclude any potential retinal or choroidal disorders. Written informed consent was obtained from all patients, and approval was attained from the local ethical committee in accordance with the Declaration of Helsinki and in compliance with data protection regulations. All retinal OCT volumes were acquired in nondilated pupils with a SSOCT device (DRI OCT Triton; Topcon, Tokyo, Japan). The SSOCT volume was captured in a 3D scan pattern over a 3 × 3 mm, 6.0 × 6.0 mm or 9 × 12 mm area, respectively, centred on the region of interest (ROI) with 256 B-scans and a scan density of 512 × 256 pixel. Image processing was performed with a previously published 3D speckle-noise removal method with structure preservation (Gyger Cyrill et al. 2014). For choroidal vessel lumen and tumour extraction, the hyporeflective choroidal vessels and hyperreflective tumour structures, respectively, were manually segmented by threshold filtering in the speckle-free OCT volume (imagej v1.467; ref – Rasband, W.S., imagej, US National Institutes of Health, Bethesda, MD, USA, https://imagej.nih.gov/ij/, 1997–2016) by extracting lumen information from the scan volume. The 3D information of the processed choroid was saved as obj-file which was then enhanced by sealing gaps in the mesh or removing obvious artefacts. Ultimately, a 3D printable OCT model was obtained (Fig. 1). Some models were sent for 3D stereolithography printing in transparent resin or constructed from a hardened liquid (i.materialise, i.Materialise HQ, Leuven, Belgium). One model was submerged in a bath of carat gold (24K) to increase robustness and durability. Other models were printed in additive fused deposition modelling using a gypsum powder for testing combined vessel and tumour structure printing, respectively (3d-prototyp.com, Stans, Switzerland). Design specifications for 3D printing included minimum wall thickness of 1 mm, minimum details of 0.5–1 mm and a size of 130 × 200 × 10 mm. In addition, 3D prints of 300 × 300 × 23 and 210 × 390 × 23 mm have been made (Fig. 2). This corresponds to a magnification of up to 70–100 times. Analysis of 3D print models allows a detailed spatio-anatomical characterization of choroidal vessels and their interactions with other ocular structures and pigmented choroidal tumours. Moreover, the ability to visually represent and magnify the choroidal vasculature allows these models to serve didactic purposes, more specifically as tactile models used in medical and patient education. The use of the 3D models offers new insight into the spatial organization of ocular structures and as such, has already been used for medical teaching purposes with not only medical students and medical staff but also patients and their relatives, including visually-impaired or blind patients. Choroidal vessel analysis and selective laser sintering 3D printing technology were earlier tested in our first choroidal vessel printing prototyping (Fig. 2A). The polyamide model was constructed from a white, fine, granular powder which renders a sandy, granular and slightly porous surface. The 3D print proved to be durable, as evidenced by the preservation of the architecture of smaller vessels over time. The material did not change in colour and showed no inherent brittleness. Thick collecting branches were seen stemming from choroidal vessels. Vessel density was highest in the fovea. The choriocapillaris could not be displayed due to the inability to image the vascular detail of this layer with our current OCT technology. There were, however, numerous vascular stumps, which ran perpendicular from the choroidal vessel surface towards the retina, which possibly correspond to Sattler's feeding channels to the choriocapillaris. The peripapillary choroidal vessels formed a discontinuous ring with gaps. The larger-sized 3D prints of the choroid (Fig. 2B) enhanced the choroidal vascular network with a trade-off in structural resolution. This is likely to occur due to the lower local resolution during larger-volume OCT acquisition or due to postprocessing settings. As a consequence, the peripapillary vessels appeared more round and bulky and fewer small branching vessels were recognizable. Interestingly, the foveolar choroidal vessels were extremely dense and compact. This may arise due to real existing anatomical structures or to segmentation artefacts. Tumour 3D printing (Fig. 3) revealed differing features, likely related to the size and volume of the tumour. While the smaller tumour of Fig. 1A–D had palpable openings and channels, the large tumour was a solid mass with no visible openings (Fig. 3B). This 3D print demonstrated the interdigitation border between the tumour and surrounding choroidal vessels which can potentially represent a new marker for monitoring tumour size, growth or response to therapy. The tumour surface was smooth as this area was modelled and outlined by the intact retinal pigment epithelium/Bruch's membrane complex. The tumour surface, however, showed multiple lines which correspond to posterior retinal vessel projection artefacts described in other studies. The two-colour model depicted the choroidal tumour in red. Unfortunately, the material was very brittle which resulted in damage to several choroidal vessels after manipulation. The polymer gypsum powder material was not suitable for demonstrations to a wide audience due its vulnerability. This study was limited to 13 choroidal 3D prints due to time-consuming data processing and relatively high 3D printing costs. The printing costs are likely to decrease over time as 3D printing and printers becomes more ubiquitous. There is no correlation with histopathology as none of these eyes were enucleated. The segmentation was performed once, manually, by two users, and therefore, reliability of the segmentation must be improved in future studies. It is likely smaller vessels of the choroid were not printed through a combination of them not having a dark lumen. This study reports the first 3D printing of choroidal vessels and choroidal tumours based on SSOCT volume data. These models shed new light into the 3D architecture of the choroidal vessels and the interactions of choroidal tumours and the surrounding vascular network. The 3D viewing may be helpful in assessing the choroidal vasculature and may have particular utility in infiltrative or inflammatory diseases affecting the choroid." @default.
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• W2774148973 date "2017-12-14" @default.
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• W2774148973 title "3D printing of the choroidal vessels and tumours based on optical coherence tomography" @default.
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