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Jyoti R. Dugar, Carlos Alexandre A. Garcia Filho, Zohar Yehoshua, Giovanni Gregori, William Feuer, Philip J. Rosenfeld; Qualitative Analysis Of Intraretinal Pigment Using en-face SDOCT Imaging. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2667.
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To describe a new method for identifying the presence and distribution of intraretinal pigment clumps derived from retinal pigment epithelial cell migration using SDOCT imaging.
Patients with the diagnosis of age-related macular degeneration (AMD) were enrolled in a prospective SDOCT imaging study. Patients were followed for a minimum of 6 months. Eyes were imaged using the 200x200 A-scan raster pattern (Cirrus HD-OCT, Carl Zeiss Meditec)) centered on the fovea. En face images were obtained by summing the OCT intensities in a region bounded by the retinal pigment epithelium (RPE) segmentation line and a line parallel to the RPE segmentation line but located at distances of 40 µm, 60 µm, 90 µm and 120 µm above it. A second set of en-face images was obtained by translating each of these regions upwards by 20 µm.
A total of 16 eyes with drusenoid detachments of the RPE were included in this study. Mean follow-up was 23.8 months. The drusenoid RPE detachments persisted in 8 eyes (50%), evolved to geographic atrophy (GA) in 5 eyes (31.25%), developed CNV in 2 eyes, and resolved without formation of GA or CNV in 1 eye. During follow-up, retinal pigment was observed on exam, color fundus imaging, and SDOCT imaging in 9 out of 16 eyes (56.3%). Intraretinal pigment clumping was observed in all 5 eyes developing GA, in 2 out of 8 eyes with persistent RPE detachments, in one eye developing CNV, and in the one eye with resolution of the PED in the absence of obvious disease progression. Intra-retinal pigment was observed in all en face images of the same patient. Images obtained by shifting the RPE contour by 20 µm and using a slab thickness of 40 µm and 60 µm provided the best visualization of the pigment.
SDOCT en face imaging can provide qualitative assessment of pigment clumps within the central macula by using a slab based on the RPE segmentation contour but shifted 20 µm above the actual RPE boundary. The exclusion of the RPE and the photoreceptor IS/OS junction from these images may be responsible for the better contrast and identification of the pigment clumps.
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