September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Unilateral isolated foveal hypoplasia
Author Affiliations & Notes
  • Adam Jacobson
    St. Joseph's Hospital Health Center, Syracuse, New York, United States
    Ophthalmology, Westchester Medical Center, Westchester, New York, United States
  • Thaddeus Wandel
    Ophthalmology, Westchester Medical Center, Westchester, New York, United States
  • Alan D Springer
    New York Medical College, Valhalla, New York, United States
  • Footnotes
    Commercial Relationships   Adam Jacobson, None; Thaddeus Wandel, None; Alan Springer, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 79. doi:
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      Adam Jacobson, Thaddeus Wandel, Alan D Springer; Unilateral isolated foveal hypoplasia. Invest. Ophthalmol. Vis. Sci. 2016;57(12):79.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Foveal hypoplasia is described as an absent or shallow pit, thickened inner retina, shortened outer segments and an increased retinal thickness. Bilateral foveal hypoplasia is often associated with other ocular comorbidities, including albinism, aniridia, microphthalmia and retinopathy of prematurity. We report the first case of unilateral isolated foveal hypoplasia.

Methods : The patient was a 67 year old female glaucoma suspect with a history of bilateral posterior vitreous detachments. A vertical, high density 5 line Cirrus optical coherence tomography (OCT) raster scan was performed (4,096 A-scans/B-scan). The middle B-scan was analyzed using a longitudinal reflectivity profile to determine laminar thicknesses. Mean pixel intensity of the ONL was used to assess for edema. The scan was centered on the foveola as indicated by the presence of a fovea externa.

Results : The patient had 20/20 vision in both eyes, with normal OD foveal morphology (Fig. 1A). The OS scan showed an epiretinal membrane (ERM) overlying a hypoplastic fovea (Fig. 1B). There were no signs of retinal holes, separations or inward “tenting” of the foveal tissue. OS retinal thickness was 3.3 times greater than OD, as measured from the inner (ILM) to the external limiting membrane (ELM; 346.1 µm vs. 104.3 µm). Inner segment ellipsoid (IS-E) to retinal pigment epithelium (RPE) distance was the same for both eyes (66.2 µm) as was ELM-RPE distance (96.6 µm). Thus, photoreceptor lengths for both eyes were the same. Mean pixel intensity of the OD and OS ONLs were 16 and 13, respectively (Fig. 2), suggesting the absence of fluid.

Conclusions : Quantitative analyses suggests the patient presented with unilateral foveal hypoplasia, including an absent foveal pit and greater overall retinal thickness. It is unlikely that the observed morphology is secondary to edema caused by the ERM for several reasons. First, retinal deformation from an ERM is caused by edema, which we ruled out by measuring mean pixel intensity of the ONL and the absence of laminar separations. Furthermore, the high resolution scans allowed us to visualize undisplaced inner retinal laminae, further suggesting that a foveal pit had never been formed. A lower resolution scan might have been misinterpreted as reflecting foveal tenting and edema. Removing the ERM over a hypoplastic fovea should not be expected to restore a foveal pit, and this is often the case. Whether hypoplastic foveas are more prone to having ERMs is unclear.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

 

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