June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Choroidal and sub-retinal pigment epithelium caverns: multimodal imaging characteristics and relation to Friedman lipid globules.
Author Affiliations & Notes
  • Christine Curcio
    Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Rosa Dolz-Marco
    Vitreous Retina Macula Consultants of NY, New York, New York, United States
    LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
  • Mariano Cozzi
    Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Milan, Italy
  • Orly Gal-Or
    Vitreous Retina Macula Consultants of NY, New York, New York, United States
    LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
  • Marco Pellegrini
    Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Milan, Italy
  • K Bailey Freund
    Vitreous Retina Macula Consultants of NY, New York, New York, United States
    LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
  • Giovanni Staurenghi
    Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Milan, Italy
  • Footnotes
    Commercial Relationships   Christine Curcio, Janssen Cell Therapy (C), Novartis (C), Roche (F); Rosa Dolz-Marco, None; Mariano Cozzi, Alcon (F), Bayer AG (F), Heidelberg Engineering (F); Orly Gal-Or, None; Marco Pellegrini, Optovue (R); K Bailey Freund, Bayer Healthcare (C), Genentech (C), Heidelberg Engineering (C), Optivue (C), Optos (C); Giovanni Staurenghi, Heidelberg Engineering (C), Nidek (C), Optovue (C), Zeiss Meditec (C)
  • Footnotes
    Support  NIH EY06109; EyeSight Foundation of Alabama; Research to Prevent Blindness; Macula Foundation
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 6000. doi:
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      Christine Curcio, Rosa Dolz-Marco, Mariano Cozzi, Orly Gal-Or, Marco Pellegrini, K Bailey Freund, Giovanni Staurenghi; Choroidal and sub-retinal pigment epithelium caverns: multimodal imaging characteristics and relation to Friedman lipid globules.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):6000.

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

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Abstract

Purpose : Extracellular lipid globules without associated inflammation were first shown histologically in choroidal stroma of healthy eyes by Friedman [1] and also in geographic atrophy (GA) and neovascular (nv) tissue in age-related macular degeneration (AMD).[2] Querques described hyporeflective choroidal caverns in GA by optical coherence tomography (OCT)[3] and OCT angiography (OCT-A)[4]. We observed similar OCT signatures in the sub-retinal pigment epithelium (sub-RPE) space in nvAMD, and in the choroid of several retinal diseases. We investigated multimodal imaging features of choroidal and subRPE caverns, their relation to histology, and hypothesized on their nature.

Methods : Thirty-six eyes of 25 subjects underwent multimodal imaging, including color fundus, near-infrared reflectance (NIR), spectral-domain (SD) or swept source (SS) structural OCT and OCT-A (cross-sectional, en face). Caverns were first identified on en face OCT.

Results : Caverns were seen in eyes with GA (15), nvAMD (7), Stargardt disease (4), cone dystrophy (1), pachychoroid spectrum (5), choroidal hemangioma (1), and healthy eyes (3). En face OCT showed sharply delimited hyporeflective areas as large as choroidal vessels, frequently grouped around or following choroid vessels or in the nv tissue. Cross-sectional OCT showed a characteristic posterior hypertransmission. In the presence of RPE atrophy, SD and SS-OCT were both useful. If RPE was intact, SS-OCT was superior in detecting choroidal caverns. OCT-A showed absence of flow signal within caverns. Caverns were hyperreflective on NIR and mainly undetectable in color fundus (2 eyes showed crystalline lesions).

Conclusions : We describe the presence of hyporeflective choroidal and sub-RPE caverns in a wide spectrum of retinal diseases and healthy subjects. Based on the optical similarity to intraretinal silicon oil droplets (hyporeflective with hypertransmission), we speculate that caverns are lipid-rich. Friedman lipid globules, with similar sizes and tissue locations in AMD and healthy subjects, are candidates for histologic correlates of caverns. Their role in chorioretinal physiology, perhaps as a lipid depot, is approachable through clinical imaging. 1. Friedman, 1966 PMID: 5903818. 2. Glover, 2014 ARVO Abstract. 3. Querques, 2016 PMID: 27163770. 4. Corbelli, 2016 PMID: 27880806.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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