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Ganeshan Ramsamy, Jonathan Aboshiha, Ranjan Rajendram, Yusufu N B Sulai, Joseph Carroll, Alfredo Dubra, Michel Michaelides, Adam M Dubis; Persistent and Reversible Structural Retinal Disruption Associated with Selected Outer Retinopathies. Invest. Ophthalmol. Vis. Sci. 2014;55(13):262.
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A wide range of acute onset outer retinopathies have been described, which following the acute phase, may either progress, or varying degrees of recovery may occur. Predictive factors to determine which subjects will recover or progress are not yet known. In this study we applied serial high-resolution imaging to three outer retinopathies to characterise detailed structural changes, which may potentially be predictive of progression or recovery.
Subjects with Acute Macular Neuroretinopathy (AMN), Persistent Placoid Maculopathy (PPM) and Poppers Maculopathy were imaged longitudinally using spectral domain optical coherence tomography (SDOCT), fundus autofluorescence (AF) and confocal adaptive optics scanning light ophthalmoscopy (AOSLO).
Outer retinal disturbance was observed in all subjects at presentation. These changes included loss or marked disruption of outer retinal lamination on SDOCT, areas of reduced AF, and loss of wave-guiding photoreceptor structure on confocal AOSLO. The changes in outer retinal integrity over time were characterized with serial imaging. The outer retinopathy progressed in PPM, while the AMN and Poppers Maculopathy recovered a variable degree of outer retinal structure. In the PPM patient, the area of loss of retinal architecture increased and photoreceptor appearance on confocal AOSLO changed from a ‘swollen’ appearance to loss of reflectivity, suggesting further deteriorating photoreceptor structure and function (associated with further loss in visual acuity). The AMN and Poppers patients both had a degree of recovery of wave-guiding photoreceptor cells on confocal AOSLO, improved retinal lamination on SDOCT, and decreased area of reduced AF, which was coupled with an increase in visual acuity.
Current clinical tools such as AF imaging and SDOCT can be used to monitor disease in acute onset outer maculopathies. Cellular resolution analysis with confocal AOSLO allows more precision in identifying functional cones, but new split-detection imaging will likely prove even more helpful in identification of remaining cones that may be saved.
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