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Renata Portella Nunes, Carlos Alexandre A. Garcia Filho, Zohar Yehoshua, Giovanni Gregori, William Feuer, Philip J. Rosenfeld; Natural History Of Drusenoid Retinal Pigment Epithelial Detachments Using SDOCT Imaging. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2908.
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To evaluate the natural history of drusenoid retinal pigment epithelial detachments (PEDs) secondary to age-related macular degeneration (AMD) imaged with spectral domain optical coherence tomography (SDOCT).
In this prospective study of eyes with dry AMD, eyes with drusenoid PEDs were identified and evaluated for at least 6 months. Patients were imaged using the 200×200 A-scan raster pattern (Cirrus HD-OCT, carl Zeiss Meditec) contained within a 6x6 mm area. Custom software was used to quantify volumetric changes in the drusenoid PED and to detect the development and progression of geographic atrophy (GA). The outcome measures were changes in area and volume of the drusenoid PEDs and progression to advanced AMD, which included either geographic atrophy (GA) or choroidal neovascularization (CNV).
A total of 186 eyes of 130 patients with dry AMD were evaluated. Of the 186 eyes, 16 eyes of 11 patients presented with drusenoid PEDs at some point during the study. The mean follow-up was 23.8 months. The mean initial visual acuity (VA) was 80 letters (~20/25). At baseline, 14 out of 16 eyes were found to have drusenoid PEDs with a total area exceeding 1 disc area based on color fundus imaging. SDOCT imaging measurements revealed a mean area of 4.25 mm2 (range, 1.821 mm2 - 6.122 mm2). The mean volume at baseline was 0.4661 mm3 (range, 0.1469 mm3 - 1.187 mm3). Four different patterns were observed during the follow up period: drusenoid PEDs persisted in 8 eyes (50%), GA developed in 5 eyes (31.25%), CNV developed in 2 eyes, and in 1 eye, the drusenoid PED resolved without progression to GA or CNV. Mean final visual acuity was 72 letters. Eyes that progressed to GA or CNV had a worse visual outcome (62.8 letters) than eyes having a persistent drusenoid PED (71letters). The eye with resolution of the PED without progression to GA or CNV had good visual acuity (77.3 letters). Imaging with SDOCT revealed a dynamic growth pattern, with a tendency for drusenoid PEDs to increase in volume and area before progressing to CNV or GA.
SDOCT imaging of drusenoid PEDs can detect subtle changes in area and volume measurements that provide a convenient quantifiable way to monitor disease progression in eyes with dry AMD.
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