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E. H. Souied, H. Kerrate, N. Massamba, V. LeTien, L. Querques, N. Leveziel, G. Coscas, G. Querques; Integrated Imaging of Avascular Pigment Epithelium Detachment in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):267.
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To analyze the integrated confocal scanning laser ophthalmoscopy (cSLO) fundus imaging of avascular pigment epithelial detachment (PED) and, using real-time eye tracking technology, the corresponding high-resolution spectral-domain optical coherence tomography (SD-OCT) B-scan features in a prospective observational case series.
Consecutive AMD patients with avascular PED were prospectively analyzed as regards best-corrected visual acuity (BCVA), infrared (IR) reflectance, fundus autofluorescence (FAF) fluorescein angiographic (FA) and indocyanine green angiography (ICGA) by cSLO technology and corresponding SD-OCT. Criteria for avascular PED were large PED without hyperfluorescence on late phase of ICG, at baseline and repeated at month 3.
A total of 19 eyes of 14 patients (4 male and 10 female; mean age 69.6 ± 7.8 years) were included for analysis. Mean follow-up was 9.9 ± 6.9 months. Mean baseline BCVA was 20/32 and mean BCVA at last follow up visit was 20/40 (p>0.05). In all eyes, a dark area of inhomogeneous decreased IR reflectance, matching with increased fluorescence on FAF and late FA frames and hypocyanescence on late ICGA frames, was consistent with serous accumulation of the avascular PED. SD-OCT showed mainly hyporeflective fluid, with some collections of hypereflective material within the PED. A sharp border of increased IR reflectance, matching with a halo of reduced fluorescence on both FAF and late FA frames, appeared as a sharp hypocyanescent border on late ICGA frames, represented the abrupt elevation of the RPE on SD-OCT. A highly refelective (IR) and hyperautofluorescent lesion disposed in a reticular pattern, matching with a reticular area of decreased fluorescence (FA) and cyanescence (ICGA) was responsible, on SD-OCT, for dense hypereflective deposits seen beneath and within the sensory retina. In one eye (1/19), a CNV developed 12 months after the diagnosis of avascular PED.
Integrated cSLO imaging and corresponding SD-OCT, shows peculiar reticular features of avascular PED and possibly allows distinguish this clinical identity from neovascular PED in AMD.
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