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G. Querques, K. Atmani, E. Berboucha, N. Leveziel, D. Martinelli, L. Querques, G. Coscas, G. Soubrane, E. Souied; Analysis of the Progressive Phases Establishing Retinal-Choroidal Anastomosis (RCA), Using Confocal Scanning Laser Ophthalmoscopy (cSLO) Angiography and Corresponding (Eye-Tracked) Spectral-Domain Optical Coherence Tomography (SD-OCT). Invest. Ophthalmol. Vis. Sci. 2010;51(13):2264.
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To propose a classification for the progressive phases establishing retinal-choroidal anastomosis (RCA), using confocal scanning laser ophthalmoscopy (cSLO) angiography and corresponding (eye-tracked) spectral-domain optical coherence tomography (SD-OCT).
We retrospectively evaluated the angiographic and corresponding tomographic features for all consecutive eyes with RCA, who underwent HRA (Heidelberg Retina Angiograph)+Spectralis SD-OCT over a 18-month period.
Thirty eyes of 27 patients were included for analysis. In 7 / 8 eyes showing a focal staining on cSLO angiography, the corresponding SD-OCT scan showed a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation. In 9 / 10 eyes showing a typical "hot spot" in the late cSLO angiographic frames, and absence of a serosanguineous pigment epithelium detachment (PED), the corresponding SD-OCT scan showed a focal RPE break leaving 2 free RPE flaps ("flap sign") at the level of a small, localized RPE elevation. In 11 / 12 eyes showing a typical "hot spot" in the late cSLO angiographic frames, and presence of a serosanguineous PED, the corresponding (eye-tracked) SD-OCT scan showed, at the level of a large serosanguineous RPE detachment, a focal funnel-shaped RPE joining an inverted focal funnel-shaped inner neuroepithelium ("kissing sign"). Presence of the typical "hot spot" in the late angiographic frames, in eyes showing a serosanguineous PED, as well as the "kissing sign" on SD-OCT, were significantly associated with presence of the intraretinal hemorrhages, SRF and CME (p<0.001).
Based on our findings, we propose that, an early neovascularization arising from the choroid (focal staining), initially simply erodes the basement membrane / RPE ("erosion sign") (PHASE 1), and later breaks the basement membrane / RPE ("flap sign") (PHASE 2), infiltrating first into the outer retina, forming an early RCA (typical "hot spot" without serosanguineous PED), and later into the inner retina ("kissing sign") (PHASE 3), forming an established RCA (typical "hot spot" with serosanguineous PED).
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