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Benjamin J Kim, Grace K. Han, Alexander J Brucker, Alfredo Dubra, Jessica Ijams Wolfing Morgan; Longitudinal Imaging of Cone Inner and Outer Segment Mosaics in Central Serous Chorioretinopathy . Invest. Ophthalmol. Vis. Sci. 2016;57(12):5106.
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© ARVO (1962-2015); The Authors (2016-present)
To perform a prospective, longitudinal investigation of the cone photoreceptor inner and outer segment (IS, OS) mosaic changes secondary to subretinal fluid (SRF) from central serous chorioretinopathy (CSCR).
Retinal areas overlying and adjacent to SRF were imaged in 15 subjects with CSCR at presentation. Eight of these subjects were also imaged at 1.5 and 3 months, and then every 3 months (up to 6-12 months). The test protocol included adaptive optics scanning light ophthalmoscopy (AOSLO), spectral-domain optical coherence tomography (OCT), fundus photography, visual acuity, and microperimetry. Using an AOSLO from Canon, Inc. (Tokyo, Japan) and a custom instrument, all subjects had confocal AOSLO photoreceptor imaging. Nonconfocal split-detection and dark-field AOSLO images were also acquired in 5 of the 8 subjects imaged longitudinally.
Cone IS were visible even in the presence of SRF. Locations with SRF showed only some visible cone OS in the AOSLO confocal images, all of which appear dim relative to adjacent areas free of fluid. Following the resolution of SRF, photoreceptor OS signal was restored in most areas, although dark patches remained. Within and outside of these dark patches, the cone IS mosaic was visible in the non-confocal split-detection AOSLO images, sometimes showing signal changes involving a group of IS that co-located with the dark patches in the OS mosaic. OCTs at the OS dark patches showed intact outer nuclear layer plus Henle’s fiber layer, external limiting membrane, and retinal pigment epithelium. The ellipsoid zone and interdigitation zone in OCT images exhibited local areas of disruption and/or dimming that co-located with the confocal AOSLO dark patches. AOSLO imaging allowed cell-by-cell alignment over time, thus providing longitudinal information about specific areas of the mosaics. The OS located outside of the dark patches remained present, while the OS mosaic within the dark patches either partially became visible or remained dark. The IS remained present over time both within and outside of dark patches.
Areas of temporary/reversible and permanent OS structural disruption with preserved IS mosaic were observed in CSCR patients. This data has relevance to potential interventions in CSCR and has broader implications for photoreceptor damage from SRF seen in other retinal diseases.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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