July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Histologic correlates of optical coherence tomography signatures in geographic atrophy (GA) secondary to age-related macular degeneration (AMD)
Author Affiliations & Notes
  • Christine A Curcio
    Univ of Alabama at Birmingham, Mountain Brk, Alabama, United States
  • Miaoling Li
    Univ of Alabama at Birmingham, Mountain Brk, Alabama, United States
    Sun Yat-sen University, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, Guangzhou, China
  • Rosa Dolz-Marco
    Unit of Macula, Oftalvist Clinic, Valencia, Spain
  • Carrie Huisingh
    Univ of Alabama at Birmingham, Mountain Brk, Alabama, United States
  • Jeffrey Messinger
    Univ of Alabama at Birmingham, Mountain Brk, Alabama, United States
  • Richard Feist
    Univ of Alabama at Birmingham, Mountain Brk, Alabama, United States
  • Daniela Ferrara
    Genentech, California, United States
  • K. Bailey Freund
    Vitreous Retina Macula Consultants of New York, New York, United States
    Ophthalmology, New York University Langone School of Medicine, New York, United States
  • Footnotes
    Commercial Relationships   Christine Curcio, Heidelberg Engineering (F), Hoffman LaRoche (F); Miaoling Li, None; Rosa Dolz-Marco, Alcon (F), Genentech (F), Heidelberg Engineering (F), Hoffman LaRoche (F), Novartis (F), Thea (F); Carrie Huisingh, None; Jeffrey Messinger, None; Richard Feist, None; Daniela Ferrara, Genentech (E), Genentech (I); K. Freund, Allergan (C), Genentech (C), Heidelberg Engineering (C), Hoffman LaRoche (F), Novartis (C), Optovue (C), Zeiss (C)
  • Footnotes
    Support  Hoffman-LaRoche
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3488. doi:
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      Christine A Curcio, Miaoling Li, Rosa Dolz-Marco, Carrie Huisingh, Jeffrey Messinger, Richard Feist, Daniela Ferrara, K. Bailey Freund; Histologic correlates of optical coherence tomography signatures in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2019;60(9):3488.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In an eye with GA, we correlated histology with in vivo findings resulting from OCT, near-infrared reflectance (NIR), and autofluorescence (AF) imaging.

Methods : In an 86-year-old white woman, NIR and eye-tracked OCT B-scans at each of 6 clinic visits and baseline AF were correlated with osmium tannic acid paraphenylenediamine-post-fixed, toluidine-blue-stained epoxy resin sections.

Results : Clinical imaging showed a small parafoveal multilobular GA, sub-foveal soft drusen, refractile drusen, hyperreflective lines near Bruch membrane (BrM), subretinal drusenoid deposit (SDD), and absence of hyper-AF at the GA margin. Histology showed that soft drusen end-stages included avascular fibrosis containing highly reflective cholesterol crystals corresponding to hyperreflective lines near BrM in OCT and plaques in NIR imaging. SDD was thick, continuous, extracellular, extensive outside the fovea and associated with distinctive retinal pigment epithelium (RPE) dysmorphia and photoreceptor degeneration. A hyporeflective wedge corresponded to ordered Henle fibers without cellular infiltration. The descent of the external limiting membrane (ELM), which delimits GA, was best visualized in high quality OCT B-scans.

Conclusions : This case informs on the extent, topography, and lifecycle of extracellular deposits. High quality OCT scans are required to reveal all tissue features relevant to AMD progression to GA, especially the ELM descent. Histologically validated signatures of structural OCT B-scans can serve as references for other imaging modalities.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

In vivo OCT and histopathology of GA in AMD.
Colors refer to arrowheads. Layers: IPL, inner plexiform; INL, inner nuclear; OPL, outer plexiform; HFL, Henle fiber; ONL, outer nuclear; BrM, black; ChC, choriocapillaris. Deposits: BLamD, basal laminar; BLinD, basal linear. A. In vivo OCT shows complete RPE-outer retinal atrophy, OPL subsidence, inner retinal thickening, and hyperreflective lines above BrM (pink). B. Atrophy of photoreceptor and RPE layers, flanked by artifactual post-mortem retinal detachment. Drusen, red; SDD, teal. C. ONL and RPE are absent in the atrophic area. Photoreceptor nuclei are retracted towards HFL in the non-atrophic area, near the ELM descent (green). Avascular fibrosis (AF) underlies BLamD. Clefts (pink) correlate to hyperreflective lines. Blue, sloughed RPE.

In vivo OCT and histopathology of GA in AMD.
Colors refer to arrowheads. Layers: IPL, inner plexiform; INL, inner nuclear; OPL, outer plexiform; HFL, Henle fiber; ONL, outer nuclear; BrM, black; ChC, choriocapillaris. Deposits: BLamD, basal laminar; BLinD, basal linear. A. In vivo OCT shows complete RPE-outer retinal atrophy, OPL subsidence, inner retinal thickening, and hyperreflective lines above BrM (pink). B. Atrophy of photoreceptor and RPE layers, flanked by artifactual post-mortem retinal detachment. Drusen, red; SDD, teal. C. ONL and RPE are absent in the atrophic area. Photoreceptor nuclei are retracted towards HFL in the non-atrophic area, near the ELM descent (green). Avascular fibrosis (AF) underlies BLamD. Clefts (pink) correlate to hyperreflective lines. Blue, sloughed RPE.

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