Abstract
Purpose :
Hyperpigmented lesions (HP) in the macula on color fundus photographs (CFP) and intraretinal hyperreflective foci (IHRF) on OCT are both well-established risk factors for progression of age-related macular degeneration (AMD). In this study, we evaluate the OCT features of HP without evidence of IHRF in AMD eyes.
Methods :
In this retrospective analysis, we evaluated OCT B-scans of 49 eyes of 39 AMD patients with evidence of macular HP on CFP without IHRF in the corresponding region on OCT. For eyes in which multiple HP lesions were present, the most prominent HP lesion was selected.CFP and infrared reflectance (IR) images from the Spectralis OCT were co-registered using Image J. The corresponding location of the HP was annotated on the IR image, and the OCT B-scan at this location was reviewed for evidence of abnormalities, specifically,in RPE reflectivity (hyper or hypo-reflective relative to adjacent RPE), RPE band thickening (focal or diffuse), RPE elevation, ellipsoid zone (EZ) and external limiting membrane (ELM) disruption, and acquired vitelliform lesion (AVL). RPE elevations were classified as being drusenoid, serous, or fibrovascular. Drusenoid lesions < 350µm in basal width were classified as drusen whereas those ≥ 350µm were classified as drusenoid pigment epithelial detachments (PED).
Results :
The mean age of the patients was 68.21 ± 4.37 years. Forty-six (94%) of the HP showed thickening of the RPE band, among which 34 (74%) were focal and 12 (26%) were diffuse. RPE reflectivity was increased in 37 (76%) of the lesions. Of note, RPE thickening was not correlated with RPE reflectivity (p = 0.31). There was, however, either thickening or hyperreflectivity of the RPE present at the location of HP in all cases. Forty-two (86%) lesions showed evidence of EZ disruption and 20 (41%) lesions displayed ELM disruption. Five (10%) HPs demonstrated evidence of an AVL at that location. Among cases with RPE elevation (15 eyes, 31%), 10 (66.7%) were classified as drusen, 2 (13.3%) as drusenoid PED, and 3 (20%) as fibrovascular PEDs.
Conclusions :
In AMD eyes with HP on CFP without evidence of IHRF on OCT, RPE thickening and/or RPE hyperreflectivity were present in all cases. Further study is required to determine whether these lesions are associated with the same increased risk for AMD progression as HP corresponding to IHRF on OCT.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.