En face enhanced depth imaging optical coherence tomography of polypoidal choroidal vasculopathy

PURPOSE

To analyse retinal and choroidal changes associated with polypoidal choroidal vasculopathy (PCV) using en face spectral-domain optical coherence tomography (SD-OCT).

METHODS

In this retrospective and descriptive study, we collected imaging of patients affected with PCV examined using enhanced depth imaging (EDI) SD-OCT, fluorescein and indocyanine green angiography for a qualitative analysis. The three-dimensional reconstruction of 197 transverse sections with EDI SD-OCT at 30 μm intervals provided a virtual macular brick through which 496 sections in the coronal plane resulted in a C-scan or en face OCT image.

RESULTS

30 eyes of 30 patients affected with PCV were studied. En face OCT revealed polyps as roundish structures visible deeper than pigment epithelium layer, attached to its posterior face, easily detected in all cases. Hyper-reflective dots were visible on en face OCT in all cases within the retinal layers, associated to a well-defined dark area suggesting serous exudation in 27 eyes. The abnormal choroidal network was identified in four eyes. At the Bruch membrane level, all polyps were associated with a localised back shadowing, and were no more visible at the choriocapillaris layer level. Large choroidal vessels were visible in all eyes, mainly at the polypoidal lesion periphery, not directly behind.

CONCLUSIONS

En face OCT imaging using SD-OCT is an easy, reproducible, non-invasive and effective tool to visualise and to understand retinal and choroidal changes PCV. It provides complementary morphological information, describes new semiological entities and might substitute other exams in the future, without dye injection.

Reticular pattern dystrophy of the retina: a spectral-domain optical coherence tomography analysis

PURPOSE

To analyze the outer retinal and retinal pigment epithelium (RPE) features of reticular pattern dystrophy of the retina using spectral-domain optical coherence tomography (SDOCT).

DESIGN

Retrospective observational case series.

METHODS

Consecutive patients with reticular pattern dystrophy of the retina underwent a complete ophthalmologic examination, including assessment of best-corrected visual acuity (BCVA), fundus biomicroscopy, fluorescein angiography (FA), and SDOCT.

RESULTS

Twenty-two eyes of 13 patients (6 men, 7 women, mean age 68.6 ± 14.5 years) were included. In the foveal area, the RPE layer appeared normal in 45.5% of eyes, while small RPE elevations and RPE bumps were detected in 31.8% and 22.7% of eyes, respectively. The SDOCT scans showed disruption of inner segment/outer segment (IS/OS) junction in 54.6% of eyes, a slight elevation in 59.1% of eyes, and an absence in 45.5% of eyes. The outer limiting membrane (OLM) appeared disrupted in 50.0% of eyes, absent in 22.7% of eyes, and elevated in 63.6% of eyes. Hyper-reflective subretinal material accumulation or hyporeflective subretinal lesions in the retrofoveolar region were detected in 70% and in 20% of eyes, respectively. SDOCT showed hyporeflective retinal pseudocysts in 13.6% of eyes.

CONCLUSION

In this study on reticular pattern dystrophy of the retina, SDOCT provided a description of the material deposits and the alterations of the RPE and the different retinal layers. We observe that the lesions present specific features distinct from other macular dystrophies, but closer to those reported in fundus flavimaculatus than those reported in adult-onset foveomacular vitelliform dystrophy. Further analyses are needed, particularly to analyze the progression of the lesions.

Clinical and laboratory factors associated with the severity of proliferative sickle cell retinopathy in patients with sickle cell hemoglobin C (SC) and homozygous sickle cell (SS) disease

Proliferative sickle cell retinopathy (PSCR) is the most frequent vision-threatening complication of sickle cell disease (SCD). We investigated the relationship between the severity of sickle cell retinopathy in heterozygous (SC) or homozygous (SS) adult SCD patients and the clinical and laboratory data obtained during visits to a national SCD referral center. This retrospective longitudinal analysis included 942 SCD patients (313 patients with SC and 629 with SS disease) with ophthalmologic evaluations who were followed over a 19-year period by a multidisciplinary team in a referral center. PSCR was graded using the Goldberg classification. We identified patient and SCD characteristics associated with sickle cell retinopathy severity using multinomial logistic-regression models. Multivariate analysis associated severe PSCR forms (stages III-V) with older age (p=0.032), pulmonary involvement (documented pulmonary hypertension with pulmonary arterial pressure≥40 mm Hg, restrictive syndrome>20%, or previous history of pulmonary embolism diagnosed by vascular imaging) (p=0.029), deafness or tinnitus (p=0.026), and no history of osteomyelitis (p=0.013) for SC patients; and with older age (p<0.001), male sex (p=0.003), and acute pyelonephritis (p=0.04) for SS patients. The model of severe PSCR versus no PSCR showed good calibration and discrimination for SC and SS patients. Awareness of the clinical and laboratory factors significantly associated with severe PSCR in patients with SC or SS SCD may contribute to improved preventive strategies.