No abstract

No abstract

Purpose. Spectral-domain optical coherence tomography (SD-OCT) provides new insights into the understanding of age-related macular degeneration (AMD) but limited information on the nature of hyperreflective tissue at the level of the retinal pigment epithelium. Therefore, polarization-sensitive (PS) SD-OCT was used to identify and characterize typical RPE findings in AMD. Methods. Forty-four eyes of 44 patients with AMD were included in this prospective case series representing the entire AMD spectrum from drusen (n = 11), geographic atrophy (GA; n = 11), neovascular AMD (nAMD; n = 11) to fibrotic scars (n = 11). Imaging systems were used for comparative imaging. A PS-SD-OCT instrument was developed that was capable of recording intensity and polarization parameters simultaneously during a single scan. Results. In drusen, PS-SD-OCT identified a continuous RPE layer with focal elevations. Discrete RPE atrophy (RA) could be observed in two patients. In GA, the extension of the RA was significantly larger. Residual RPE islands could be detected within the atrophic zone. PS-SD-OCT identified multiple foci of RPE loss in patients with nAMD and allowed recognition of advanced RPE disease associated with choroidal neovascularization. Wide areas of RA containing residual spots of intact retinal pigment epithelium could be identified in fibrotic scars. Conclusions. PS-SD-OCT provided precise identification of retinal pigment epithelium in AMD. Recognition of these disease-specific RA patterns in dry and wet forms of AMD is of particular relevance to identify the status and progression of RPE disease and may help to better estimate the functional prognosis of AMD.

Retinal thickness values were generally higher in SD-OCT analysis. Different performances of automatic retinal thickness analysis indicate the potential of different software algorithms to quantify retinal morphology in nAMD. Further development of current algorithms may improve quantification of retinal thickness detection in the future even further.

Results suggest that CMM may correlate with BCVA at BSL, but has limited predictive value regarding recovery of visual function. Most interesting, ODR correlated with BCVA under therapy and was the only parameter that was pathognomic for nAMD in contrast to CSC in this study. ODR may reflect the status of the blood-retina barrier and may be used for pathophysiologic differentiation and prognostic purposes in exudative macular disease.

ABSTRACT.Purpose: Optical coherence tomography (OCT) is restricted by its low scanning speed and limited resolution. High-definition raster-scanning OCT (HD-OCT) was used to evaluate changes in retinal microstructure in patients with acute central serous chorioretinopathy (CSCR) and to find new morphological features. Methods: Eighteen patients with subretinal fluid accumulation caused by acute CSCR were imaged in a cross-sectional study design. High-speed frequencydomain HD-OCT was used to image an area of 6 · 6 mm in the macular retina. Three-dimensional analyses were performed using en-face imaging and section analysis of single HD-OCT scans. Results: Detailed information about fluid accumulation can be obtained in all compartments. Discrete changes in reflectivity are visualized within the outer nuclear or plexiform layers in > 90% of patients. Subretinal fluid appears as a dome-shaped pool of fluid and is not associated with a loss of photoreceptor layer integrity. Deposits are demarcated beneath the outer cone segments. Multiple small pigment epithelial detachments are present in > 60% of patients. Conclusions: High-definition OCT provides extensive information regarding precise topographic and layer-specific localization of discrete morphological changes. Along with well-known changes in the retinal microstructure, hyperreflectivity can be imaged in the outer nuclear or plexiform layers and may represent intraretinal changes indicating the presence of subretinal pathologies or retinal maladjustment caused by the underlying pathology.

An exact quantification of fluid in different anatomic compartments based on SD-OCT imaging, using appropriate segmentation software systems, may be useful to determine optimal treatment and retreatment parameters and explains the lack of correlation of best-corrected visual acuity and conventional OCT values.

No abstract