Bacillary Layer Detachment in a Korean Cohort With Neovascular Age-Related Macular Degeneration

Abstract

To evaluate the incidence and characteristics of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration.Methods: This retrospective study was performed at Kim's Eye Hospital in South Korea. Patients who were diagnosed with neovascular age-related macular degeneration between January 2017 and December 2017 were included. The incidence of BALAD was compared among different types of macular neovascularization (MNV). The best-corrected visual acuity and central retinal thickness at diagnosis were compared between patients showing BALAD at diagnosis and those who did not.Results: Among the 442 patients included, BALAD was observed in 20 patients (4.5%). There was a significant difference in the incidence of BALAD between Type 1 MNV (2.7%), Type 2 MNV (12.5%), and Type 3 MNV (0%) (P , 0.001). The best-corrected visual acuity was significantly worse (mean 1.26 ± 0.79 vs. 0.62 ± 0.50, P = 0.001), and the central retinal thickness was significantly greater (mean 648.2 ± 211.1 mm vs. 464.0 ± 175.5 mm, P , 0.001) in patients with BALAD than in those without it. After antivascular endothelial growth factor therapy, all BALADs resolved.Conclusion: This study first reported the incidence of the BALAD in neovascular agerelated macular degeneration in a Korean population. The incidence of BALAD was the highest in Type 2 MNVs. Bacillary layer detachment generally develops in eyes with great macular thickness and poor visual acuity.

Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration: Case Series

“…We also observed a hyper-reflective band contiguous to an attenuated EZ on the floor of the BALAD. These findings have been reported in the literature [ 10 , 14 , 15 , 16 , 20 , 21 ]. Ramtohul et al postulated that floor hyper-reflectivity could be related to the remaining mitochondria of the residual photoreceptor IS on the RPE–basal lamina–Bruch membrane complex.…”

“…It was predominantly associated with type 1 and 2 mixed MNV, higher fluid volumes, increased EZ attenuation, and sub-RPE disease [ 15 ]. Instead, Jae Hui Kim et al reported an incidence of bacillary detachment in 4.5% (20 of 442) of the patients examined [ 16 ]. In a Korean cohort, Kim et al observed that the incidence of BALAD was significantly different in the types of MNV.…”

“…In a Korean cohort, Kim et al observed that the incidence of BALAD was significantly different in the types of MNV. Type 2 MNV was found to be the most associated with BALAD [ 16 ]. These results accorded to the findings of Jung et al [ 10 ].…”

“…It is characterized by a splitting of the photoreceptor layer at the myoid level, resulting in a space posterior to the external limiting membrane (ELM). Several authors have reported BALAD in various ophthalmic conditions as well as ocular trauma, multifocal placoid pigment epitheliopathy, pachychoroid syndrome, tubercular choroidal granuloma, acute idiopathic maculopathy, type 2 macular telangiectasia, Vogt–Koyanagi–Harada disease, choroidal metastasis, osteoma, and age-related macular degeneration (AMD) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The exact BALAD physiopathology is unknown.…”

Bacillary layer detachment with malignant choroidal tumors: a case series

“…Special attention has recently been given to studying BALAD as a prognostic indicator in exudative macular pathologies, especially neovascular age-related macular degeneration [ 2 – 5 ], and in inflammatory choroidal conditions such as Vogt-Koyanagi-Harada disease [ 6 ]. This may have led to an overrepresentation of these cases within the literature [ 1 ].…”