Linear and planar reflection artifacts on swept-source and spectral-domain optical coherence tomography due to hyperreflective crystalline deposits

Fragiotta, Serena; Fernández-Avellaneda, Pedro; Breazzano, Mark P.; Yannuzzi, Lawrence A.; Curcio, Christine A.; Freund, K. Bailey

doi:10.1007/s00417-019-04565-y

Cited by 10 publications

(12 citation statements)

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“…Another noteworthy aspect is the presence of hyperreflective crystalline deposits. ese cholesterol-based crystalline formations [5] were not observed in any patient at baseline, but appeared only in the long term, in double (albeit not significant) percentages in the PD group compared to AMD. Furthermore, in the PD group, HCD was associated with the permanence of intraretinal fluid and the final central macular thickness, confirming and integrating their already known nature of the negative prognostic factor, demonstrated to date in relation to the dry forms of AMD [4,21].…”

Section: Discussionmentioning

confidence: 76%

“…At time 0 and at 3 years, we evaluated the following parameters: central retinal thickness (CRT, automatically measured by the software), subretinal fluid (SRF, presence/absence), intraretinal fluid (IRF, including cystic formations, excluding tubulation phenomena, presence/absence), subretinal hyperreflective material (SHRM, defined as the hyperreflective material located between the neuroretina and the anterior lamina of RPE [3], presence/absence), hyperreflective crystalline deposits (HCD, diagnosed in OCT as single or multiple highly reflective lines between the RPE and Bruch's membrane [4]. On near-infrared reflectance, HCD appeared as intensively reflective plaques [5], presence/absence), hyperreflective foci (HRF, diagnosed in OCT as small and well-circumscribed hyperreflective particles in the outer retinal layers. In fundus color photography, they could appear as hard exudates; no alterations in fluorescein angiography, presence/absence), central choroidal thickness (cCT, manually measured as the distance between the outer edge of the hyperreflective line of Bruch's membrane and the inner surface of the chorioscleral junction at the level of the foveola), sublesional choroidal thickness (slCT, manually measured as the distance between the outer edge of the hyperreflective line of Bruch's membrane and the inner surface of the chorioscleral junction at the level of the center of the neovascular formation), and ellipsoid zone disruption (EZd, diagnosed in OCT as disappearance of ellipsoid zone, presence/absence).…”

Section: Methodsmentioning

confidence: 99%

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Clinical Features, Prognosis, and Long-Term Response to Ranibizumab of Macular CNVs in Pattern Dystrophies Spectrum: A Pilot Study

Casillo

Tricarico

Contento

2021

Journal of Ophthalmology

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Introduction. To analyze the morphological and functional features of choroidal neovascularizations (CNVs) in eyes affected by pattern dystrophies (PD), evaluating their long-term response to intravitreal ranibizumab, and comparing them with CNVs in age-related macular degeneration (AMD). The mean goal is to identify possible disease biomarkers and to evaluate the long-term prognosis of CNVs in PD. Materials and Methods. A retrospective study of 42 patients with naïve CNV (26 PD and 16 AMD), for a total of 47 eyes (29 eyes in the PD group and 18 eyes in the AMD group). Each patient received a loading dose of ranibizumab (one monthly for three months) followed by pro re nata (PRN) reinjection protocol for a period of at least three years. Morphological OCT parameters (CRT, central retinal thickness; SRF, subretinal fluid; IRF, intraretinal fluid; SHRM, subretinal hyperreflective material; HRF, hyperreflective foci; HCD, hyperreflective crystalline deposits; cCT, central choroidal thickness; slCT, sublesional choroidal thickness; EZd, ellipsoid zone disruption; and best corrected visual acuity (BCVA in logMAR scale)) were reported at baseline and last follow-up. Results. At baseline, no significant differences were found between the two groups, except for choroidal thickness parameters that were significantly greater in the PD group ( p = 0.009). Longitudinal PD analysis demonstrated reduction in BCVA ( p = 0.009), decrease in CRT ( p = 0.046), resolution of SRF in 61.6% of cases ( p = 0.004) and SHRM in 30% ( p = 0.034), and choroidal thinning both centrally ( p = 0.004) and sublesional ( p = 0.011) compared to baseline. At 3 years, the PD group received significantly more injections than the AMD ( p = 0.011) and showed significantly thicker choroid ( p = 0.033) and more frequent HRF ( p = 0.006). Regarding the PD group, we found a negative correlation between age and choroidal thicknesses at baseline and at 3 years ( p < 0.05); significant positive correlations were found between baseline BCVA and at 3 years ( p < 0.001), BCVA at 3 years and IRF ( p = 0.003) and SHRM at 3 years ( p = 0.003); CRT baseline and CRT 3 years ( p = 0.017); HCD at 3 years was associated with greater CRT ( p = 0.04) and IRF at 3 years ( p = 0.019). Conclusions. Early and long-term morphofunctional features of CNVs in PD and in AMD are overlapping. CNVs in PD have poorer long-term response to ranibizumab and higher choroidal thickness suggesting different pathogenetic and evolutionary mechanisms.

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Section: Discussionmentioning

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Clinical Features, Prognosis, and Long-Term Response to Ranibizumab of Macular CNVs in Pattern Dystrophies Spectrum: A Pilot Study

Casillo

Tricarico

Contento

2021

Journal of Ophthalmology

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“…Hyperreflective crystalline deposits in AMD can produce multiple hyper-intense vertical lines passing through these lesions, extending anterior and posteriorly in cross-sectional B-scans. [45] Fringe washout artifact occurs in en face choroidal slabs. In contrast to retinal vasculature, choroidal vessels appear as cord-like dark vessels.…”

Section: Low-oct-signal Artifactsmentioning

confidence: 99%

Artifacts in Optical Coherence Tomography Angiography

Anvari

Ashrafkhorasani

Habibi

et al. 2021

JOVR

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We performed a comprehensive search of the published literature in PubMed and Google Scholar to identify types, prevalence, etiology, clinical impact, and current methods for correction of various artifacts in optical coherence tomography angiography (OCTA) images. We found that the prevalence of OCTA image artifacts is fairly high. Artifacts associated with eye motion, misidentification of retinal layers, projections, and low optical coherence tomography signal are the most prevalent types. Artifacts in OCTA images are the major limitations of this diagnostic modality in clinical practice and identification of these artifacts and measures to mitigate them are essential for correct diagnosis and follow-up of patients.

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“…However, these authors have not sufficiently demonstrated retinal origin for a disease process that has been histologically established to primarily begin in the choroid [ 2 – 5 ]. Though a powerful tool, SD-OCT has limitations [ 6 – 8 ] which can mislead the examiner as illustrated in this study [ 1 ] and another before it [ 9 ], with misinterpretation of results. Understanding the pathogenesis of ECE as a primarily chorioretinal process, rather than retinal, is critical given important ramifications with clinical course, prognosis, and treatment [ 2 , 10 , 11 ].…”

Section: Main Textmentioning

confidence: 99%

“…The discrepancy here of SD-OCT interpretation with prior histopathology can be attributed to oversight of a crucial finding. Posterior shadowing is a well-established artifact for many OCT modalities [ 6 – 8 ], and accounts for the signal void posterior to the reflective, anterior surfaces of the ECE lesions (Fig. 1 ).…”

Section: Main Textmentioning

confidence: 99%

Choroidal origin of endogenous Candida endophthalmitis

Breazzano

2020

BMC Ophthalmol

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Endogenous Candida endophthalmitis (ECE) has been established with microscopic histopathology, both by autopsy and experimentation, to primarily originate from and involve the choroid. Zhuang et al. examined a series of patients with ECE using spectral-domain optical coherence tomography (SD-OCT) imaging and present a new classification scheme. The authors conclude the majority of lesions are primarily retinal in location without report of choroidal involvement. This discrepancy may be explained by posterior shadowing artifact and lack of discernment from associated retinal findings like infarction. These considerations are necessary in reviewing SD-OCT, characterizing ECE, and proposing new classification systems.

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Linear and planar reflection artifacts on swept-source and spectral-domain optical coherence tomography due to hyperreflective crystalline deposits

Cited by 10 publications

References 50 publications

Clinical Features, Prognosis, and Long-Term Response to Ranibizumab of Macular CNVs in Pattern Dystrophies Spectrum: A Pilot Study

Clinical Features, Prognosis, and Long-Term Response to Ranibizumab of Macular CNVs in Pattern Dystrophies Spectrum: A Pilot Study

Artifacts in Optical Coherence Tomography Angiography

Choroidal origin of endogenous Candida endophthalmitis

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