Clear subretinal fluid in a case of non-neovascular early-onset drusen: Swept-source imaging evaluation

Abstract

A 50-year-old male presented with recent metamorphopsia in the right eye. Fundus examination revealed bilateral multiple cuticular drusen along with few large colloid drusen (phenotype 3 cuticular drusen). No vitelliform material was evident in the macula in either eye. Fluorescein angiography (FA), indocyanine green angiography (ICGA) did not demonstrate a macular neovascularization (MNV) in either eye. Swept-source optical coherence tomography (SS-OCT) revealed sub-retinal pigment epithelial (RPE) drusen and a clear space beneath the inter-digitation zone and above the RPE-Bruch’s complex. SS-OCTA did not reveal MNV in either eye. The patient was kept under observation, and follow-up at 3 months did not reveal any structural change. Among patients with early-onset drusen, vitelliform detachments may occur due to accumulation of yellow pseudo-vitelliform material. However, serous detachments with an “optically clear” subretinal space can occur by the same mechanism without MNV. Such patients do not merit therapy with anti-vascular endothelial growth factor agents.

Imaging in uveitis

“…For instance, by applying this ultrawide field technique, we recently reported a peculiar pattern of vitritis along the vitreous fibrils in cases of vitreoretinal lymphoma (Figure 5). 52 In another paper, the assessment of vitritis with this technique was found to well correlate with the grade of vitritis observed clinically. 53 This application may provide an additional tool for monitoring the grade of vitreous haze, which is one of the main end-points in clinical trials for uveitis.…”

“…Thus, OCTA can be serially used in assessing the treatment response in eyes with VKH, adding significant value alongside OCT and other tests. 38,52 In eyes with acute CSC, the authors observed no choriocapillaris flow deficit on OCTA or ICGA. In certain eyes, areas of PED appeared as a "flow deficit" area on OCTA, but this hypo-reflectivity on OCTA was due to inaccurate segmentation in areas of PED (not due to true ischemia).…”

“…OCTA can be helpful in differentiating between CSC and VKH. Aggarwal et al 38,52 used OCTA to analyze eyes with acute CSC and acute VKH and observed true choriocapillaris flow deficit areas in eyes with VKH in the choriocapillaris slab. These co-localized with the hypofluorescent spots on the ICGA, suggesting choriocapillaris ischemia in the area of choroidal granulomas.…”

“…In certain eyes, areas of PED appeared as a "flow deficit" area on OCTA, but this hypo-reflectivity on OCTA was due to inaccurate segmentation in areas of PED (not due to true ischemia). 38,52 Finally, OCTA can be used to detect and follow the evolution of choroidal granulomas overtime. 53,54 In summary, OCT and OCTA provide important information in eyes with VKH and CSC aiding in differentiating between the two conditions.…”

“…In the context of AMD, various multi-center clinical trials and their extension studies have shown that these patients often require anti-VEGF therapy for several years. [49][50][51][52][53] For instance, the SEVEN-UP study (n = 65), a multicenter, non-interventional cohort study, examined the long-term results of patients 7 years after entering the ANCHOR/MARINA trials with monthly anti-VEGF therapy. In this study, 37% eyes maintained visual acuity ≥ 20/70.…”