Hyperreflective Pyramidal Structures on Optical Coherence Tomography in Geographic Atrophy Areas

Bonnet, Clémence; Querques, Giuseppe; Zerbib, Jennyfer; Garavito, Rocio Blanco; Puche, Nathalie; Souied, Eric H.

doi:10.1097/iae.0000000000000165

Cited by 30 publications

(31 citation statements)

References 41 publications

(48 reference statements)

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“…Fleckenstein et al 15 using SD-OCT described in GA areas elevations with crownlike appearance with presumed debris beneath. Recently, Bonnet et al 20 reported on hyperreflective structures in GA areas, which the authors suggested to name as "ghost drusen." As for wedge-shaped subretinal hyporeflective lesions, also these structures, which were smaller and crownlike/pyramidal rather than wedge-shaped, often correlated with an increased FAF signal within the atrophy.…”

Section: Discussionmentioning

confidence: 99%

Wedge-Shaped Subretinal Hyporeflectivity in Geographic Atrophy

Querques

Capuano

Frascio

et al. 2015

Retina

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PURPOSE: To describe wedge-shaped subretinal hyporeflectivity, a peculiar spectral domain optical coherence tomography finding in geographic atrophy (GA) areas of atrophic age-related macular degeneration. METHODS: We reviewed the charts of consecutive patients with GA who presented between January 2012 and December 2013. A standardized imaging protocol was performed in all patients, which included blue fundus autofluorescence, and spectral domain optical coherence tomography. RESULTS: Wedge-shaped subretinal hyporeflective lesions were found in 12 of 161 included eyes (11 of 94 consecutive patients, 6 males/5 females, mean age 79.6 ± 9.3 years). On spectral domain optical coherence tomography, regions immediately adjacent to the wedge-shaped subretinal hyporeflective lesions were characterized by absence of the hyporeflective outer nuclear layer, the hyperreflective external limiting membrane, the ellipsoid zone, the interdigitation zone, and the retinal pigment epithelium. On "en face" images, they appeared as round-oval hyporeflectivities delimited by hyperreflective borders, which we interpreted as the outer plexiform layer. Mean GA area was significantly larger in eyes with as compared with eyes without wedge-shaped subretinal hyporeflective lesions. Overall, the dimensions of the wedge-shaped subretinal hyporeflective lesions did not change after a mean of 15 months. CONCLU-SION: Wedge-shaped subretinal hyporeflectivity, a previously unreported peculiar finding in GA areas of atrophic age-related macular degeneration eyes, appears delimited internally by the hyperreflective outer plexiform layer and externally by the hyperreflective Bruch membrane. These lesions, which are detected in eyes with large GA (even though stable over time), should be recognized and distinguished from subretinal fluid (and other exudative signs of age-related macular degeneration) because their presence should not require prompt treatment.

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Section: Discussionmentioning

confidence: 99%

Wedge-Shaped Subretinal Hyporeflectivity in Geographic Atrophy

Querques

Capuano

Frascio

et al. 2015

Retina

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“…The distinctive feature as seen by SD-OCT imaging was a laminar intense hyperreflectivity at the level of Bruch's membrane or a pyramidal structure at the level of the outer retina (''ghost drusen''). 22,41,42 One of the two eyes with refractile deposits presented RDR, while the presence of refractile deposits and the local atrophy development appeared not to be spatially associated with RDR presence. Further, progressive disruption of outer retinal bands by SD-OCT was noted.…”

Section: Type 2c: Association With Refractile Depositsmentioning

confidence: 99%

Multimodal Imaging Patterns for Development of Central Atrophy Secondary to Age-Related Macular Degeneration

Thiele

Pfau

Larsen

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To evaluate the development of central atrophy in eyes with age-related macular degeneration (AMD).METHODS. Six-year longitudinal multimodal retinal imaging data (MODIAMD study) from 98 eyes of 98 subjects with non-late-stage AMD in the study eye at baseline were analyzed for the presence of central atrophy at each annual follow-up visit. Development, manifestation, and further progression of complete retinal pigment epithelium and outer retinal atrophy (cRORA) by multimodal imaging data were compared with atrophy detection based on color fundus photography only.RESULTS. Seventeen study eyes with development of central cRORA within 6 years (cumulative rate: 17.4%) were identified based on multimodal imaging. In 10 (60%) of these eyes, presence of central manifest atrophy was initially not detectable by color fundus photography. In six (35%) eyes, central cRORA occurred by the spread of existing paracentral atrophy toward the fovea. Drusen-associated atrophy development was noted in eight eyes. In two eyes, atrophy development was associated with refractile deposits, while only pigmentary changes in absence of large drusen or refractile deposits were detectable before atrophy occurrence in one eye.CONCLUSIONS. The earlier and more precise detection of central cRORA by multimodal imaging as compared to atrophy detection solely based on color fundus photography allows for more accurate detection and identification of different pathways for atrophy development. In accordance with previous clinical and histopathologic reports, the results confirm that different precursor lesions may independently proceed to central cRORA in AMD.

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“…Shortly after, in the same year, Bonnet et al described their own findings in patients with GA (Bonnet et al, 2014). These authors preferred to introduce the term "hyperreflective pyramidal structures" (HPS) to describe the same OCT feature that Ooto and colleagues had called outer retinal corrugations (Bonnet 2014).…”

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confidence: 99%

“…Using short wavelength autofluorescence, HPS were most commonly hypoautofluorescent, in 57 of 96 cases (59%). Multicolor reflectance imaging identifies these structures as having a "peculiar green reflectivity" (Bonnet et al, 2014). Imaging with SD-OCT, HPS present a heterogeneous hyper-reflective internal boundary with a hyporeflective core.…”

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confidence: 99%

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Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes

Khan

Mahroo

Khan

et al. 2016

Progress in Retinal and Eye Research

181

159

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Drusen are discussed frequently in the context of their association with age-related macular degeneration (AMD). Some types may, however, be regarded as a normal consequence of ageing; others may be observed in young age groups. They also occur in a number of inherited disorders and some systemic conditions. Whilst drusen are classically located external (sclerad) to the retinal pigment epithelium, accumulations of material internal (vitread to) this layer can display a drusen-like appearance, having been variously termed pseudodrusen or subretinal drusenoid deposits. This review first briefly presents an overview of drusen biogenesis and subclinical deposit. The (frequently overlapping) subtypes of clinically detectable deposit, seen usually in the context of ageing or AMD, are then described in more detail, together with appearance on imaging modalities: these include hard and soft drusen, cuticular drusen, reticular pseudodrusen and "ghost drusen". Eye disorders other than AMD which may exhibit drusen or drusen-like features are subsequently discussed: these include monogenic conditions as well as conditions with undefined inheritance, the latter including some types of early onset drusen such as large colloid drusen. A number of systemic conditions in which drusen-like deposits may be seen are also considered. Throughout this review, high resolution images are presented for most of the conditions discussed, particularly the rarer ones, providing a useful reference library for images of the range of conditions associated with drusen-like appearances. In the final section, some common themes are highlighted, as well as a brief discussion of some future avenues for research.

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Hyperreflective Pyramidal Structures on Optical Coherence Tomography in Geographic Atrophy Areas

Abstract: We describe a multimodal imaging of distinctive lesions that presented as hyperreflective pyramidal structures on SD-OCT. We suggest the name "ghost drusen" because these HPS appear in GA areas, and because of their pyramidal or dome-shaped aspect on SD-OCT.

Cited by 30 publications

References 41 publications

Wedge-Shaped Subretinal Hyporeflectivity in Geographic Atrophy

Wedge-Shaped Subretinal Hyporeflectivity in Geographic Atrophy

Multimodal Imaging Patterns for Development of Central Atrophy Secondary to Age-Related Macular Degeneration

Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes

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