Multimodal Imaging of White and Dark Without Pressure Fundus Lesions

Fawzi, Amani A.; Nielsen, Jared S.; Mateo-Montoya, Aránzazu; Somkijrungroj, Thanapong; Li, Helen K.; Gonzales, John A.; Mauget‐Faÿsse, Martine; Jampol, Lee M.

doi:10.1097/iae.0000000000000388

Cited by 34 publications

(41 citation statements)

References 4 publications

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“…Fawzi et al 4 reported that the OCT characteristics of these 'dark without pressure' lesions consist of hyporeflectivity of photoreceptor zones, consistent with the OCT findings in our cases. As in our study, no vitreoretinal alterations were found on OCT, although the authors acknowledge the possibility that the changes may have been precipitated by vitreous traction.…”

Section: Discussionsupporting

confidence: 80%

“…In a series of 10 patients with 'white' or 'dark without pressure,' 6 of 7 patients with 'dark without pressure' were of pigmented race, whereas 2 of 3 patients with 'white without pressure' were Caucasian. 4 In our series, all patients were of pigmented race with hyperpigmented fundi, and this may have led to the appearance of 'dark without pressure' rather than 'white without pressure. ' In Cases 4-6, longer follow-up revealed a decrease in the shadow sign, which may be related to the theoretical breakdown of the vitreous with age reducing the Elevated appearing pigmented lesion with a well-demarcated shadow anteriorly, with disappearance after 3 years Figure 1 Ultra wide-field color fundus photograph of a 41-yearold Hispanic female demonstrating a well-demarcated 'shadow sign' anterior to a CHRPE lesion (arrow).…”

Section: Discussionmentioning

confidence: 99%

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‘Shadow sign’ in congenital hypertrophy of the retinal pigment epithelium of young myopic pigmented patients

Chang

McBeath²,

McCannel

et al. 2015

Eye

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Purpose Congenital hypertrophy of the retinal pigment epithelium (CHRPE) may simulate choroidal melanoma in certain cases. We report unique clinical features we have observed in cases of CHRPE in young myopic pigmented patients. Methods Patients who were referred for evaluation of a suspicious choroidal lesion and found to have a CHRPE lesion with the clinical appearance of lesion elevation and a subretinal fluid-like 'shadow sign' were included. Patient and lesion characteristics were tabulated. Available images, including fundus photography, ultrasonography, optical coherence tomography (OCT), and fluorescein angiography (FA) were reviewed. Results Six patients were included. The 'shadow sign' was anterior to the CHRPE lesion in all cases. The mean age of the patients was 27.3 years. The ethnicities of the patients were Chinese (n = 1), Hispanic (n = 3), or African-American (n = 2). Five of six patients were myopic. Conclusions Although most CHRPE lesions appear flat on ophthalmoscopy, lesions in young myopic patients of pigmented ethnicities may appear elevated with a 'shadow sign' due to 'dark without pressure.' This new finding may be related to the vitreoretinal interface in young myopic pigmented patients and must be distinguished from true subretinal fluid and lesion thickness, which are often observed in choroidal melanoma.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

‘Shadow sign’ in congenital hypertrophy of the retinal pigment epithelium of young myopic pigmented patients

Chang

McBeath²,

McCannel

et al. 2015

Eye

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“…1 Subsequent cases described as "dark without pressure" revealed EZ hyporeflectivity, whereas patients with "white without pressure" demonstrated hyperreflectivity of these zones; in these patients, the vitreoretinal interface appeared normal, and the authors postulated that these lesions represented a spectrum of varying intrinsic photoreceptor reflectivity. 2 In a cohort of nine children with achromatopsia, six had EZ disruption, with one having a complete hyporeflective EZ subfoveally. 3 Our patient did not have EZ band hyporeflectivity in the macula, noted normal color perception and contrast sensitivity, and he was able to see 10/10 color plates correctly.…”

Section: Discussionmentioning

confidence: 99%

“…Ellipsoid zone hyporeflectivity has been described in asymptomatic patients and in patients with severe visual dysfunction from cone-rod dystrophies or posttreatment with ocriplasmin. [1][2][3][4] Advances in ophthalmic imaging modalities have allowed for greater characterization of these lesions, leading to new insight into the underlying pathophysiology.…”

mentioning

confidence: 99%

Multimodal Imaging of Geographic Areas of Retinal Darkening

Moysidis

Koulisis²,

Ameri³

et al. 2015

RETINAL Cases &Amp; Brief Reports

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Geographic areas of darkening with photoreceptor hyporeflectivity have been described previously as "dark without pressure." In this case, the authors demonstrate photoreceptor hyporeflectivity that localizes to the clinically darkened areas, without topographic qualitative differences on en face spectral domain OCT images. The authors term these dark areas as geographic areas of retinal darkening because of ellipsoid nonreflectivity (GARDEN) spots.

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“…NIR imaging showed distinct morphological features and reflectance between infants and the other three groups as well as an obvious tendency that the reflectance of choroidal vascular components accumulated with age. Due to the long wavelength, NIR can penetrate through melanin and lipofuscin [14] and, therefore, enable visualization of the choroid and may also detect pathological changes despite the presence of hemorrhages or cataracts [15]. In addition, NIR minimizes pre-stimulation of the retina, avoiding the effects of absorption changes caused by photopigment bleaching.…”

Section: Discussionmentioning

confidence: 99%

Multimodal imaging of the retina and choroid in healthy Macaca fascicularis at different ages

Fan

Ding

Rao

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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The aim of this study was to identify the morphological features of the retina and choroid in Macaca fascicularis of different ages using multimodal imaging. Methods A total of 27 Macaca fascicularis with no ocular diseases were studied (mean age, 104.2 months; range, 1.2-223.6 months). Multimodal imaging was obtained from each subject. The morphological features were compared within four subgroups according to age. Results On spectrum-domain optical coherence tomography (SD-OCT), four hyper-reflective bands could be observed in the outer retina in non-infant macaques (21/21, 100%), while the interdigitation zone could not be observed in the six infant macaques. A narrow hypo-reflective band just posterior to the retinal pigment epithelium (RPE) was noted in most eyes (25/ 27, 92.6%). The choroidal-scleral junction (CSJ) was visible in 83.3% of infants but only in 12.5% of adults and 14.3% of the geriatric population, and it could not be seen in juveniles. There was a significant difference in CSJ visibility between the infant group and the other three groups (P < 0.001). Tessellated fundus, in which the choroidal vessels are visible through the retina, could be observed clearly with near-infrared reflectance imaging (NIR). Some granular spots were noted in juveniles, and they accumulated dramatically with age, but were absent in infants. Conclusion Notable morphological features can be observed in the Macaca fascicularis subjects using multimodal imaging, and these features vary distinctly according to their age. It is important to note that infant macaques had no interdigitation zone, while the other macaques had no visible CSJ but did have well-defined choroidal capillaries. Age and the features should be considered seriously in future animal studies.

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Multimodal Imaging of White and Dark Without Pressure Fundus Lesions

Cited by 34 publications

References 4 publications

‘Shadow sign’ in congenital hypertrophy of the retinal pigment epithelium of young myopic pigmented patients

‘Shadow sign’ in congenital hypertrophy of the retinal pigment epithelium of young myopic pigmented patients

Multimodal Imaging of Geographic Areas of Retinal Darkening

Multimodal imaging of the retina and choroid in healthy Macaca fascicularis at different ages

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