Reticular Pseudodrusen Are Subretinal Drusenoid Deposits

Mahroo

Progress in Retinal and Eye Research

et al. 2016

179

159

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.

Section: Reticular Pseudodrusen (Rpd)mentioning

confidence: 99%

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

Mahroo

Progress in Retinal and Eye Research

et al. 2016

179

159

“…Early detection of photoreceptor degeneration in eyes with subretinal drusenoid deposits, another term for reticular pseudodrusen, could be a biomarker prognostic of advanced AMD, including GA development with subsequent visual loss as supported mainly by the use of adaptive optics imaging [50][51][52][53] in addition to older histopathologic findings of drusenoid deposits on the inner RPE in areas surrounding geographic atrophy. 13 Therefore, presence of such lesions in eyes that are treated for wet AMD with anti-VEGF therapy should be noted, not only in the context of future prospective studies, but even in routine clinical practice, where a combination of continuous anti-VEGF administration and pre-existing RPD could increase chances of visual loss due to GA progression.…”

Section: Eyementioning

confidence: 99%

Risk of geographic atrophy in age-related macular degeneration patients treated with intravitreal anti-VEGF agents

Gemenetzi

Lotery

Patel

2016

Eye

104

Anti-vascular endothelial growth factor (VEGF) intravitreal agents are the only successful treatment for wet age-related macular degeneration (AMD). However, there are emerging signals that anti-VEGF treatment can potentially increase development of geographic atrophy (GA). Histopathologic, animal, and clinical studies support this hypothesis although direct proof of a relationship between GA and use of anti-VEGF agents in neovascular AMD is not yet established. This review presents current evidence supporting an association between anti-VEGF therapy and progression of geographic atrophy. The need of exploring alternative methods of treating AMD is indirectly but clearly emphasized.

“…4 Case 1 may lend credence to original histopathologic evidence suggesting a choroidal origin of RPD, 2 and case 2 may support RPD as originating above the RPE.…”

Section: Discussionmentioning

confidence: 74%

“…They postulated that RPD originated as choroidal disease, perhaps by loss of choroidal vessels being accompanied by fibrous replacement of the choroidal stroma in a reticular pattern. 2 The advent of spectral-domain OCT (SD-OCT) clearly demonstrated hyperreflective material above the RPE, leading Zweifel et al 4 to coin the term 'subretinal drusenoid deposits.' They proposed an elaborate grading scheme based on SD-OCT, with stage 1 characterized as diffuse deposition of granular hyperreflective material between the RPE and IS/OS boundary, stage 2 with mounds of accumulated material sufficient to alter the contour of the IS/OS boundary, and stage 3 with thicker material breaking through the IS/OS boundary.…”

Section: Introductionmentioning

confidence: 99%

Reticular pseudodrusen: a tale of two species?

Kapoor

Pulido

2013

Eye

Introduction The anatomic localization of reticular pseudodrusen (RPD) has been an important area of research study. Methods A multimodal imaging analysis was conducted of two patients who were classified as having presumed RPD. Results Analysis of case 1 lends credence to original histopathologic evidence suggesting a choroidal origin of RPD, and analysis of case 2 supports RPD as originating above the RPE. Conclusion This case series demonstrates that RPD may represent a compilation of diseases rather than one distinct clinical entity.