The Evolution of Outer Retinal Tubulation, a Neurodegeneration and Gliosis Prominent in Macular Diseases

Dolz-Marco, Rosa; Litts, Katie M.; Tan, Anna C. S.; Freund, K. Bailey; Curcio, Christine A.

doi:10.1016/j.ophtha.2017.03.043

Cited by 63 publications

(59 citation statements)

References 59 publications

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“…Close examination of advanced disease, followed by backtracking to precursors, can provide new mechanistic insights. [4][5][6][7] An international working group is currently documenting indicators of progression to atrophy. 8 Fleckenstein et al 9 were the first to describe highly reflective lines at the fourth reflective band on OCT, that is, at the level of the RPE/Bruch's membrane (BrM) complex in eyes with nonneovascular AMD.…”

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confidence: 99%

The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration

Fragiotta

Fernández-Avellaneda

Breazzano

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To explore patterns of disease progression in nonneovascular age-related macular degeneration (AMD) associated with hyperreflective crystalline deposits (HCDs) in the subretinal pigment epithelium-basal laminar space. METHODS. Retrospective review of medical records, multimodal imaging, and longitudinal eyetracked near-infrared reflectance (NIR) and optical coherence tomography (OCT) spanning ‡2 years. NIR/OCT images were analyzed with ImageJ software to identify HCD morphology and location. Associated macular complications were reviewed from the time of HCD detection to the most recent follow-up, using NIR/OCT. RESULTS. Thirty-three eyes with HCDs from 33 patients (mean age: 72 6 7.5 years) had 46.7 months (95% confidence limits: 33.7, 59.6) of serial eye-tracked NIR/OCT follow-up. Baseline best-corrected visual acuity (BCVA) was 0.44 logMAR (Snellen equivalent 20/55). At a mean of 11.3 months (3.1, 19.6) after HCD detection, 31/33 (93.9%) eyes had developed macular complications including de novo areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in 21/33 (64%) eyes, enlargement of preexisting cRORA in 4/33 (12%) eyes, and incident macular neovascularization in 3/33 (9%) eyes. Movement and clearance of HCDs in 9/33 (27%) eyes was associated with enlargement of preexisting cRORA (r ¼ 0.44, P ¼ 0.02). BCVA at the last follow-up visit had decreased to 0.72 logMAR (20/105). CONCLUSIONS. Eyes with nonneovascular AMD demonstrating HCDs are at risk for vision loss due to macular complications, particularly when movement and clearance of these structures appear on multimodal imaging. HCD reflectivity and dynamism may be amenable to automated recognition and analysis to assess cellular activity related to drusen end-stages.

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confidence: 99%

The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration

Fragiotta

Fernández-Avellaneda

Breazzano

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…Histologically, the hyperreflective border of ORS seen in SD-OCT images corresponds with the presence of both an EML delimiting the lumen and mitochondria migrating from the inner segments to the cell bodies of degenerating cone photoreceptor. The main histologic characteristics of ORTs are [41] A branching or pseudodendritic pattern is observed mainly in macular neovascularization, whereas a single tube is more frequent in the border of geographic atrophy [42]. Regarding the etiology of these tubulations, it has been hypothesized to be related to the different shapes of the ELM descent (flat, curved, and reflected).…”

Section: Outer Retinal Tubulation (Ort)mentioning

confidence: 99%

“…The presence of a scrolled ELM descent may represent a predictive factor for progression toward ORT. It has been reported that in cases of neovascularization, the progression to ORT experienced a shorter period between New Landmarks, Signs, and Findings in Optical Coherence Tomography DOI: http://dx.doi.org/10.5772/intechopen.84242 the steps of flat and curved ELM than eyes only with atrophic [42]. ORTs have a significant prognostic value since their presence suggests a poor visual acuity.…”

Section: Outer Retinal Tubulation (Ort)mentioning

confidence: 99%

“…Because outer tubulations tend to change slowly over time, it is unlikely to be associated with an active exudative or inflammatory process. For that reason, they do not require treatment [3,42]. ORT can also be differentiated from rosettes described in retinoblastoma by their large size, tubular structure, and degenerative instead of developmental nature.…”

Section: Outer Retinal Tubulation (Ort)mentioning

confidence: 99%

“…ORT can also be differentiated from rosettes described in retinoblastoma by their large size, tubular structure, and degenerative instead of developmental nature. In retinitis pigmentosa, there are also rosettes which are distinguished from ORTs by their location outside the macula and absence of degeneration of the underlying RPE [42].…”

Section: Outer Retinal Tubulation (Ort)mentioning

confidence: 99%

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New Landmarks, Signs, and Findings in Optical Coherence Tomography

Lara-Medina¹,

Esteban²,

Bartolomé³

et al. 2019

A Practical Guide to Clinical Application of OCT in Ophthalmology

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Spectral domain optical coherence tomography (SD-OCT) is a common useful noninvasive imaging instrument which is used for the diagnosis and follow-up of macular disorders. The clinical findings by OCT in these pathologies are well known. Currently, due to the development of this technology and its wide use, new OCT findings have been reported in the literature. The aim of this chapter is to describe new pathological or abnormal signs and findings in SD-OCT, including hyperreflective spots or dots, flyer saucer sign, outer retinal tubulations, dipping sign, focal choroidal excavation, outer retina-choroid complex splitting, foveal pseudocyst, brush border pattern, dome-shaped macula, pearl necklace sign, choroidal macrovessel, cystoid foveal degeneration, and disorganization of the retinal inner layers (DRIL).

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