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

Abstract

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.

De-novo multilayering in fibrovascular pigment epithelial detachment

“…Also, additional hyperreflective laminar deposits were noted in 3 eyes as described by Clements et al and these could be a manifestation of organized fibrin deposits or represent detached neovascular tissue 16 . Similar hyperreflective crystalline deposits (HCDs) in the subretinal pigment epithelium–basal laminar space has also been described by Fraggiota et al 17 . In the series by Rahimy et al 6 , the MLPED reflectivity was evaluated and was noted to be hyperreflective in all of them.…”

Clinical Features, Prognosis, and Long-Term Response to Ranibizumab of Macular CNVs in Pattern Dystrophies Spectrum: A Pilot Study

“…ese cholesterol-based crystalline formations [5] were not observed in any patient at baseline, but appeared only in the long term, in double (albeit not significant) percentages in the PD group compared to AMD. Furthermore, in the PD group, HCD was associated with the permanence of intraretinal fluid and the final central macular thickness, confirming and integrating their already known nature of the negative prognostic factor, demonstrated to date in relation to the dry forms of AMD [4,21]. Furthermore, their presence could represent a further point in support of the greater tendency to atrophic evolution of the disease; this evidence was also observed in the course of avascular lesions, such as drusenoid detachments of the retinal pigment epithelium.…”

De-novo Multilayering in Fibrovascular Pigment Epithelial Detachment

“…Also, additional hyperre ective laminar deposits were noted in 3 eyes as described by Clements et al and these could be a manifestation again of organized brin deposits or may represent detached neovascular tissue. 16 Similar hyperre ective crystalline deposits (HCDs) in the subretinal pigment epithelium-basal laminar space has also been described by Fraggiota et al 17 Choroidal Clefts were noted in 7 patients during the follow-up period. Choroidal clefts are believed to occur either due to uid accumulation due to disease activity and located below the neovascular element in a brovascular PED or due to mechanical separation of the brous tissue from the underlying choroidal vasculature.…”