Nathalie Massamba

Choroidal changes associated with reticular pseudodrusen.

PURPOSE To analyze choroidal changes associated with reticular pseudodrusen by indocyanine green angiography (ICGA) and enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT). METHODS Twenty-two consecutive patients (22 eyes) with reticular pseudodrusen, and without medium/large drusen, underwent ICGA and EDI OCT. Twenty-one age- and sex-matched subjects (21 eyes) with early age-related macular degeneration (AMD), and without pseudodrusen, also underwent EDI OCT. RESULTS Mean age of patients with reticular pseudodrusen and with early AMD was 82.5 ± 0.9 and 79.3 ± 4.4 years of age, respectively (P = 0.9), and 59.0% and 76.2% were females, respectively (P = 0.7). On ICGA, reticular patterns appeared as hypofluorescent, not overlying the large choroidal vessels. Areas of iso/hyperfluorescence on ICGA, occurring adjacently to reticular patterns, appeared on OCT as subretinal deposits. The mean subfoveal choroidal thickness was significantly reduced in the group with reticular pseudodrusen compared with that in the control group (174.6 ± 10.1 and +241.4 ± 16.5, respectively; P < 0.001). At all measurement points, but the 3000 μm superior to the fovea, the choroidal thickness of eyes with reticular pseudodrusen appeared thinner than that of the control group. Interestingly, the choroid of eyes with reticular pseudodrusen appeared thicker at 3000 μm superior to the fovea compared with that at all other measurement points. CONCLUSIONS It was shown that the reticular patterns appeared as hypofluorescent lesions on ICGA, closely abutting, but not overlying the large choroidal vessels. In eyes with reticular pseudodrusen, EDI OCT revealed an overall thinned choroid.

Pathologic insights from integrated imaging of reticular pseudodrusen in age-related macular degeneration.

Purpose: The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluorescence, and fluorescein angiography (integrated confocal scanning laser ophthalmoscopy fundus imaging) features of reticular pseudodrusen and eye-tracked Spectralis high-resolution spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany). Methods: Twenty-two consecutive patients with reticular pseudodrusen were prospectively enrolled and evaluated regarding confocal scanning laser ophthalmoscopy fundus imaging and eye-tracked SD-OCT findings. Results: Integrated fundus imaging revealed a “target” aspect of most reticular pseudodrusen in the 42 included eyes (22 patients; 12 women, 10 men; mean age 81.38 ± 6.47 years). On fundus autofluorescence and infrared reflectance, the center of most reticular pseudodrusen appeared as an area of isoautofluorescence/reflectance surrounded by halos of reduced autofluorescence/reflectance. Similarly, on fluorescein angiography, the center of reticular pseudodrusen appeared as an area of decreased fluorescence surrounded by a faint halo of increased fluorescence. Spectral domain optical coherence tomography showed a well-defined round or triangular hyperreflective deposit localized between, externally, the retinal pigment epithelium layer, and, internally, the external limiting membrane or the outer plexiform layer. Moreover, SD-OCT showed the loss of both outer segment/retinal pigment epithelium interface and inner segment/outer segment interface over the hyperreflective lesions, as well as an abrupt interruption of both these interfaces at the border of the hyperreflective lesions. Conclusion: The peculiar confocal scanning laser ophthalmoscopy fundus imaging and tracked SD-OCT of reticular pseudodrusen suggest the presence of central lipofuscin-like retinal deposits localized above the retinal pigment epithelium. These findings give insights to other possible aspects of age-related retinal changes.

Analysis of progression of reticular pseudodrusen by spectral domain-optical coherence tomography.

PURPOSE To analyze reticular pseudodrusen progression using spectral domain-optical coherence tomography (SD-OCT). METHODS Thirty-three consecutive patients (48 eyes) underwent SD-OCT using the eye-tracked follow-up protocol 24 ± 2 months after baseline examination. Each pair of B-scans (only one per eye was evaluated among those showing pseudodrusen progression) was compared with respect to pseudodrusen appearance and retinal layer structure. Stage 1 pseudodrusen was defined as granular material between the RPE and the inner segment/outer segment (IS/OS), stage 2 as mounds of material sufficient to alter the contour of the IS/OS, stage 3 as thicker material adopting a conical appearance and breaking through the IS/OS, and stage 4 as fading of the material because of reabsorption and migration within the inner retinal layers. RESULTS A total of 78 pseudodrusen (detected on the 48 analyzed B-scans, and counting for a mean of 2.3 pseudodrusen per scan) showed progression over a mean of 23.9 ± 1.2 months. All 58 pseudodrusen (100%) graded as stage 1 at baseline examination progressed to stage 2. Thirteen of 16 pseudodrusen (81.3%) graded as stage 2 at baseline examination progressed to stage 3, and three (18.7%) progressed to stage 4. All four pseudodrusen (100%) graded as stage 3 at baseline examination progressed to stage 4. Among pseudodrusen that were stage 3 or 4 at follow-up (n = 20), 100% had IS/OS disruption whereas 12.1% (n = 7) had IS/OS disruption at stage 1 or 2 (n = 58) (OR, 1.736; 95% CI, 1.02-2.43). CONCLUSIONS The frequency of stage changes over time suggest that reticular pseudodrusen are dynamic pathologic structures.

Impact of reticular pseudodrusen on macular function.

Purpose: To investigate the impact of reticular pseudodrusen on macular function using microperimetry. Methods: Eighteen consecutive patients (18 eyes) with reticular pseudodrusen (Group 1), and without medium/large drusen, underwent microperimetry. Eighteen age-matched and sex-matched subjects (18 eyes) with typical drusen and without pseudodrusen (Group 2) also underwent microperimetry. Macular sensitivity was assessed by microperimetry and compared between the two Groups. Results: Mean age of patients with reticular pseudodrusen and with typical drusen was 77.3 ± 6.8 years and 75.0 ± 9.9 years, respectively (P = 0.4), and 61.1% and 61.1% were women, respectively. Mean best-corrected visual acuity was 0.14 ± 0.09 logarithm of the minimum angle of resolution and 0.13 ± 0.09 logarithm of the minimum angle of resolution (P = 0.8) in Group 1 and Group 2, respectively. Microperimetry revealed a significant difference in overall mean macular sensitivity (“square 7 × 7”; 49 points) between Group 1 and Group 2 (5.9 ± 1.7 dB vs. 8.8 ± 2.4 dB, P < 0.001). Both mean central macular sensitivity (“square 3 × 3”; 9 points) and mean peripheral macular microperimetric sensitivity (overall “square 7 × 7” − central “square 3 × 3”; 40 points) were significantly reduced in Group 1 compared with Group 2 (central macular sensitivity: 6.9 ± 1.7 dB vs. 8.9 ± 2.6 dB in Group 1 and Group 2, respectively; P = 0.01; peripheral macular sensitivity: 5.7 ± 1.8 dB vs. 8.7 ± 2.3 dB in Group 1 and Group 2, respectively; P < 0.001). In Group 1, mean peripheral sensitivity was reduced when compared with mean central sensitivity (5.7 ± 1.8 dB vs. 6.9 ± 1.7 dB, P = 0.01), whereas in Group 2, mean sensitivity was similar in both peripheral and central macula (8.7 ± 2.3 dB vs. 8.9 ± 2.6 dB, P = 0.4). Conclusion: Eyes with reticular pseudodrusen present a greater extent of reduced sensitivity than eyes with typical drusen.

Multimodal imaging of dry age-related macular degeneration

Purpose:  The purpose of this study was to understand clinical significance of near‐infrared reflectance (NIR), blue fundus autofluorescence (FAF) and near‐infrared autofluorescence (NIA) in dry age‐related macular degeneration (AMD), by correlation with fluorescein angiography (FA) and cross‐sectional spectral domain optical coherence tomography (SD OCT).

Natural Course of Adult-Onset Foveomacular Vitelliform Dystrophy: A Spectral-Domain Optical Coherence Tomography Analysis

PURPOSE To describe the natural course of adult-onset foveomacular vitelliform dystrophy using spectral-domain optical coherence tomography (SD-OCT). DESIGN Retrospective study. METHODS We reviewed the charts of all consecutive patients with adult-onset foveomacular vitelliform dystrophy who underwent SD-OCT at baseline and at least 12 months later (last visit). Main outcome measures were changes of clinical and SD-OCT features over time. RESULTS Forty-six eyes (31 patients, 15 male and 16 female; mean age 74.6 ± 8.2 years) were included. Follow-up was 16.2 ± 6 (range, 12-30) months. Visual acuity (VA) reduced from 0.32 ± 0.22 logMAR at baseline to 0.39 ± 0.28 logMAR at last visit (P=.03). The stage of the disease was vitelliform in 28 eyes (60.8%), pseudohypopyon in 7 eyes (15.2%), vitelliruptive in 11 eyes (23.9%) at baseline; vitelliform in 23 eyes (50%), pseudohypopyon in 5 eyes (10.9%), vitelliruptive in 13 eyes (28.2%), and atrophic in 5 eyes (10.9%) at last visit. Stabilization of the disease stage, inner segment/outer segment (IS/OS) interface status, and lesion reflectivity on SD-OCT determined no VA changes (P>.05), while their worsening determined a reduction of VA (P=.03). In eyes that presented a progression of the disease stage, mean central macular thickness, maximal thickness of the lesion, and maximal width of the lesion showed a significant change (from 404.1 ± 107.6 μm to 246.1 ± 74.0 μm, P = .004; from 277.0 ± 80.8 μm to 105.3 ± 92.3 μm, P=.001; from 2324.2 ± 1250.3 μm to 1751.0 ± 858.3 μm, P = .04, respectively). CONCLUSIONS In adult-onset foveomacular vitelliform dystrophy, progression of the lesion stage (partial/complete resorption of the material) is generally accompanied by IS/OS interface disruption/loss and visual impairment.

Precursors of type 3 neovascularization: a multimodal imaging analysis.

Purpose: To study the advent of exudative age-related macular degeneration in uninvolved fellow eyes of patients with unilateral Type 3 neovascularization and to investigate the precursors at the site of lesion development. Methods: We studied 37 consecutive patients with the diagnosis of unilateral Type 3 neovascularization, for the advent of exudative age-related macular degeneration in uninvolved fellow eyes (study eyes). Looking for the precursors of Type 3 neovascularization, we reviewed the multimodal imaging (fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography) in the study eyes and interpreted the changes over time at the site of lesion development. Results: Of the 37 patients, 12 (32%) developed exudative age-related macular degeneration in the study eye, after a mean of 19.6 ± 9.5 months (range, 9–36 months) from the diagnosis of Type 3 neovascularization in the first involved eye (baseline). All these patients (12 of 12 eyes; 100%) developed Type 3 neovascularization in the study eye. Retrospective analysis of the precursors of these lesions revealed, at baseline, a focal hyperautofluorescence (fundus autofluorescence) that turned to focal hypoautofluorescence over time. In all eyes, a focal hyperfluorescence (fluorescein angiography and indocyanine green angiography) appeared over time at the site of Type 3 neovascularization development. The corresponding spectral-domain optical coherence tomography showed a localized retinal pigment epithelial (RPE) elevation characterized by a focal disruption of the RPE and photoreceptors and by the overlying outer plexiform layer that progressively took contact with the RPE. Based on these findings, it seems that a small, localized RPE elevation might be the lesion before the development of Type 3 neovascularization. This precursor lesion progresses over time to focal atrophy of RPE and photoreceptor. Conclusion: Type 3 neovascularization presents a predictable symmetry and bilaterality. Identification of the precursors of Type 3 neovascularization looks particularly useful for clinicians to detect the earliest changes in the vasogenic process in the fellow eye.

Analysis of Retinal Flecks in Fundus Flavimaculatus Using High-Definition Spectral-Domain Optical Coherence Tomography

PURPOSE To assess morphologic changes associated with retinal flecks in fundus flavimaculatus using spectral-domain optical coherence tomography (SD-OCT). DESIGN Observational case series. METHODS Simultaneous recordings of SD-OCT and confocal scanning laser ophthalmoscope (cSLO) fundus autofluorescence images were obtained in fundus flavimaculatus patients. Morphologic aspects of the retinal flecks were analyzed and classified. RESULTS Thirty-one eyes of 17 consecutive patients (8 male, 9 female; mean age 47.9 +/- 17.1 years) were included for analysis. SD-OCT revealed 5 distinct types of lesions. Group A lesions were limited to the outer segment (OS) of the photoreceptors, the retinal pigment epithelium (RPE) interdigitations, and the RPE/Bruch membrane complex. Group B showed a protrusion of the hyper-reflective material through the interface of inner segment (IS)/OS of the photoreceptors up to the external limiting membrane. A further protrusion of the hyper-reflective material into the outer nuclear layer was seen in group C lesions. Group D lesions were characterized by an accumulation of the hyper-reflective material limited to the outer nuclear layer. Type E lesions can be described as drusen-like retinal pigment detachments. No significant correlation between the different types of flecks and visual acuity was observed (P > .05). CONCLUSIONS SD-OCT allows one to distinguish at least 5 different types of lesions associated with retinal flecks in fundus flavimaculatus. The ability to characterize the different types of flecks and to analyze the photoreceptor layers surrounding these lesions suggests that SD-OCT might have a potential clinical role in the evaluation and follow-up of the structural changes in fundus flavimaculatus.

Angiography features of early onset drusen

Aims Drusen are rarely observed in patients <50 years of age. Two types of early onset drusen (EOD) are commonly described: basal laminar drusen (BLD) and drusen associated with Malattia Leventinese (ML). Our purpose was to classify the phenotype of EOD on the basis of fundus examination, and fluorescein angiography (FA) and indocyanine green angiography (ICGA) features. Methods We performed a prospective study including 48 consecutive EOD patients. All of them had a complete ophthalmologic examination including FA and ICGA. Results BLD (67%) were extremely hyperfluorescent on FA and ICGA. ML (10%) was characterised by a combination of small radial and large round drusen with differences in staining in both FA and ICGA. We evidenced a third type of EOD (23%) harbouring an aspect of large colloid drusen (LCD), mildly hyperfluorescent in the early phases of FA, with a progressive staining in late phases. In intermediate and late phases of ICGA, LCD presented as hypofluorescent dot surrounded by a hyperfluorescent halo bordered by a thin hypofluorescent ring. Conclusion Three types of EOD are distinguished by their FA and ICGA features. We report a new kind of juvenile drusen, distinct from BLD and ML, named LCD, associated with a good vision and absence of complications.

Ranibizumab for exudative age-related macular degeneration: A five year study of adherence to follow-up in a real-life setting.

PURPOSE To analyze adherence to follow-up over 5 years in patients treated with intravitreal ranibizumab for exudative age-related macular degeneration (AMD) in a tertiary health care center. To investigate factors associated with failure to continue follow-up. METHODS Retrospective chart review of all consecutive patients with exudative AMD, who received their first intravitreal ranibizumab injection at the Créteil Intercommunal University Hospital Eye Clinic between October 1, 2006 and March 31, 2007. Patient clinical characteristics at baseline and at the last follow-up visit were recorded. Distance from home to hospital was measured for each patient. A multiple-choice telephone survey was conducted for patients lost to follow-up to determine the main reasons for failure to continue follow-up. RESULTS Two hundred and one patients were included. The rate of loss to follow-up over the 5-year period was 57% (115/201). Fifty-eight patients lost to follow-up completed the questionnaire. The main reasons reported by patients for follow-up discontinuation were long distance from home to hospital (51.7%, 30/58), subjective dissatisfaction with the benefits of intravitreal injections (34.5%, 20/58), and the excessive burden of periodic follow-up visits (24.1%, 14/58). Three factors were significantly associated with follow-up discontinuation: high age at baseline (82.2 vs. 76.5 years, P<0.001), poor best-corrected visual acuity (BCVA) at baseline (42.5 vs. 51.0 letters, P=0.020), and long distance from home to hospital (132 vs. 17.1km, P<0.001). CONCLUSION In this study, adherence to follow-up over 5 years was poor. Age and BCVA at baseline and distance from home to hospital were independently associated with long-term adherence.