Enhanced depth imaging optical coherence tomography of retinal pigment epithelial detachment in age-related macular degeneration.

PURPOSE To describe the internal structure of pigment epithelial detachments (PEDs) seen in eyes with age-related macular degeneration (AMD) as imaged with enhanced depth imaging (EDI) spectral-domain optical coherence tomography (OCT). DESIGN Retrospective observational case series. METHODS The images were obtained by positioning a spectral-domain OCT device close enough to the eye to obtain an inverted image and 7 sections, each comprised of 100 averaged scans, were obtained within a 5 degrees x 15 degrees or larger rectangle to encompass the PED and accompanying neovascularization if present. The resultant images were reinverted and compared with fluorescein and indocyanine green angiographic findings. RESULTS The full extent of the choroid was visualized under the PED in each of the 22 consecutive eyes imaged with EDI OCT. The entire PED cavity filled with hyperreflective tissue in 11 eyes. In the remaining 11 regions, what appeared to be serous fluid and collections of reflective material were found within the PED. The reflective material was seen to be contiguous with subretinal pigment epithelial neovascularization, had angiographic suggestive of fibrovascular proliferation, and was seen to course up along the back surface of the retinal pigment epithelium (RPE). Intravitreal ranibizumab injection caused PED flattening with apparent contracture of the accumulated material within the PED. CONCLUSIONS PEDs in the context of AMD show material suggestive of choroidal neovascularization, frequently on the back surface of the RPE. These findings can help explain the pathogenesis of PEDs, retinal vascular anastomosis with choroidal neovascularization, and RPE tears.

[1]  A. Bird,et al.  The pathogenesis of tears of the retinal pigment epithelium. , 1988, American journal of ophthalmology.

[2]  D. Sarraf,et al.  TEARS OF THE RETINAL PIGMENT EPITHELIUM: An Old Problem in a New Era , 2007, Retina.

[3]  R. Spaide,et al.  Enhanced depth imaging spectral-domain optical coherence tomography. , 2008, American journal of ophthalmology.

[4]  W R Green,et al.  Age-related Macular Degeneration Histopathologic Studies: The 1992 Lorenz E. Zimmerman Lecture , 1993, Ophthalmology.

[5]  K. Bartz-Schmidt,et al.  Clinicopathological correlation of retinal pigment epithelial tears in exudative age related macular degeneration: pretear, tear, and scarred tear , 2001, The British journal of ophthalmology.

[6]  R. Spaide.  Rationale for combination therapies for choroidal neovascularization. , 2006, American journal of ophthalmology.

[7]  J. Slakter,et al.  Digital subtraction indocyanine green angiography of occult choroidal neovascularization. , 1998, Ophthalmology.

[8]  J. Gass.  Retinal pigment epithelial rip during krypton red laser photocoagulation. , 1984, American journal of ophthalmology.

[9]  D. Weinberger,et al.  Angiographic and flow patterns of retinal choroidal anastomoses in age-related macular degeneration with occult choroidal neovascularization. , 2002, Ophthalmology.

[10]  T. Stappler,et al.  Histological findings of a choroidal neovascular membrane removed at the time of macular translocation in a patient previously treated with intravitreal bevacizumab treatment (Avastin) , 2006, British Journal of Ophthalmology.

[11]  A. Bird,et al.  Retinal pigment epithelial detachments in the elderly. , 1986, Transactions of the ophthalmological societies of the United Kingdom.

[12]  Gabriel Coscas,et al.  Optical coherence tomography identification of occult choroidal neovascularization in age-related macular degeneration. , 2007, American journal of ophthalmology.

[13]  Ning Zhang,et al.  Stimulation of apical and basolateral VEGF-A and VEGF-C secretion by oxidative stress in polarized retinal pigment epithelial cells. , 2006, Molecular vision.

[14]  K. Csaky,et al.  Choroidal neovascularization in the rat induced by adenovirus mediated expression of vascular endothelial growth factor. , 2000, Investigative ophthalmology & visual science.

[15]  A. Bird.  Pathogenesis of retinal pigment epithelial detachment in the elderly; the relevance of Bruch's membrane change , 1991, Eye.

[16]  J. Gass.  SEROUS RETINAL PIGMENT EPITHELIAL DETACHMENT WITH A NOTCH: A Sign of Occult Choroidal Neovascularization , 1984, Retina.

[17]  A. Bird,et al.  Tears of detached retinal pigment epithelium. , 1981, Transactions of the New Orleans Academy of Ophthalmology.

[18]  E. Norton,et al.  Serous detachment of the retinal pigment epithelium. , 1966, Transactions - American Academy of Ophthalmology and Otolaryngology. American Academy of Ophthalmology and Otolaryngology.

[19]  G. Soubrane,et al.  Imaging of chorioretinal anastomoses in vascularized retinal pigment epithelium detachments. , 1995, Archives of ophthalmology.

[20]  C. Toth,et al.  Clinicopathologic correlation of spontaneous retinal pigment epithelial tears with choroidal neovascular membranes in age-related macular degeneration. , 1995, Ophthalmology.

[21]  S M Bloom,et al.  Subfoveal neovascular lesions in age-related macular degeneration. , 1993, Archives of ophthalmology.

[22]  Gass Jd.  Drusen and disciform macular detachment and degeneration. , 1972 .

[23]  J. Slakter,et al.  RETINAL ANGIOMATOUS PROLIFERATION IN AGE–RELATED MACULAR DEGENERATION , 2001, Retina.

[24]  J. Marshall,et al.  Age-related variation in the hydraulic conductivity of Bruch's membrane. , 1995, Investigative ophthalmology & visual science.

[25]  A. Bird,et al.  Aging changes in Bruch's membrane. A histochemical and morphologic study. , 1990, Ophthalmology.

[26]  F. Fitzke,et al.  Computer assisted analysis of fluorescein videoangiograms. , 1990, The British journal of ophthalmology.

[27]  L. Yannuzzi,et al.  Review of retinal angiomatous proliferation or type 3 neovascularization. , 2008, Retina.

[28]  H. Grossniklaus,et al.  Macrophage and retinal pigment epithelium expression of angiogenic cytokines in choroidal neovascularization. , 2002, Molecular vision.

[29]  L A Yannuzzi,et al.  Retinal choroidal anastomoses and occult choroidal neovascularization in age-related macular degeneration. , 2000, Ophthalmology.

[30]  G. Soubrane,et al.  The pretear characteristics of pigment epithelial detachments. A study of 40 eyes. , 1990, Archives of ophthalmology.

[31]  H. Grossniklaus,et al.  Histopathologic and ultrastructural findings of surgically excised choroidal neovascularization. Submacular Surgery Trials Research Group. , 1998, Archives of ophthalmology.

[32]  David J. Wilson,et al.  Histopathologic and ultrastructural features of surgically excised subfoveal choroidal neovascular lesions: submacular surgery trials report no. 7. , 2005 .

[33]  J. Gass,et al.  Pathogenesis of tears of the retinal pigment epithelium. , 1984, The British journal of ophthalmology.

[34]  A Kijlstra,et al.  Polarized vascular endothelial growth factor secretion by human retinal pigment epithelium and localization of vascular endothelial growth factor receptors on the inner choriocapillaris. Evidence for a trophic paracrine relation. , 1999, The American journal of pathology.

[35]  A. Agarwal,et al.  Focal Inner Retinal Hemorrhages in Patients with Drusen: An Early Sign of Occult Choroidal Neovascularization and Chorioretinal Anastomosis , 2003, Retina.

[36]  R. Schlingemann.  Role of growth factors and the wound healing response in age-related macular degeneration , 2003, Graefe's Archive for Clinical and Experimental Ophthalmology.

[37]  R. Avery,et al.  Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy , 2007, British Journal of Ophthalmology.

[38]  A. Bird,et al.  Retinal pigment epithelial detachments in the elderly: classification and outcome. , 1985, The British journal of ophthalmology.

[39]  I J Constable,et al.  Overexpression of vascular endothelial growth factor (VEGF) in the retinal pigment epithelium leads to the development of choroidal neovascularization. , 2000, The American journal of pathology.