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Choroidal Round Hyporeflectivities in Geographic Atrophy

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: In geographic atrophy (GA), choroidal vessels typically appear on structural optical coherence tomography (OCT) as hyperreflective round areas with highly reflective borders. We observed that some GA eyes show choroidal round hyporeflectivities with highly reflective borders beneath the atrophy, and futher investigated the charcteristcs by comparing structural OCT, indocyanine green angiography (ICGA) and OCT angiography (OCT-A).

Methods: Round hyporeflectivities were individuated from a pool of patients with GA secondary to non-neovascular age-related macular degeneration consecutively presenting between October 2015 and March 2016 at the Medical Retina & Imaging Unit of the University Vita-Salute San Raffaele. Patients underwent a complete ophthalmologic examination including ICGA, structural OCT and OCT-A. The correspondence between choroidal round hyporeflectivities beneath GA on structural OCT and ICGA and OCT-A imaging were analyzed.

Results: Fifty eyes of 26 consecutive patients (17 females and 9 males; mean age 76.8±6.2 years) with GA were included. Twenty-nine round hyporeflectivities have been found by OCT in choroidal layers in 21 eyes of 21 patients (42.0%; estimated prevalence of 57.7%). All 29 round hyporeflectivities showed constantly a hyperreflective border and a backscattering on structural OCT, and appeared as hypofluorescent in late phase ICGA and as dark foci with non detectable flow in the choroidal segmentation of OCT-A. Interestingly, the GA area was greater in eyes with compared to eyes without round hyporeflectivities (9.30±5.74 and 5.57±4.48mm2, respectively; p = 0.01).

Conclusions: Our results suggest that most round hyporeflectivities beneath GA may represent non-perfused or hypo-perfused choroidal vessels with non-detectable flow.

No MeSH data available.


Related in: MedlinePlus

Optical coherence tomography angiography (OCT-A), spectral domain optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA) in the right eye of a patient with hyporeflective round areas.Choroidal segmentation on 3x3 OCT-A (first row, left panel) / en face imaging (first row, middle panel), and ICGA (first row, right panel) reveal, respectively, non detectable flow / focal hyporeflectivity and hypofluorescence (arrowhead) along the course of a large choroidal vessel. Structural SD-OCT B-scan with (second row, left panel) and without flow analysis (second row, right panel) discloses a round hyporeflectivity (arrowhead) localized in the large choroidal vessel layer within geographic atrophy, beneath the fovea.
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pone.0166968.g002: Optical coherence tomography angiography (OCT-A), spectral domain optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA) in the right eye of a patient with hyporeflective round areas.Choroidal segmentation on 3x3 OCT-A (first row, left panel) / en face imaging (first row, middle panel), and ICGA (first row, right panel) reveal, respectively, non detectable flow / focal hyporeflectivity and hypofluorescence (arrowhead) along the course of a large choroidal vessel. Structural SD-OCT B-scan with (second row, left panel) and without flow analysis (second row, right panel) discloses a round hyporeflectivity (arrowhead) localized in the large choroidal vessel layer within geographic atrophy, beneath the fovea.

Mentions: On OCT B-scan, all choroidal hyporeflectivities were typically empty, round / oval, characterized by a hyperreflective border, and in most cases, by backscattering (Figs 1 and 2). Only 2 out of 29 hyporeflectivities did not show backscattering because they were overlaid by subretinal/sub-RPE hyperreflective material. The mean greatest linear dimension of round hyporeflectivities was 67.7±29.0 μm (range, 26–134 μm; ICC = 0.994 [0.987–0.997]). The mean round hyporeflectivities was 4247±3392 μm2 (range, 530–14102 μm2; ICC = 0.991 [0.980–0.996]). Mean choroidal thickness at the round hyporeflectivities site was 171±59 μm (range, 71–280 μm; ICC = 0.998 [0.995–0.999]), and 165±84 μm (range, 45–412 μm; ICC = 0.997 [0.994–0.998]) in subfoveal area. Interobserver variability (ICC; 95% CI) was excellent for all these measurements.


Choroidal Round Hyporeflectivities in Geographic Atrophy
Optical coherence tomography angiography (OCT-A), spectral domain optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA) in the right eye of a patient with hyporeflective round areas.Choroidal segmentation on 3x3 OCT-A (first row, left panel) / en face imaging (first row, middle panel), and ICGA (first row, right panel) reveal, respectively, non detectable flow / focal hyporeflectivity and hypofluorescence (arrowhead) along the course of a large choroidal vessel. Structural SD-OCT B-scan with (second row, left panel) and without flow analysis (second row, right panel) discloses a round hyporeflectivity (arrowhead) localized in the large choroidal vessel layer within geographic atrophy, beneath the fovea.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120831&req=5

pone.0166968.g002: Optical coherence tomography angiography (OCT-A), spectral domain optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA) in the right eye of a patient with hyporeflective round areas.Choroidal segmentation on 3x3 OCT-A (first row, left panel) / en face imaging (first row, middle panel), and ICGA (first row, right panel) reveal, respectively, non detectable flow / focal hyporeflectivity and hypofluorescence (arrowhead) along the course of a large choroidal vessel. Structural SD-OCT B-scan with (second row, left panel) and without flow analysis (second row, right panel) discloses a round hyporeflectivity (arrowhead) localized in the large choroidal vessel layer within geographic atrophy, beneath the fovea.
Mentions: On OCT B-scan, all choroidal hyporeflectivities were typically empty, round / oval, characterized by a hyperreflective border, and in most cases, by backscattering (Figs 1 and 2). Only 2 out of 29 hyporeflectivities did not show backscattering because they were overlaid by subretinal/sub-RPE hyperreflective material. The mean greatest linear dimension of round hyporeflectivities was 67.7±29.0 μm (range, 26–134 μm; ICC = 0.994 [0.987–0.997]). The mean round hyporeflectivities was 4247±3392 μm2 (range, 530–14102 μm2; ICC = 0.991 [0.980–0.996]). Mean choroidal thickness at the round hyporeflectivities site was 171±59 μm (range, 71–280 μm; ICC = 0.998 [0.995–0.999]), and 165±84 μm (range, 45–412 μm; ICC = 0.997 [0.994–0.998]) in subfoveal area. Interobserver variability (ICC; 95% CI) was excellent for all these measurements.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: In geographic atrophy (GA), choroidal vessels typically appear on structural optical coherence tomography (OCT) as hyperreflective round areas with highly reflective borders. We observed that some GA eyes show choroidal round hyporeflectivities with highly reflective borders beneath the atrophy, and futher investigated the charcteristcs by comparing structural OCT, indocyanine green angiography (ICGA) and OCT angiography (OCT-A).

Methods: Round hyporeflectivities were individuated from a pool of patients with GA secondary to non-neovascular age-related macular degeneration consecutively presenting between October 2015 and March 2016 at the Medical Retina & Imaging Unit of the University Vita-Salute San Raffaele. Patients underwent a complete ophthalmologic examination including ICGA, structural OCT and OCT-A. The correspondence between choroidal round hyporeflectivities beneath GA on structural OCT and ICGA and OCT-A imaging were analyzed.

Results: Fifty eyes of 26 consecutive patients (17 females and 9 males; mean age 76.8±6.2 years) with GA were included. Twenty-nine round hyporeflectivities have been found by OCT in choroidal layers in 21 eyes of 21 patients (42.0%; estimated prevalence of 57.7%). All 29 round hyporeflectivities showed constantly a hyperreflective border and a backscattering on structural OCT, and appeared as hypofluorescent in late phase ICGA and as dark foci with non detectable flow in the choroidal segmentation of OCT-A. Interestingly, the GA area was greater in eyes with compared to eyes without round hyporeflectivities (9.30±5.74 and 5.57±4.48mm2, respectively; p = 0.01).

Conclusions: Our results suggest that most round hyporeflectivities beneath GA may represent non-perfused or hypo-perfused choroidal vessels with non-detectable flow.

No MeSH data available.


Related in: MedlinePlus