Abstract

P 251

High-resolution in vivo imaging using Simultaneous confocal scanning laser ophthalmoscopy and spectral Domain-OCT in white-dot-syndromes

Nina Peters1, Peter Charbel Issa1, Robert P. Finger1, Steffen Schmitz-Valckenberg2, Hendrik P. Scholl1, Frank G. Holz2
1Universitäts-Augenklinik Bonn, 2GRADE Reading Center, Universitäts-Augenklinik Bonn

Objective
White-Dot-Syndromes (WDS) are a group of heterogeneous retinal diseases which amongst others includes Acute Posterior Multifocal Placoid Pigmentepitheliopathy (APMPPE), Multiple Evanescent White Dot Syndrome (MEWDS) and Punctate Inner Choroidopathy (PIC). Histopathological examinations of these rare disorders are not yet available. We used novel high-resolution imaging methods in patients with WDS in order to detect morphological alterations in vivo.
Methods
Three patients each with APMPPE (bilateral, male, 22 years), MEWDS (unilateral, female, 35 years) or PIC (unilateral, female, 37 years) were examined. The diagnosis was based on medical history and typical alterations of the fundus and angiographic findings. The characteristic pathologies of the posterior pole were evaluated using simultaneous confocal scanning laser ophthalmoscopy (cSLO) and spectral domain optical coherence tomography (SD-OCT, 870 nm, 40.0000 A-Scans/second, Spectralis HRA-OCT, Heidelberg Engineering). Hyperreflective layers on SD-OCT scans were matched with corresponding anatomical layers.
Results
On funduscopic examination all three patients presented with whitish lesions of characteristic size and location in the outer retinal layers. On SD-OCT imaging alterations in PIC showed small excrescences of medium reflectivity that appeared to extend through Bruch’s membrane and the retinal pigment epithelium (RPE) into the outer nuclear layer of the retina. Obviously identified desintegrations of Bruch´s membrane can favour secondary development of choroidal neovascularisations. In contrast, Bruch´s membrane appeared continuously intact in MEWDS and APMPPE. SD-OCT scans through lesions in MEWDS showed alterations of the retinal structure between RPE and the outer limiting membrane. In APMPPE similar changes extended into the outer plexiform layer. In both MEWDS and APMPPE the morphological alterations regressed with time.
Conclusions
Simultane cSLO und SD-OCT-Untersuchungen ermöglichen eine quasi-histologische Untersuchung von Fundus-Pathologien in vivo. Dies ermöglicht pathophysiologische Rückschlüsse und erlaubt präzise morphologische Verlaufsbeobachtungen bei seltenen Erkrankungen wie den WDS.

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