Abstract

DO.18.05

Subpigmentepithelial morphologic analysis using high resolution Optical Coherence Tomography in patients with Pigment Epithelial Detachments secondary to AMD

Christoph Clemens, Nina Kosanetzky, Peter Charbel Issa, Hans-Martin Helb, Frank G. Holz, Nicole Eter
Universitäts-Augenklinik Bonn

Objective: Pigment epithelium detachment (PED) in the context of exudativ age-related macular degeneration (AMD) may cause to severe vision loss. Here we used high-resolution spectral domain-optical coherence tomography (SD-OCT) to study alterations in the subpigmenthelial space of RPE-detachment.
Methods: Eighty-two eyes of 74 patients with PED were simultaneously analysed by means of confocal Scanning Laser Ophthalmoskopy (cSLO) and
SD-OCT (Spectralis HRA+OCT, Heidelberg Engineering). Serial tomographic sections were obtained by means of volume scans covering the entire area of the PED.
Results: In the SD-OCT-scans from 9 eyes (8%) with RPE-detachment, discrete, hyperreflective structures arranged in a lamellar-like fashion were identified. In several eyes this material seemed to course across the entire width of the PED. Some of these strands were in contact with the detached RPE. The three-dimensional mapping revealed a peculiar network between the structures. The localisation of the structures within the dome of the PED was not uniform. While these were scattered across the subpigmentepithelial space in some eyes, the localisation was either more anterior or posterior.
Conclusions: Using SD-OCT it is possible for the first time to identify subpigmentepithelial structures in vivo in patients with PED. The precise morphologic substrate is not knwon. Possibly, these structure are part of the fibrovasular, angiographically “occult” CNV membrane detached from the basal membrane of the RPE cell monolayer. This could reflect chronicity and limited elasticity of such membrane with detachment due to increasing vertical extension of the PED. In an initiated longitudinal study the prognostic relevance of such alterations will be addressed including the response pattern to anti-VEGF therapy.

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