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The Evolution of the Plateau, an Optical Coherence Tomography Signature Seen in Geographic Atrophy.
- Source :
-
Investigative ophthalmology & visual science [Invest Ophthalmol Vis Sci] 2017 Apr 01; Vol. 58 (4), pp. 2349-2358. - Publication Year :
- 2017
-
Abstract
- Purpose: Histologic details of progression routes to geographic atrophy (GA) in AMD are becoming available through optical coherence tomography (OCT). We studied the origins and evolution of an OCT signature called plateau in eyes with GA and suggested a histologic correlate.<br />Methods: Serial eye-tracked OCT scans and multimodal imaging were acquired from eight eyes of seven patients with GA and plateau signatures over a mean follow-up of 7.7 years (range, 3.7-11.6). The histology of unrelated donor eyes with AMD was reviewed.<br />Results: Drusenoid pigment epithelial detachment (PED) on OCT imaging progressed into wide-based mound-like signatures with flattened apices characterized by a hyporeflective yet heterogeneous interior and an overlying hyperreflective exterior, similar to outer retinal corrugations previously ascribed to persistent basal laminar deposit (BLamD) but larger. These new signatures are described as "plateaus." An initial increase of the PED volume and hyporeflectivity of its contents was followed by a decrease in PED volume and thinning of an overlying hyperreflective band attributable to the loss of the overlying RPE leaving persistent BLamD. Both imaging and histology revealed persistent BLamD with defects through which gliotic Müller cell processes pass.<br />Conclusions: Plateaus can be traced back to drusenoid PEDs on OCT imaging. We hypothesize that during progressive RPE atrophy, Müller cell extension through focal defects in the residual persistent BLamD may contribute to the heterogeneous internal reflectivity of these entities. The role of Müller cell activation and extension in the pathogenesis of AMD should be explored in future studies.
- Subjects :
- Aged
Aged, 80 and over
Disease Progression
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Geographic Atrophy complications
Humans
Male
Middle Aged
Reproducibility of Results
Retinal Drusen etiology
Retrospective Studies
Forecasting
Geographic Atrophy diagnosis
Retinal Drusen diagnosis
Retinal Pigment Epithelium pathology
Tomography, Optical Coherence methods
Subjects
Details
- Language :
- English
- ISSN :
- 1552-5783
- Volume :
- 58
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Investigative ophthalmology & visual science
- Publication Type :
- Academic Journal
- Accession number :
- 28437524
- Full Text :
- https://doi.org/10.1167/iovs.16-21237