Abstract
Purpose
To describe the OCT angiography characteristics of flat irregular pigment epithelial detachments (PEDs), an overlapping tomographic feature of various macular disorders.
Methods
Consecutive patients with a dimpled retinal pigment epithelium profile on OCT, referred for a second opinion, were enrolled. Fluorescein (FA) and indocyanine green angiography (ICGA) were performed in all patients and compared to previous examinations, when available. In all patients, enhanced depth imaging-OCT and OCT angiography were performed upon referral and at subsequent follow-ups.
Results
Twenty-five eyes from 25 patients (9 women and 16 men, mean age of 63.4 years) were enrolled. The diagnoses of CSCR were already established by the referring physicians in 10 patients, acute in 15% and chronic in 26%; 48% of patients were referred with a diagnosis of type 1 CNV, and 11% of CSCR complicated by CNV. After performing OCT angiography, 2 masked examiner identified 7 type 1 CNV (29%), 18 eyes with pachychoroid disease of which 31% pachychoroid pigment epitheliopathies (PPEs) at baseline evolved to CSCR, 22% PPE at baseline evolved to pachychoroid neovasculopathy, 18% pachychoroid neovasculopathy stable.
Conclusion
Central serous chorioretinopathy, type 1 CNV, and the pachychoroid spectrum of diseases cause abnormalities in the choroidal circulation that make the overlying RPE dysfunctional, resulting in flat irregular PED. Discrimination between avascular and vascular flat irregular PEDs is crucial for a good visual outcome, but since chronic alterations of the RPE can compromise the diagnostic specificity of FA and ICGA, OCT angiography may become a fundamental tool to differentiate these clinical entities.
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References
Hage R, Mrejen S, Krivosic V, Quentel G, Tadayoni R, Gaudric A (2015) Flat irregular retinal pigment epithelium detachments in chronic central serous chorioretinopathy and choroidal neovascularization. Am J Ophthalmol 159(5):890–903
Karatepe Hashas AS, Göktas A, Atas M (2014) Isolated multiple pigment epithelial detachments with unknown cause. Case Rep Ophthalmol Med 2014:289107
Mukai R, Sato T, Kishi S (2014) A hyporeflective space between hyperreflective materials in pigment epithelial detachment and Bruch’s membrane in neovascular age-related macular degeneration. BMC Ophthalmol 14:159
Bonini Filho MA, de Carlo TE, Ferrara D, Adhi M, Baumal CR, Witkin AJ, Reichel E, Duker JS, Waheed NK (2015) Association of choroidal neovascularization and central serous chorioretinopathy with optical coherence tomography angiography. JAMA Ophthalmol 133(8):899–906
McClintic SM, Kim DY, Fingler J, Garcia S, Zawadzki RJ, Morse LS, Park SS, Fraser SE, Werner JS, Ruggiero JP, Schwartz DM (2015) Detection of pigment epithelial detachment vascularization in age-related macular degeneration using phase-variance OCT angiography. Clin Ophthalmol 15(9):1299–1305
Gallego-Pinazo R, Dolz-Marco R, Gómez-Ulla F, Mrejen S, Freund KB (2014) Pachychoroid diseases of the macula. Med Hypothesis Discov Innov Ophthalmol 3(4):111–115
Warrow DJ, Hoang QV, Freund KB (2013) Pachychoroid pigment epitheliopathy. Retina 33(8):1659–1672
Pang CE, Freund KB (2015) Pachychoroid neovasculopathy. Retina 35(1):1–9
Miyake M, Ooto S, Yamashiro K, Takahashi A, Yoshikawa M, Akagi-Kurashige Y, Ueda-Arakawa N, Oishi A, Nakanishi H, Tamura H, Tsujikawa A, Yoshimura N (2015) Pachychoroid neovasculopathy and age-related macular degeneration. Sci Rep 5:16204
Yannuzzi NA, Mrejen S, Capuano V, Bhavsar KV, Querques G, Freund KB (2015) A central hyporeflective subretinal lucency correlates with a region of focal leakage on fluorescein angiography in eyes with central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 46(8):832–836
Spaide RF, Fujimoto JG, Waheed NK (2015) Optical coherence tomography angiography. Retina 35(11):2161–2162
El Ameen A, Cohen SY, Semoun O, Miere A, Srour M, Quaranta-El Maftouhi M, Oubraham H, Blanco-Garavito R, Querques G, Souied EH (2015) Type 2 neovascularization secondary to age-related macular degeneration imaged by optical coherence tomography angiography. Retina 35(11):2212–2218
Palejwala NV, Jia Y, Gao SS, Liu L, Flaxel CJ, Hwang TS, Lauer AK, Wilson DJ, Huang D, Bailey ST (2015) Detection of nonexudative choroidal neovascularization in age-related macular degeneration with optical coherence tomography angiography. Retina 35(11):2204–2211
Bonnin S, Mané V, Couturier A, Julien M, Paques M, Tadayoni R, Gaudric A (2015) New insight into the macular deep vascular plexus imaged by optical coherence tomography angiography. Retina 35(11):2347–2352
Rahimy E, Freund KB, Larsen M, Spaide RF, Costa RA, Hoang Q, Christakopoulos C, Munch IC, Sarraf D (2014) Multilayered pigment epithelial detachment in neovascular age-related macular degeneration. Retina 34(7):1289–1295
Dansingani KK, Balaratnasingam C, Klufas MA, Sarraf D, Freund KB (2015) Optical coherence tomography angiography of shallow irregular pigment epithelial detachments in pachychoroid spectrum disease. Am J Ophthalmol 160(6):1243–1254
Dansingani KK, Balaratnasingam C, Naysan J, Freund KB (2015) En face imaging of pachychoroid spectrum disorders with swept-source optical coherence tomography. Retina 36(3):499–516
Pang CE, Freund KB (2014) Pachychoroid pigment epitheliopathy may masquerade as acute retinal pigment epitheliitis. Investig Ophthalmol Vis Sci 55(8):5252
Lehmann M, Bousquet E, Beydoun T, Behar-Cohen F (2015) Pachychoroid: an inherited condition? Retina 35(1):10–16
Chen FK, Viljoen RD, Bukowska DM (2015) Classification of image artefacts in optical coherence tomography angiography of the choroid in macular diseases. Clin Exp Ophthalmol. doi:10.1111/ceo.12683 (Epub ahead of print)
Zago Filho LA, Moreira AT, Malafaia O, Matias JE (2014) Grid laser photocoagulation in the treatment of serous avascular pigment epithelial detachment in age-related macular degeneration. Arq Bras Oftalmol 77(5):315–320
Hoerster R, Muether PS, Sitnilska V, Kirchhof B, Fauser S (2014) Fibrovascular pigment epithelial detachment is a risk factor for long-term visual decay in neovascular age-related macular degeneretion. Retina 34(9):1767–1773
Huang D, Jia Y, Rispoli M, Tan O, Lumbroso B (2015) Optical coherence tomography angiography of time course of choroidal neovascularization in response to anti-angiogenic treatment. Retina 35(11):2260–2264
Dansingani KK, Freund KB (2014) Optical coherence tomography angiography reveals mature, tangled vascular networks in eyes with neovascular age-related macular degeneration showing resistance to geographic atrophy. Ophthalmic Surg Lasers Imaging Retina 46(9):907–912
Chen FK, Viljoen RD, Bukowska DM (2015) Classification of image artefacts in optical coherence tomography angiography of the choroid in macular diseases. Clin Exp Ophthalmol. doi:10.1111/ceo.12683 (Epub ahead of print)
Cheng Y, Guo L, Pan C, Lu T, Hong T, Ding Z, Li P (2015) Statistical analysis of motion contrast in optical coherence tomography angiography. J Biomed Opt 20(11):116004
Spaide RF, Fujimoto JG, Waheed NK (2015) Image artifacts in optical coherence tomography angiography. Retina 35(11):2163–2180
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Pichi, F., Morara, M., Veronese, C. et al. The overlapping spectrum of flat irregular pigment epithelial detachment investigated by optical coherence tomography angiography. Int Ophthalmol 38, 975–983 (2018). https://doi.org/10.1007/s10792-017-0547-x
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DOI: https://doi.org/10.1007/s10792-017-0547-x