Choroidal and Sub-Retinal Pigment Epithelium Caverns Multimodal Imaging and Correspondence with Friedman Lipid Globules
Por:
Dolz-Marco R, Glover JP, Gal-Or O, Litts KM, Messinger JD, Zhang Y, Cozzi M, Pellegrini M, Freund KB, Staurenghi G and Curcio CA
Publicada:
1 ago 2018
Categoría:
Ophthalmology
Resumen:
Purpose: To survey Friedman lipid globules by high-resolution histologic examination and to compare with multimodal imaging of hyporeflective caverns in eyes with geographic atrophy (GA) secondary to age-related macular (AMD) and other retinal diseases.
Design: Histologic survey of donor eyes with and without AMD. Clinical case series with multimodal imaging analysis.
Participants: Donor eyes (n = 139; 26 with early AMD, 13 with GA, 40 with nAMD, 52 with a healthy macula, and 8 with other or unknown characteristics) and 41 eyes of 28 participants with GA (n = 16), nAMD (n = 8), Stargardt disease (n = 4), cone dystrophy (n = 2), pachychoroid spectrum (n = 6), choroidal hemangioma (n = 1), and healthy eyes (n = 4).
Methods: Donor eyes were prepared for macula-wide epoxy resin sections through the foveal and perifoveal area. In patients, caverns were identified as nonreflective spaces on OCT images. Multimodal imaging included color and red-free fundus photography; fundus autofluorescence; fluorescein and, indocyanine green angiography; OCT angiography; near-infrared reflectance; and confocal multispectral (MultiColor [Spectralis, Heidelberg Engineering, Germany]) imaging.
Main Outcome Measures: Presence and morphologic features of globules, and presence and appearance of caverns on multimodal imaging.
Results: Globules were found primarily in the inner choroidal stroma (91.0%), but also localized to the sclera (4.9%) and neovascular membranes (2.1%). Mean diameters of solitary and multilobular globules were 58.9 +/- 37.8 mu m and 65.4 +/- 27.9 mu m, respectively. Globules showed morphologic signs of dynamism including pitting, dispersion, disintegration, and crystal formation. Evidence for inflammation in the surrounding tissue was absent. En face OCT rendered sharply delimited hyporeflective areas as large as choroidal vessels, frequently grouped around choroid vessels or in the neovascular tissue. Cross-sectional OCT revealed a characteristic posterior hypertransmission. OCT angiography showed absence of flow signal within caverns.
Conclusions: Based on prior literature documenting OCT signatures of tissue lipid in atheroma and nAMD, we speculate that caverns are lipid rich. Globules, with similar sizes and tissue locations in AMD and healthy persons, are candidates for histologic correlates of caverns. The role of globules in chorioretinal physiologic features, perhaps as a lipid depot for photoreceptor metabolism, is approachable through clinical imaging. (C) 2018 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology
Filiaciones:
:
Vitreous Retina Macula Consultants of New York, New York, New York
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
FISABIO Ophthalmology Medicine, Valencia, Spain
Glover JP:
Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama
Gal-Or O:
Vitreous Retina Macula Consultants of New York, New York, New York
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Israel
Litts KM:
Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama
Department of Ophthalmology Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
Messinger JD:
Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama
Zhang Y:
Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama
Cozzi M:
Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," University of Milan, Milan, Italy
Pellegrini M:
Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," University of Milan, Milan, Italy
Freund KB:
Vitreous Retina Macula Consultants of New York, New York, New York
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York
Department of Ophthalmology, New York University School of Medicine, New York, New York
Staurenghi G:
Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," University of Milan, Milan, Italy
Curcio CA:
Vitreous Retina Macula Consultants of New York, New York, New York
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