OPTICAL COHERENCE TOMOGRAPHY OF RETINAL PIGMENT EPITHELIUM FOLDS Salomon Y. Cohen, MD, PHD, Lise Dubois, Chistophe Debibie
Purpose: To report the optical coherence tomography (OCT) findings in retinal pigment epithelium (RPE) folds. Methods: Fluorescein and/or indocyanine green angiography, and OCT were performed in four consecutive patients presenting RPE folds with typical fingerprint pattern of RPE detachment. Results: In the 4 cases, OCT allowed direct visualization of the folds. Conclusion: OCT valited the initial hypothesis by Schatz et al, who interpreted the fingerprint pattern as RPE folds. RETINAL CASES & BRIEF REPORTS 2:309 –311, 2008
From Centre Ophtalmologique d’Imagerie et de Laser, Paris, France.
fluorescein angiography, and OCT 3 of the right eye revealed an RPE tear. Fundus examination and fluorescein angiography of the left eye showed RPE folds, with a typical fingerprint pattern (Fig. 1, left and top right). OCT 3 of the left eye allowed direct visualization of these folds. The RPE detachment was tiny. A shallow serous retinal detachment was also observed (Fig. 1, bottom right).
I
n 1990, Schatz et al1 described six eyes of patients with age-related macular degeneration with a fingerprint image of a retinal pigment epithelium (RPE) detachment. This particular pattern was interpreted as the formation of RPE folds. The hypothesis was that contraction of the subpigmentary epithelial fibrovascular tissue may cause folding of the overlying adherent RPE. To date, there has been no histologic confirmation of this hypothesis. However, it is currently admitted that vascularized RPE detachments may evolve toward the formation of RPE folds and, more frequently, toward RPE tears.2,3 We recently examined four patients with typical RPE folds. Herein, we report our optical coherence tomography (OCT) findings for this condition.
Case 2 An 86-year-old woman was referred for visual loss in the right eye. Visual acuity (measured with an ETDRS chart) was 20/40 in the right eye and 20/200 in the left eye. Fundus examination of the left eye showed a diskiform scar. Fundus examination, fluorescein angiography, and OCT of the right eye disclosed RPE folds with faint macular edema. The RPE detachment was tiny (Fig. 2).
Case 3 A 78-year-old woman was referred for visual loss in the right eye. Visual acuity (measured with an ETDRS chart) was 20/200 in the right eye and 20/25 in the left eye. Fundus examination, fluorescein angiography, and OCT of the right eye showed classic choroidal neovascularization, while the left eye had RPE folds (Fig. 3).
Case Reports Case 1
Case 4
A 72-year-old woman was referred for visual loss in the right eye. Visual acuity (measured with an ETDRS chart) was 20/50 in the right eye and 20/25 in the left eye. Fundus examination,
A 75-year-old woman was referred for indocyanine green angiography. Age-related macular degeneration had been diagnosed 1 year before with vascularized RPE detachment in the left eye, which was left untreated. Visual acuity (measured with an ETDRS chart) was 20/40 in the right eye and 20/100 in the left eye. Fundus examination, indocyanine green angiography, and OCT showed a fibrous diskiform scar in the left eye and an RPE detachment with RPE folds in the right eye (Fig. 4).
Reprint requests: Salomon Y. Cohen, MD, PhD, Centre Ophtalmologique d’Imagerie et de Laser, 11 Rue Antoine Bourdelle, 75015 Paris, France; e-mail: [email protected]
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RETINAL CASES & BRIEF REPORTSℜ
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Fig. 1. Case 1. Folds of the retinal pigment epithelium (RPE). Red-free photography (left), fluorescein angiography (top right), and optical coherence tomography (OCT; bottom right) of the left eye of a 72-year-old woman. The red-free picture showed a fingerprint image of the temporal part of the fovea. Fluorescein angiography disclosed an image typical of RPE folds. The orientation of the OCT scan is shown on the red-free picture. The RPE folds were directly visible. A tiny RPE detachment and a shallow serous retinal detachment were also present.
Discussion OCT has become a very important tool for noninvasive imaging of retinal diseases, especially for the diagnosis, follow-up, and management of RPE detachments complicating age-related macular degeneration.4,5 However, after a computer-assisted search of the literature using MEDLINE, OCT of RPE folds has not, to our knowledge, been previously reported, despite numerous studies of OCT findings in age-related macular degeneration. On the contrary, other kinds of
folds, such as retinal folds and chorioretinal folds, have been imaged by OCT.6,7 In the current cases, OCT allowed confirmation of the initial interpretation of fluorescein angiography by Schatz et al,1 who considered that the fingerprint pattern observed in some RPE detachments corresponds to the formation of RPE folds. They also postulated that folds occur when RPE detachments partially flatten. In fact, in three of our four cases, OCT showed a very shallow RPE detachment compatible with this hypothesis.
Fig. 2. Case 2. Fluorescein angiography (top) and vertical optical coherence tomography (OCT; bottom) showed typical folds of the retinal pigment epithelium (RPE) with faint macular edema. The RPE detachment was tiny. The orientation of the OCT scan is shown on the fluorescein angiogram.
Fig. 3. Case 3. Fluorescein angiography (top) and horizontal optical coherence tomography (OCT; bottom) showed folds of the retinal pigment epithelium (RPE). Macular edema and RPE detachment appeared minimal. The orientation of the OCT scan is shown on the fluorescein angiogram.
311
OCT OF RPE FOLDS
Key words: optical coherence tomography, agerelated macular degeneration, retinal pigment epithelium detachment, retinal pigment epithelium folds. References 1.
2.
3. 4.
5.
Fig. 4. Case 4. Indocyanine green angiography (top) and oblique optical coherence tomography (OCT; bottom) showed serous detachment of the retinal pigment epithelium (RPE) with folds. Serous retinal detachment was observed around the RPE detachment. The orientation of the OCT scan is shown on the indocyanine green angiogram.
6.
7.
Schatz H, McDonald HR, Johnson RN. Retinal pigment epithelial folds associated with retinal pigment epithelial detachment in macular degeneration. Ophthalmology 1990;97:658– 665. Lindblom B, Andersson T. Choroidal neovascularization with retinal pigment epithelial folds. Arch Ophthalmol 1995;113: 946–947. Gass JDM. Stereoscopic Atlas of Macular Diseases. 4th ed. St. Louis: Mosby; 1997:86–91. Sato T, Iida T, Hagimura N, Kishi S. Correlation of optical coherence tomography with angiography in retinal pigment epithelial detachment associated with age-related macular degeneration. Retina 2004;24:910–914. Hee MR, Baumal CR, Puliafito CA, et al. Optical coherence tomography of age-related macular degeneration and choroidal neovascularization. Ophthalmology 1996;103:1260–1270. Yamaguchi K, Yoshida M, Kano T, et al. Adult-onset foveomacular vitelliform dystrophy with retinal folds. Jpn J Ophthalmol 2001;45:533–537. Kokame GT, de Leon MD, Tanji T. Serous retinal detachment and cystoid macular edema in hypotony maculopathy. Am J Ophthalmol 2001;131:384–386.
Purpose: To report the optical coherence tomography (OCT) findings in retinal pigment epithelium (RPE) folds. Methods: Fluorescein and/or indocyanine green angiography, and OCT were performed in four consecutive patients presenting RPE folds with typical fingerprint pattern of RPE detachment. Results: In the 4 cases, OCT allowed direct visualization of the folds. Conclusion: OCT valited the initial hypothesis by Schatz et al, who interpreted the fingerprint pattern as RPE folds. RETINAL CASES & BRIEF REPORTS 2:309 –311, 2008
From Centre Ophtalmologique d’Imagerie et de Laser, Paris, France.
fluorescein angiography, and OCT 3 of the right eye revealed an RPE tear. Fundus examination and fluorescein angiography of the left eye showed RPE folds, with a typical fingerprint pattern (Fig. 1, left and top right). OCT 3 of the left eye allowed direct visualization of these folds. The RPE detachment was tiny. A shallow serous retinal detachment was also observed (Fig. 1, bottom right).
I
n 1990, Schatz et al1 described six eyes of patients with age-related macular degeneration with a fingerprint image of a retinal pigment epithelium (RPE) detachment. This particular pattern was interpreted as the formation of RPE folds. The hypothesis was that contraction of the subpigmentary epithelial fibrovascular tissue may cause folding of the overlying adherent RPE. To date, there has been no histologic confirmation of this hypothesis. However, it is currently admitted that vascularized RPE detachments may evolve toward the formation of RPE folds and, more frequently, toward RPE tears.2,3 We recently examined four patients with typical RPE folds. Herein, we report our optical coherence tomography (OCT) findings for this condition.
Case 2 An 86-year-old woman was referred for visual loss in the right eye. Visual acuity (measured with an ETDRS chart) was 20/40 in the right eye and 20/200 in the left eye. Fundus examination of the left eye showed a diskiform scar. Fundus examination, fluorescein angiography, and OCT of the right eye disclosed RPE folds with faint macular edema. The RPE detachment was tiny (Fig. 2).
Case 3 A 78-year-old woman was referred for visual loss in the right eye. Visual acuity (measured with an ETDRS chart) was 20/200 in the right eye and 20/25 in the left eye. Fundus examination, fluorescein angiography, and OCT of the right eye showed classic choroidal neovascularization, while the left eye had RPE folds (Fig. 3).
Case Reports Case 1
Case 4
A 72-year-old woman was referred for visual loss in the right eye. Visual acuity (measured with an ETDRS chart) was 20/50 in the right eye and 20/25 in the left eye. Fundus examination,
A 75-year-old woman was referred for indocyanine green angiography. Age-related macular degeneration had been diagnosed 1 year before with vascularized RPE detachment in the left eye, which was left untreated. Visual acuity (measured with an ETDRS chart) was 20/40 in the right eye and 20/100 in the left eye. Fundus examination, indocyanine green angiography, and OCT showed a fibrous diskiform scar in the left eye and an RPE detachment with RPE folds in the right eye (Fig. 4).
Reprint requests: Salomon Y. Cohen, MD, PhD, Centre Ophtalmologique d’Imagerie et de Laser, 11 Rue Antoine Bourdelle, 75015 Paris, France; e-mail: [email protected]
309
310
RETINAL CASES & BRIEF REPORTSℜ
●
2008
●
VOLUME 2
●
NUMBER 4
Fig. 1. Case 1. Folds of the retinal pigment epithelium (RPE). Red-free photography (left), fluorescein angiography (top right), and optical coherence tomography (OCT; bottom right) of the left eye of a 72-year-old woman. The red-free picture showed a fingerprint image of the temporal part of the fovea. Fluorescein angiography disclosed an image typical of RPE folds. The orientation of the OCT scan is shown on the red-free picture. The RPE folds were directly visible. A tiny RPE detachment and a shallow serous retinal detachment were also present.
Discussion OCT has become a very important tool for noninvasive imaging of retinal diseases, especially for the diagnosis, follow-up, and management of RPE detachments complicating age-related macular degeneration.4,5 However, after a computer-assisted search of the literature using MEDLINE, OCT of RPE folds has not, to our knowledge, been previously reported, despite numerous studies of OCT findings in age-related macular degeneration. On the contrary, other kinds of
folds, such as retinal folds and chorioretinal folds, have been imaged by OCT.6,7 In the current cases, OCT allowed confirmation of the initial interpretation of fluorescein angiography by Schatz et al,1 who considered that the fingerprint pattern observed in some RPE detachments corresponds to the formation of RPE folds. They also postulated that folds occur when RPE detachments partially flatten. In fact, in three of our four cases, OCT showed a very shallow RPE detachment compatible with this hypothesis.
Fig. 2. Case 2. Fluorescein angiography (top) and vertical optical coherence tomography (OCT; bottom) showed typical folds of the retinal pigment epithelium (RPE) with faint macular edema. The RPE detachment was tiny. The orientation of the OCT scan is shown on the fluorescein angiogram.
Fig. 3. Case 3. Fluorescein angiography (top) and horizontal optical coherence tomography (OCT; bottom) showed folds of the retinal pigment epithelium (RPE). Macular edema and RPE detachment appeared minimal. The orientation of the OCT scan is shown on the fluorescein angiogram.
311
OCT OF RPE FOLDS
Key words: optical coherence tomography, agerelated macular degeneration, retinal pigment epithelium detachment, retinal pigment epithelium folds. References 1.
2.
3. 4.
5.
Fig. 4. Case 4. Indocyanine green angiography (top) and oblique optical coherence tomography (OCT; bottom) showed serous detachment of the retinal pigment epithelium (RPE) with folds. Serous retinal detachment was observed around the RPE detachment. The orientation of the OCT scan is shown on the indocyanine green angiogram.
6.
7.
Schatz H, McDonald HR, Johnson RN. Retinal pigment epithelial folds associated with retinal pigment epithelial detachment in macular degeneration. Ophthalmology 1990;97:658– 665. Lindblom B, Andersson T. Choroidal neovascularization with retinal pigment epithelial folds. Arch Ophthalmol 1995;113: 946–947. Gass JDM. Stereoscopic Atlas of Macular Diseases. 4th ed. St. Louis: Mosby; 1997:86–91. Sato T, Iida T, Hagimura N, Kishi S. Correlation of optical coherence tomography with angiography in retinal pigment epithelial detachment associated with age-related macular degeneration. Retina 2004;24:910–914. Hee MR, Baumal CR, Puliafito CA, et al. Optical coherence tomography of age-related macular degeneration and choroidal neovascularization. Ophthalmology 1996;103:1260–1270. Yamaguchi K, Yoshida M, Kano T, et al. Adult-onset foveomacular vitelliform dystrophy with retinal folds. Jpn J Ophthalmol 2001;45:533–537. Kokame GT, de Leon MD, Tanji T. Serous retinal detachment and cystoid macular edema in hypotony maculopathy. Am J Ophthalmol 2001;131:384–386.
