Zhang Yuhua, Wang Xiaolin, Rivero Ernesto Blanco, Clark Mark E, Witherspoon Clark Douglas, Spaide Richard F, Girkin Christopher A, Owsley Cynthia, Curcio Christine A
Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Am J Ophthalmol. 2014 Sep;158(3):584-96.e1. doi: 10.1016/j.ajo.2014.05.038. Epub 2014 Jun 5.
To describe the microscopic structure of photoreceptors impacted by subretinal drusenoid deposits, also called pseudodrusen, an extracellular lesion associated with age-related macular degeneration (AMD), using adaptive optics scanning laser ophthalmoscopy (AOSLO).
Observational case series.
We recruited 53 patients with AMD and 10 age-similar subjects who had normal retinal health. All subjects underwent color fundus photography, infrared reflectance, red-free reflectance, autofluorescence, and spectral-domain optical coherence tomography (OCT). Subretinal drusenoid deposits were classified by a 3-stage OCT-based grading system. Lesions and surrounding photoreceptors were examined by AOSLO.
Subretinal drusenoid deposits were found in 26 eyes of 13 patients with AMD and imaged by AOSLO and spectral-domain OCT in 18 eyes (n = 342 lesions). Spectral-domain OCT showed subretinal drusenoid deposits as highly reflective material accumulated internal to the retinal pigment epithelium. AOSLO revealed that photoreceptor reflectivity was qualitatively reduced by stage 1 subretinal drusenoid deposits and was greatly reduced by stage 2. AOSLO presented a distinct structure in stage 3, a hyporeflective annulus consisting of deflected, degenerated or absent photoreceptors. A central core with a reflectivity superficially resembling photoreceptors is formed by the lesion material itself. A hyporeflective gap in the photoreceptor ellipsoid zone on either side of this core shown in spectral-domain OCT corresponded to the hyporeflective annulus seen by AOSLO.
AOSLO and multimodal imaging of subretinal drusenoid deposits indicate solid, space-filling lesions in the subretinal space. Associated retinal reflectivity changes are related to lesion stages and are consistent with perturbations to photoreceptors, as suggested by histology.
利用自适应光学扫描激光检眼镜（AOSLO）描述受视网膜下类玻璃膜疣沉积物（也称为假性玻璃膜疣）影响的光感受器的微观结构，该沉积物是一种与年龄相关性黄斑变性（AMD）相关的细胞外病变。
观察性病例系列。
我们招募了53例AMD患者和10名视网膜健康状况正常的年龄相仿受试者。所有受试者均接受了彩色眼底照相、红外反射、无赤光反射、自发荧光和光谱域光学相干断层扫描（OCT）检查。视网膜下类玻璃膜疣沉积物通过基于OCT的3级分级系统进行分类。通过AOSLO检查病变及周围的光感受器。
在13例AMD患者的26只眼中发现了视网膜下类玻璃膜疣沉积物，并在18只眼中通过AOSLO和光谱域OCT进行了成像（n = 342个病变）。光谱域OCT显示视网膜下类玻璃膜疣沉积物为积聚在视网膜色素上皮内部的高反射性物质。AOSLO显示，1期视网膜下类玻璃膜疣沉积物使光感受器反射率在质量上降低，2期时则大幅降低。AOSLO在3期呈现出一种独特的结构，即由偏斜、退化或缺失的光感受器组成的低反射环。病变物质本身形成了一个反射率表面上类似于光感受器的中央核心。光谱域OCT显示该核心两侧光感受器椭圆体区的低反射间隙与AOSLO所见的低反射环相对应。
AOSLO和视网膜下类玻璃膜疣沉积物的多模态成像表明视网膜下间隙存在实性、占据空间的病变。相关的视网膜反射率变化与病变阶段有关，并且如组织学所示，与光感受器的扰动一致。
