Vitreous Retina Macula Consultants of New York, New York City, New York, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York City, New York, USA; Department of Ophthalmology, Basurto University Hospital, Bilbao, SP; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York City, New York, USA.
Vitreous Retina Macula Consultants of New York, New York City, New York, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York City, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York City, New York, USA; Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York City, New York, USA.
Am J Ophthalmol. 2021 Feb;222:112-125. doi: 10.1016/j.ajo.2020.09.003. Epub 2020 Sep 9.
To describe the presence of subretinal lipid globules (SLG), analyze the multimodal imaging features inherent in their optical properties, and provide a means to distinguish them from other retinal structures and clinical signs.
Retrospective cohort study.
The clinical data and multimodal imaging features of 39 patients (49 eyes) showing SLG were evaluated. Patients underwent color fundus photography, near-infrared reflectance (NIR), spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) and OCT angiography. In vitro phantom models were used to model OCT optical properties of water, mineral oil, and intralipid droplets and to investigate the optical mechanisms producing hypertransmission tails beneath SLG.
The SLG were not visible in color fundus photographs or in NIR images. With both SD- and SS-OCT B-scans, SLG appeared as 31-157 μm, round, hyporeflective structures demonstrating a characteristic hypertransmission tail previously described with lipid globules found in the choroid and in neovascular membranes. Similarly, with en face OCT, SLG appeared as small, round, hyporeflective structures. SLG were encountered most often in eyes with neovascular age-related macular degeneration (AMD) that had type 1 macular neovascularization (MNV) (91.1%). Of those eyes, 93.3% were receiving intravitreal antivascular endothelial growth factor (VEGF) therapy (median of 15 injections) with a mean follow-up of 52.6 months. The number of prior injections positively correlated with the number of SLG. The detection of MNV preceded the presence of SLG in 66.7% of cases. En face OCT showed that, in many eyes (49%), SLG appeared in clusters of >10. In 38.8% of eyes, SLG were found overlying type 1 MNV, and in 44.9% of eyes, often those with more numerous SLG, the SLG were located near the lesion border. In 2 eyes with AMD followed for nonexudative type 1 MNV, SLG were detected prior to the detection of other imaging signs of exudation. SLG were observed in several other exudative macular diseases. Phantom models demonstrated that the hypertransmission tail beneath SLG is related to a lensing effect produced by these hyporeflective spherical structures.
SLG are a newly recognized OCT feature frequently seen in eyes receiving intravitreal anti-VEGF therapy for type 1 MNV due to AMD. OCT B-scans show SLG as small, round, hyporeflective structures with a characteristic hypertransmission tail. This OCT signature is influenced by the OCT focal plane, and it relates to reduced signal attenuation through oil and a lensing effect created by a higher refractive index compared to surrounding tissue.
描述视网膜下脂质球（SLG）的存在，分析其光学特性固有存在的多模态成像特征，并提供一种将其与其他视网膜结构和临床体征区分开来的方法。
回顾性队列研究。
评估了 39 名（49 只眼）显示 SLG 的患者的临床数据和多模态成像特征。患者接受了眼底彩色照相、近红外反射（NIR）、谱域（SD）和扫频源（SS）光学相干断层扫描（OCT）和 OCT 血管造影。使用体外模型来模拟水、矿物油和脂肪乳滴的 OCT 光学特性，并研究产生 SLG 下方超透射尾的光学机制。
眼底彩色照片或 NIR 图像均无法显示 SLG。在 SD 和 SS-OCT B 扫描中，SLG 呈现出 31-157μm、圆形、低反射性结构，呈现出先前描述的在脉络膜和新生血管膜中发现的脂质球的特征性超透射尾。同样，在 en face OCT 中，SLG 呈现为小圆、低反射性结构。SLG 最常见于接受新生血管性年龄相关性黄斑变性（AMD）治疗的眼睛，这些眼睛存在 1 型黄斑新生血管化（MNV）（91.1%）。在这些眼中，93.3%正在接受玻璃体内抗血管内皮生长因子（VEGF）治疗（中位数 15 次注射），平均随访 52.6 个月。注射次数与 SLG 的数量呈正相关。在 66.7%的病例中，MNV 的发现先于 SLG 的出现。在 38.8%的眼中，SLG 位于 1 型 MNV 上方，在 44.9%的眼中，通常是那些 SLG 数量较多的眼中，SLG 位于病变边界附近。在 2 只随访无渗出性 1 型 MNV 的 AMD 眼中，在检测到其他渗出性成像迹象之前，检测到了 SLG。SLG 还存在于其他几种渗出性黄斑疾病中。模型研究表明，SLG 下方的超透射尾与这些低反射性球形结构产生的透镜效应有关。
SLG 是一种新发现的 OCT 特征，在接受玻璃体内抗 VEGF 治疗 AMD 所致 1 型 MNV 的眼睛中经常可见。OCT B 扫描显示 SLG 为小圆、低反射性结构，具有特征性的超透射尾。这种 OCT 特征受 OCT 焦平面的影响，与通过油层的信号衰减减少以及与周围组织相比折射率较高的透镜效应有关。
