Abstract
PurposeTo report the image artifacts due to retinal pigment epithelium (RPE) hyperplasia overlying retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD), which can masquerade as neovascularization on optical coherence tomography angiography (OCTA).MethodsA hospital-based, retrospective, and cross-sectional study. Twenty-two eyes from 16 patients with non-vascularized PED related to AMD were included in this study. All patients were examined by OCTA, spectral-domain optical coherence tomography, fluorescence angiography, and indocyanine green angiography. Vascular flow signals (VFS) on both the outer retinal slab of en face OCTA and cross-sectional OCTA and their correspondence with RPE hyperplasia were evaluated.ResultsFifteen eyes (68.2%) showed VFS on both the outer retina slab of en face OCTA and cross-sectional OCTA, all corresponding to the RPE hyperplasia overlying PED. Among them, 12 eyes with lump RPE hyperplasia outside foveal avascular zone (FAZ) all showed obvious VFS on the outer retina slab of OCTA, and 3 eyes with scattered RPE hyperplasia outside FAZ showed VFS fragments. Of note, 4 eyes had accompanied RPE hyperplasia inside FAZ, and 7 eyes without RPE hyperplasia overlying PED showed no corresponding VFS on the outer retina slab of OCTA. Additionally, a round-like dark band at the edge of PED was observed in the outer retina slab on en face OCTA in 17 eyes (77.3%).ConclusionsRPE hyperplasia overlying PED in AMD can masquerade as neovascularization on OCTA. To avoid misdiagnosis and unnecessary treatment, this RPE hyperplasia-related image artifact should be considered when interpreting OCTA images.
Highlights
Optical coherence tomography angiography (OCTA) is a noninvasive technology that uses motion contrast to produce high-resolution angiographic images of the retinal and choroidal vasculature, without the need for a contrast agent [1, 2]
Of the 22 eyes with non-vascularized pigment epithelial detachment (PED) related to age-related macular degeneration (AMD), 15 eyes (68.2%) showed Vascular flow signals (VFS) at the outer retina slab of en face OCTA and cross-sectional OCTA
The position and pattern of the VFS displayed in the outer retina slab on en face OCTA were corresponding to the position and pattern of the retinal pigment epithelium (RPE) hyperplasia overlying PED, which was confirmed by other multimodal imaging including color fundus photography (FP), AF, FA, indocyanine green angiography (ICGA), IR, and optical coherence tomography (OCT)
Summary
Optical coherence tomography angiography (OCTA) is a noninvasive technology that uses motion contrast to produce high-resolution angiographic images of the retinal and choroidal vasculature, without the need for a contrast agent [1, 2]. OCTA has been shown to be valuable in the detection and evaluation of vascular abnormalities in different retinal and choroidal diseases including diabetic retinopathy (DR), retinal. The classification of PED in AMD can be divided into drusenoid, serous, vascularized, or mixed categories [12]. (FA), indocyanine green angiography (ICGA), and spectraldomain optical coherence tomography (OCT), can be used to identify PED types and determine whether neovascularization exist. OCTA have been more and more used to detect whether there is neovascularization in patients with AMD and to explore the potential factors of PED formation. In our clinical practice, it was not uncommon that non-vascularized PED was misdiagnosed as type 3 neovascularization secondary to AMD. Since a mixed serous and drusenoid PED with a closely related deep neovascular lesion is typical characteristic of type 3 neovascularization [14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
