title: Drusen with accompanying fluid underneath the sensory retina.
abstract: OBJECTIVE
  To investigate whether confluent drusen may be accompanied by fluid accumulation underneath the sensory retina and to determine if the detection of subretinal fluid on spectral-domain optical coherence tomography (OCT) in patients with coalescent drusen is indicative of choroidal neovascularization (CNV).
  
  
  METHODS
  Prospective, noncomparative case series.
  
  
  METHODS
  Seventy-four eyes of 57 patients with large, confluent drusen.
  
  
  METHODS
  The retinal structure of patients with coalescent drusen was studied by spectral-domain OCT. Optical coherence tomography reflectivity and outer retina topography maps were created and compared with fluorescein angiography (FA) and indocyanine green angiography (ICGA) images as well as with microperimetry.
  
  
  METHODS
  Optical coherence tomography-derived retinal morphologic features.
  
  
  RESULTS
  What appears to be fluid beneath the sensory retina was found on spectral-domain OCT in 8 eyes of 7 patients. The outer retina topography maps demonstrated that fluid accumulates only in the concavity between clustering soft drusen, not on their outward slopes. The maps also revealed a reduced distance between the retinal pigment epithelium (RPE) and the photoreceptor inner/outer segment (IS/OS) junction over large drusen and tiny elevations of the IS/OS junction around drusen of all sizes. Microperimetry showed decreased retinal light sensitivity at the site of diminished distance between the RPE and the IS/OS junction. Seven eyes of 6 patients who were followed up were found to have no retinal changes other than confluent drusen along with subretinal fluid during the entire observational period (12-27 months). There was no evidence of CNV on FA or ICGA in any of the patients.
  
  
  CONCLUSIONS
  Large, confluent drusen may be accompanied by subretinal spaces that appear to be filled with fluid. Specific distribution of the fluid limited to the depression between adjacent drusen may indicate that the cluster of coalescent drusen produces mechanical strain to the outer retinal layers that locally pulls the sensory retina away from its normal position. Consequently, the appearance of fluid within subretinal compartment between coalescent drusen in OCT cross-sectional images may not be a reliable marker for the presence of CNV.
authors: Department of Ophthalmology, Nicolaus Copernicus University, Bydgoszcz, Poland. sikorski@doctors.org.uk
authors: Bartosz L
authors: BL
authors: Sikorski
authors: Danuta
authors: D
authors: Bukowska
authors: Jakub J
authors: JJ
authors: Kaluzny
authors: Maciej
authors: M
authors: Szkulmowski
authors: Andrzej
authors: A
authors: Kowalczyk
authors: Maciej
authors: M
authors: Wojtkowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000175:diagnosis*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D021621:Imaging, Three-Dimensional; D007208:Indocyanine Green; D008297:Male; D011446:Prospective Studies; D015593:Retinal Drusen / Q000175:diagnosis*; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green