title: Pathologic insights from integrated imaging of reticular pseudodrusen in age-related macular degeneration.
abstract: OBJECTIVE
  The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluorescence, and fluorescein angiography (integrated confocal scanning laser ophthalmoscopy fundus imaging) features of reticular pseudodrusen and eye-tracked Spectralis high-resolution spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany).
  
  
  METHODS
  Twenty-two consecutive patients with reticular pseudodrusen were prospectively enrolled and evaluated regarding confocal scanning laser ophthalmoscopy fundus imaging and eye-tracked SD-OCT findings.
  
  
  RESULTS
  Integrated fundus imaging revealed a "target" aspect of most reticular pseudodrusen in the 42 included eyes (22 patients; 12 women, 10 men; mean age 81.38 ± 6.47 years). On fundus autofluorescence and infrared reflectance, the center of most reticular pseudodrusen appeared as an area of isoautofluorescence/reflectance surrounded by halos of reduced autofluorescence/reflectance. Similarly, on fluorescein angiography, the center of reticular pseudodrusen appeared as an area of decreased fluorescence surrounded by a faint halo of increased fluorescence. Spectral domain optical coherence tomography showed a well-defined round or triangular hyperreflective deposit localized between, externally, the retinal pigment epithelium layer, and, internally, the external limiting membrane or the outer plexiform layer. Moreover, SD-OCT showed the loss of both outer segment/retinal pigment epithelium interface and inner segment/outer segment interface over the hyperreflective lesions, as well as an abrupt interruption of both these interfaces at the border of the hyperreflective lesions.
  
  
  CONCLUSIONS
  The peculiar confocal scanning laser ophthalmoscopy fundus imaging and tracked SD-OCT of reticular pseudodrusen suggest the presence of central lipofuscin-like retinal deposits localized above the retinal pigment epithelium. These findings give insights to other possible aspects of age-related retinal changes.
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris XII, Creteil, France. giuseppe.querques@hotmail.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.forename: Lea
authors.initials: L
authors.lastname: Querques
authors.forename: Domenico
authors.initials: D
authors.lastname: Martinelli
authors.forename: Nathalie
authors.initials: N
authors.lastname: Massamba
authors.forename: Gabriel
authors.initials: G
authors.lastname: Coscas
authors.forename: Gisele
authors.initials: G
authors.lastname: Soubrane
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008062:Lipofuscin / Q000378:metabolism; D008268:Macular Degeneration / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D009887:Ophthalmoscopy; D011446:Prospective Studies; D015593:Retinal Drusen / Q000175:diagnosis* / Q000378:metabolism; D055211:Retinal Photoreceptor Cell Inner Segment / Q000473:pathology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D055213:Retinal Pigment Epithelium / Q000378:metabolism / Q000473:pathology*; D041623:Tomography, Optical Coherence
chemical_list: D008062:Lipofuscin