title: Appearance of regressing drusen on optical coherence tomography in age-related macular degeneration.
abstract: OBJECTIVE
  To describe and interpret a multilaminar sub-retinal pigment epithelium (RPE) intense hyper-reflectivity observed in vivo in eyes clinically diagnosed with regressing drusen.
  
  
  METHODS
  Observational case series.
  
  
  METHODS
  Twenty-three consecutive patients clinically diagnosed with regressing calcific drusen due to nonneovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Patients were submitted to confocal scanning laser ophthalmoscopy (cSLO) fundus imaging and "eye-tracked" spectral-domain optical coherence tomography (SD-OCT).
  
  
  METHODS
  Localization and possible origin and composition of the multilaminar sub-RPE hyperreflectivity.
  
  
  RESULTS
  Thirty eyes of 23 consecutive patients (8 male and 15 female; mean age, 82.7±10.1 years) showing on SD-OCT an intense multilaminar sub-RPE hyperreflectivity, which matched with regressing calcific drusen as visualized by cSLO infrared (IR) and MultiColor (Heidelberg Engineering, Heidelberg, Germany) images, were included in this study. The multilaminar hyperreflectivity was found to localize to beneath the RPE and above the outer Bruch's membrane (oBM) layer. A mean of 1.2 multilaminar sub-RPE hyperreflectivities per SD-OCT scan were identified by 2 readers. The SD-OCT analysis allowed the 2 readers to describe 3 different types of sub-RPE hyperreflectivity. "Type 1" laminar/multilaminar hyperreflectivity (found in 24 scans of 12 eyes) was characterized by an intense signal originating from what we interpreted as the inner Bruch's membrane (iBM) layer. "Type 2" multilaminar hyperreflectivity (found in 130 scans of 27 eyes) was characterized by an intense signal originating from the oBM layer. "Type 3" multilaminar fragmented hyperreflectivity (found in 22 scans of 11 eyes) was characterized by an intense signal originating from what we interpreted as both the iBM and the oBM, showing different degrees of fragmentation.
  
  
  CONCLUSIONS
  We describe a novel SD-OCT finding appearing as multilaminar sub-RPE intense hyper-reflectivity observed in vivo in eyes with regressing drusen. This multilaminar sub-RPE hyperreflectivity could be interpreted as layers of lipid mineralization (membranous debris also called "lipoprotein-derived debris" developing calcification), internal and external to the basement membrane, with different degrees of fragmentation.
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est Creteil, Creteil, France. Electronic address: giuseppe.querques@hotmail.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est Creteil, Creteil, France.
authors.forename: Anouk
authors.initials: A
authors.lastname: Georges
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est Creteil, Creteil, France.
authors.forename: Naima
authors.initials: N
authors.lastname: Ben Moussa
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est Creteil, Creteil, France.
authors.forename: Margaret
authors.initials: M
authors.lastname: Sterkers
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est Creteil, Creteil, France.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D057092:Geographic Atrophy / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D050356:Lipid Metabolism; D008297:Male; D009887:Ophthalmoscopy; D015593:Retinal Drusen / Q000175:diagnosis* / Q000503:physiopathology; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D041623:Tomography, Optical Coherence