Imaging of sub-retinal pigment epithelial linear structures in patients with age-related macular degeneration.
OBJECTIVE
To evaluate hyperreflective linear structures (HLS), as assessed using spectral-domain optical coherence tomography (SD-OCT), identified under the retinal pigment epithelium (RPE) in patients with age-related macular degeneration (AMD).


METHODS
This retrospective observational case study was conducted on 427 eyes of 408 consecutive patients who were scheduled to undergo anti-vascular endothelial growth factor (anti-VEGF) therapy for AMD. Patients with HLS under the RPE were investigated based on the SD-OCT findings at baseline or during the follow-up period. The associations between HLS and the lesion subtypes, localization in SD-OCT, clinical findings, and structural change after anti-VEGF treatment were also investigated.


RESULTS
HLS were identified in 18 eyes of 16 patients. From the eyes with HLS, 12 eyes (66.7%) were diagnosed with retinal angiomatous proliferation (RAP), 4 eyes (22.2%) were diagnosed with occult choroidal neovascularization, and the remaining 2 eyes (11.1%) were diagnosed with polypoidal choroidal vasculopathy. HLS were multifocal and exhibited multilocalization under the RPE in all the eyes. Although it was difficult to identify these structures in the clinical findings at baseline, crystalline deposits correlated with the linear bands were observed during the follow-up period in 16 eyes (88.9%). After the anti-VEGF treatments, the HLS remained between the Bruch membrane and RPE or combined with the fibrovascular component.


CONCLUSIONS
HLS are rare SD-OCT findings found in patients with AMD, found in only 4.2% of the patients examined in this study. HLS were found especially in RAP lesions.
Department of Ophthalmology, Yokohama City University Medical Center, Yokohama - Japan.
Maiko
M
Inoue
Akira
A
Arakawa
Shin
S
Yamane
Kazuaki
K
Kadonosono
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A