OSLI Retina

February 2020

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116 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C A S E R E P O R T ■ Longitudinal Evaluation of the Development of Wedge- Shaped Subretinal Hyporeflectivity in Geographic Atrophy Vincenzo Starace, MD; Enrico Borrelli, MD; Vittorio Capuano, MD; Riccardo Sacconi, MD; Francesco Bandello, MD; Giuseppe Querques, MD, PhD ABSTRACT: The authors present the case of a 73-year-old woman affected by geographic atrophy (GA) in her left eye. During her follow-up, she de- veloped a subretinal hyporeflective space visible on optical coherence tomography (OCT) images. This peculiar OCT sign was recognized to represent a wedge-shaped subretinal hyporeflectivity (WSSH). In contrast to previous reports showing that WSSH develops during the flattening of drusenoid pig- ment epithelium detachment (PED), the authors found that the WSSH manifestation may be even consecutive to the regression of a large PED and consequent GA appearance. Therefore, the origin of this peculiar OCT finding could be more complex and variegated. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:116-118.] INTRODUCTION Wedge-shaped subretinal hyporeflectivity (WSSH) is a peculiar optical coherence tomography (OCT) finding first described in atrophic areas of pa- tients with geographic atrophy (GA), an advanced form of age-related macular degeneration (AMD). 1 On OCT B-scan images, WSSH appears as a mostly hyporeflective (with some variable reflective punc- tate material) triangular- or irregular-shaped region, which is delimited internally by the outer plexiform layer (OPL) and externally by Bruch's membrane, both hyperreflective. The estimated prevalence of WSSH in patients with GA is about 10%, it usually involves only one eye, and it is associated with a more advanced stage of the disease. CASE REPORT A 73-year-old woman with AMD was reviewed in clinic. The patient was affected by AMD in both eyes and GA in her left eye, which had not been pre- viously treated with intravitreal anti-vascular en- dothelial growth factor (VEGF) injections and had never displayed signs of neovascularization. OCT examination of her left eye displayed the presence of a subretinal hyporeflective region locat- ed between hyperreflective OPL and Bruch's mem- brane, which indicated a WSSH (Figure 1). Before this visit, she had been followed up for 6 years in our clinic with sequential spectral-domain OCT (SD-OCT) images (Spectralis; Heidelberg En- gineering, Heidelberg, Germany) using the built-in device-tracking software that allowed for the study and follow-up of the same retinal slices. The evalua- tion of the previous visits' SD-OCT B-scans revealed the presence of a drusenoid pigment epithelium detachment (PED) in the foveal region (Figure 1). During the follow-up, the PED flattened, leaving an atrophy of the outer retina and RPE and the severe thinning/disappearance of outer nuclear layer in the corresponding zone. The WSSH appearance was thus consecutive and not concomitant with the PED regression (Figure 1). In addition, the WSSH size seemed to increase throughout the follow-up. DISCUSSION In this case report, we provided a longitudinal description of the development of WSSH in GA. We demonstrated that this OCT sign may follow the regression of a drusenoid PED with RPE atrophy. Importantly, we showed that these two events may not occur in immediate sequence and might not be strictly correlated. Recently, Tan et al. 2 proposed to rename this OCT sign as "plateau," in order to further distin- From the Department of Ophthalmology, University Vita-Salute, IRCCS Os- pedale San Raffaele, Milan, Italy (VS, EB, RS, FB, GQ); and the Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, Créteil, France (VC). Originally submitted February 21, 2019. Revision received July 16, 2019. Accepted for publication September 10, 2019. Dr. Bandello is a consultant for Alcon, Alimera Sciences, Allergan, Farmila- Thea, Bayer Shering-Pharma, Bausch + Lomb, Genentech, Hoffmann-La- Roche, Novagali Pharma, Novartis, Sanofi-Aventis, Thrombogenics, and Zeiss outside the submitted work. Dr. Querques is a consultant for Alimera Sciences, Allergan, Amgen, Bayer Shering-Pharma, Heidelberg, KBH, LEH Pharma, Lumithera, Novartis, Sandoz, Sifi, Sooft-Fidea, and Zeiss outside the submitted work. The remaining authors report no relevant financial disclosures. Address correspondence to Giuseppe Querques, MD, PhD, Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy 20132; email: giuseppe.querques@hotmail.it. doi: 10.3928/23258160-20200129-08

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