Imaging of a retinal pigment epithelium aperture using polarization-sensitive optical coherence tomography
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CLINICAL INVESTIGATION
Imaging of a retinal pigment epithelium aperture using polarization‑sensitive optical coherence tomography Ryo Obata1 · Akie Yoshinaga1,2 · Motoshi Yamamoto1 · Kayoko Komatsu1 · Nobuyori Aoki3 · Masahiro Yamanari3 · Satoshi Sugiyama3 · Takahiro Minami1 · Keiko Azuma1 · Tatsuya Inoue1,4 · Makoto Aihara1 · Satoshi Kato1 Received: 19 May 2020 / Accepted: 25 September 2020 © Japanese Ophthalmological Society 2020
Abstract Purpose To evaluate cases with a retinal pigment epithelium (RPE) aperture using polarization-sensitive optical coherence tomography (PS-OCT). Study design Retrospective consecutive case series. Methods A retrospective study that included three eyes (three patients) with RPE aperture and age-related macular degeneration (AMD) evaluated at the Macular Clinic in Tokyo University Hospital. A three-dimensional dataset of depolarization information was obtained with a clinical prototype of PS-OCT. Results All patients were categorized as intermediate AMD. RPE apertures were identified with PS-OCT as discontinuities of depolarization in the RPE layer of the pigment epithelial detachment (PED). A nonuniform decrease of depolarization in the RPE layer was also observed around the aperture. Two findings were observed above the aperture, intraretinal focal areas with high reflectivity and increased depolarization and subretinal bands with moderate reflectivity and low depolarization. Retinal sensitivity according to fundus microperimetry measured at 25 points was significantly associated with the degree of depolarization at the corresponding area (r-square = 0.60, p = 0.0001). Conclusion The RPE aperture was characterized as a round discontinuity of depolarization. The findings with PS-OCT suggest atrophic changes in the overlying RPE of the PED. The degree of depolarization was associated with retinal sensitivity. The current results indicate that RPE apertures developed within the spectrum of atrophic AMD. Keywords Age-related macular degeneration · Aperture · Polarization-sensitive optical coherence tomography · Retinal pigment epithelium
Introduction
Corresponding Author: Ryo Obata * Ryo Obata robata‑[email protected] 1
Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo 113‑8655, Japan
2
Department of Ophthalmology, Saitama Red-Cross Hospital, Saitama, Japan
3
Tomey Corporation, Nagoya, Aichi, Japan
4
Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
A retinal pigment epithelium (RPE) aperture is a rare finding observed in the evolution of an avascular pigment epithelial detachment (PED), commonly associated with age-related macular degeneration (AMD) [1, 2] It is characterized by a single round discontinuity or multiple round discontinuities of the RPE at the top or base of a PED. An RPE tear is also a discontinuity of the RPE and is more commonly seen in eyes with AMD, but an RPE aperture has different characteristics from an RPE tear. For example, RP
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