Elsevier

Ophthalmology

Volume 119, Issue 7, July 2012, Pages 1412-1419
Ophthalmology

Original article
Hyporeflective Wedge-Shaped Band in Geographic Atrophy Secondary to Age-related Macular Degeneration: An Underreported Finding

https://doi.org/10.1016/j.ophtha.2012.01.026Get rights and content

Objective

To describe and interpret the frequently observed spectral-domain optical coherence tomography (SD-OCT) finding of a marked hyporeflective wedge-shaped structure at the boundaries of the areas of atrophy.

Design

A prospective, longitudinal follow-up study.

Participants

Consecutive patients (n = 71) 50 years of age and older with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) were examined between January 2010 and June 2011.

Methods

Patients were evaluated with the use of imaging techniques that included 35° fundus photography, infrared, fundus autofluorescence (FAF), and SD-OCT. Visualization of the fundus with FAF was done simultaneously with OCT. Two acquisition protocols were followed: a macular cube for coverage (19 horizontal B-scans centered on the fovea) and high-resolution horizontal B-scan for qualitative foveal detail.

Main Outcomes Measures

Estimation of the prevalence of a hyporeflective wedge-shaped band among patients with GA.

Results

A marked hyporeflective wedge-shaped structure, with its base on Bruch's membrane and its apex pointing toward the inner limit of the outer plexiform layer (OPL) adjacent to the margin between the atrophied area and the preserved retina, was observed in 72.9% of eyes (70/96; 95% confidence interval, 63.9–82.0). This hyporeflective band appeared to be within the OPL. Using eccentric SD-OCT acquisition, the boundaries between the outer nuclear layer (ONL) and Henle's fiber layer (HFL) were well defined, showing that the ONL ends before the margin of atrophy of the retinal pigment epithelium (RPE). A narrow hyperreflective band separated the margin of the ONL and RPE from the hyporeflective band, already within the atrophic area.

Conclusions

A hyporeflective wedge-shaped structure appears frequently within the boundaries of the OPL in patients with GA secondary to AMD, corresponding to an increase in the width of the HFL, presumably because of axonal swelling or interaxonal edema. This finding may improve the interpretation of SD-OCT images of the outer layers, may help in understanding better the interactions between photoreceptor cells and the RPE, and may help in the development of monitoring techniques and therapies for GA secondary to AMD.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients and Methods

The SD-OCT images of patients with GA secondary to AMD who were participants of a prospective, longitudinal, follow-up study were reviewed. The study was based at the Institut de la Màcula i de la Retina, Centro Médico Teknon, Barcelona, Spain. Consecutive patients 50 years of age and older were examined from January 2010 through June 2011. The study followed the tenets of the Declaration of Helsinki, local ethics committee approval was obtained, and all participants signed an informed consent

Results

In total, 96 eyes of 71 patients were included. The study group included 52 women (73.2%), the mean age was 79.0 years (range, 50–95 years), and there were 44 right eyes (45.8%). All patients were white. In 70 (72.9%; 95% confidence interval, 63.9–82.0) of the 96 eyes, a marked hyporeflective wedge-shaped structure was found, with its base on Bruch's membrane and its apex pointing toward the inner limit of the OPL adjacent to the margin between the atrophied area and the preserved retina (Fig 1

Discussion

A hyporeflective wedge-shaped structure is a frequent finding in patients with GA secondary to AMD (Figure 1, Figure 3). Using an eccentrically located SD-OCT examination, differentiation of the limits between the ONL and HFL appears to be very clear. Therefore, this technique will be useful in enabling a better understanding of the composition and potential clinical implications of the wedge-shaped band.

Previously, this finding has been interpreted as the so-called falling of the ONL as a

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    Manuscript no. 2011-1537.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): Jordi Monés, Consultant, Novartis, Allegan, Bayer, Ophthotech, Alimera, and Notalvision.

    Supported by Barcelona Macula Foundation, Barcelona, Spain.

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