Macular Degeneration: Regenbogen M

Querques G, Regenbogen M, Soubrane G, Souied EH. · Department of Ophthalmology, University of Paris XI, Creteil, France. · Surv Ophthalmol. · Pubmed #19298908 No free full text.

Abstract: We describe the abnormalities seen in the mid periphery and posterior pole of two patients with multifocal vitelliform macular dystrophy as evaluated by high-definition spectral domain optical coherence tomography (HD-OCT). In patient 1, HD-OCT scans revealed, in the central area, a thicker and more reflective layer compared with the normal macula, located between the retinal pigment epithelium and the interface of the inner segment/outer segment, corresponding to the Verhoeff's membrane. Moreover, HD-OCT macular scans, as well as C-scans, revealed a slight hyper-reflective lesion just above an area of reduced reflectivity between the photoreceptor layer (interface of the inner segment and outer segment) and the Verhoeff's membrane. In patient 2, on HD-OCT macular scans, the layer corresponding to the interface of inner segment and outer segment of the photoreceptor, and the Verhoeff's membrane, appeared disrupted, whereas the retinal pigment epithelium layer appeared preserved. On the other hand, in both patient 1 and 2, the clinically evident vitelliform lesions outside the macular area appeared on HD-OCT scans either as small focal hyper-reflective lesions at the level of the retinal pigment epithelium/photoreceptor complex, either as a more pronounced diffuse thickening of the retinal pigment epithelium/photoreceptor complex, facing the deposition of lipofuscin reported on the histopathologic examination. These new findings would help in a further understanding of multifocal vitelliform macular dystrophy.

Querques G, Regenbogen M, Quijano C, Delphin N, Soubrane G, Souied EH. · Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris XII, Paris, France. · Am J Ophthalmol. · Pubmed #18619572 No free full text.

Abstract: PURPOSE: To correlate high-definition optical coherence tomography (HD OCT) and fundus examination findings at different phases of vitelliform macular dystrophy and to determine the anatomic location of vitelliform material. DESIGN: Prospective, noncomparative, observational case series. METHODS: A complete ophthalmologic examination, including fundus biomicroscopy and HD OCT, was performed in 11 consecutive patients with a diagnosis of vitelliform macular dystrophy. RESULTS: Using HD OCT, we were able to demonstrate for the first time the presence of previtelliform lesions, characterized by a thicker layer between the retinal pigment epithelium (RPE) and the inner segment and outer segment (IS/OS) interface. At this stage, a normal-appearing RPE and IS/OS interface were found in two of four eyes. In all progressive stages from the vitelliform to the vitelliruptive, the vitelliform material was visualized by HD OCT as an highly reflective lesion located between the hyporeflective outer nuclear layer and the hyperreflective RPE layer, associated or not to an optically empty lesion. At these stages, a disrupted IS/OS interface and an almost normal appearance of all major intraretinal layers was detected. At the vitelliruptive and atrophic stages, on some parts, the HD OCT scan revealed hyperreflective mottling on the RPE layer, probably representing areas of focal RPE hypertrophy. The atrophic stage and the fibrotic stage were characterized by thinning of all the retinal layers and diffuse loss of the IS/OS interface. In our series, mean best-corrected visual acuity impairment showed a statistically significant correlation to the presence of focal disruption or diffuse loss of the IS/OS interface (P = .002), as well as to a more advanced stage of the disease (P = .01). A more advanced stage of the disease showed a strong statistically significant correlation to the presence of diffuse loss of the IS/OS interface (P < .001). CONCLUSIONS: Based on the HD OCT findings, we hypothesize that early changes in vitelliform macular dystrophy involve the layer between the RPE and the IS/OS interface, first with accumulation of material beneath the sensory retina, and then with disruption and attenuation of IS and OS; late changes seem to affect the RPE, which undergoes hypertrophy, disruption, and attenuation.

Barak A, Regenbogen M, Goldstein M, Loewenstein A. · Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. · Isr Med Assoc J. · Pubmed #16544727 links to  free full text

Abstract: BACKGROUND: Diabetic macular edema causes visual loss in almost one-third of diabetic patients. There is currently no treatment for the accompanying cystoid foveal changes. OBJECTIVES: To assess the clinical outcome, i.e., change in visual acuity, in patients treated with steroids for long-standing diabetic macular edema with foveal cystoid changes. METHODS: In the ophthalmology department of a tertiary care university-affiliated medical center and the ophthalmology service of a health management organization, 46 diabetic subjects (56 eyes) who had diabetic macular edema with cystoid foveal changes received one intravitreal injection of 4 mg triamcinolone acetonide. RESULTS: The mean baseline (pre-injection) visual acuity of 0.21 increased to 0.31 and 0.48 at 1 and 3 months, respectively, after which it decreased to 0.33 at 6 months. The mean intraocular pressure was 15.07 mmHg at baseline, 15.83 at day 1, gradually rising to 17.16, 18.38 and 18.57 mmHg at 1, 3 and 6 months respectively. Three patients suffered immediate visual decline after the injection. CONCLUSIONS: Intravitreal triamcinolone acetonide may be a therapeutic option for long-standing diabetic macular edema with foveal cystoid changes.