Analysis of Retinal Flecks in Fundus Flavimaculatus Using High-Resolution Spectral Domain-Oct

Purpose:To assess morphologic variations in the outer retinal layers in eyes with fundus flavimaculatus (FFM) using high definition Spectral Domain Optical Coherence Tomography (Spectralis HRA OCT, Heidelberg Engineering, Heidelberg, Germany) Methods:This was a prospective observational case series including 13 patients. SD-OCT scans were obtained with combined confocal scanning laser ophthalmoscope (cSLO) and SD-OCT for simultaneous tomographic and topographic in vivo imaging. .Morphologic alterations of the retinal deposits, the so called flecks, were analyzed and classified. Results:These flecks are small or large, extremely polymorphous, rounded, fusiform spear-like, pisciforms, giants, butterfly or X shaped, and can be juxtamacular or diffusely distributed in the fundus. For different types of lesions were observed on OCT. The first type was less visible in autofluoresence and could be described as an accumulation of hyper-reflective material in the outer segment of the photoreceptors and their RPE interdigitation and the RPE/Bruchs membrane layer complex. The second type was characterized by a dome-shaped more important accumulation of hype-rreflective material still limited to the outer segment of the photoreceptors and their RPE interdigitation. The third one demonstrated an increased accumulation of material progressing through the through the interface of the inner and outer segments of the photoreceptor layer till the eternal limiting membrane. The forth type corresponds to the latter but showing a progression of hyper-reflective material into the outer nuclear layer. On the OCT-scans the lesions demonstrated different shapes, like dome-shaped, pyramid- or spike-like. Furthermore, especially for type 3 and 4 lesions a loss of the photoreceptor signal and a decrease of the RPE/Bruchs membrane layer complex were observed around the lesions. Type 4 lesions appeared more autofluorescent. Conclusions:This is the first study analyzing simultaneously the morphologic aspects of retinal flecks in fundus flavimaculatus in Autofluorescense and SD-OCT. Combining these two non-invasive methods new information on the location and possible progressions of the flecks could be obtained.