En face enhanced depth imaging optical coherence tomography of fibrovascular pigment epithelium detachment

To analyze the internal structure of fibrovascular pigment epithelial detachment (FV-PED) due to AMD using en face enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT).

Thirty-eight consecutive patients presenting with FV-PED due to AMD were enrolled in this study. Retinal images were automatically obtained with a spectral domain (SD) OCT instrument; the typical inverted 97 sections at 30-μm intervals, each comprised of nine averaged B-scans, were acquired in less than 60 seconds. The resultant images of en face cross-sections of the choroid (C-scans) were compared with indocyanine green angiography (ICGA) images, currently the only technique available for directly viewing occult choroidal neovascularization (CNV).

Thirty-eight eyes of 38 consecutive patients (27 females and 11 males, mean age 76.7±3 years) were studied. In all 38 eyes, ICGA allowed visualization of the CNV within the FV-PED. In 30 eyes, en face EDI-OCT revealed what appeared to be the hyperreflective course of presumed CNV, which was located just beneath the detached retinal pigment epithelium; this was confirmed by comparative analysis of the extent of hyperreflective lesions on en face EDI-OCT images and that of the neovascular network on ICGA. An area of homogeneous hyporeflectivity, consistent with serous exudation, separated the CNV from the Bruch's membrane and the choroid. In the remaining eight eyes, en face EDI-OCT revealed homogenous hyperreflectivity, consistent with fibrous tissue that partially hid the neovascular network.

Noninvasive en face EDI-OCT technique enables visualization and localization of the entire branching neovascular network of CNV within FV-PED without dye injection.