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Dark Atrophy: An Optical Coherence Tomography Angiography Study.

Marco Pellegrini1, Alessandra Acquistapace1, Marta Oldani1

  • 1Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.

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Summary

Optical coherence tomography angiography (OCTA) reveals distinct choriocapillaris changes in age-related macular degeneration (AMD) and Stargardt disease (STGD). GA eyes show rarefied choriocapillaris, while STGD eyes exhibit complete loss in atrophic areas.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Retinal Diseases

Background:

  • Macular atrophy in age-related macular degeneration (AMD) and Stargardt disease (STGD) affects vision by damaging retinal pigment epithelium (RPE) and underlying structures.
  • The choriocapillaris, a vascular layer crucial for RPE health, is implicated in these conditions, but its specific status in geographic atrophy (GA) and STGD requires detailed assessment.

Purpose of the Study:

  • To evaluate and compare the status of the choriocapillaris in eyes with geographic atrophy (GA) secondary to AMD and Stargardt disease (STGD) using optical coherence tomography angiography (OCTA).

Main Methods:

  • Prospective observational case series involving 14 patients (20 eyes) with GA and 10 patients (20 eyes) with STGD.
  • Comprehensive ophthalmological examinations included fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), enhanced-depth imaging optical coherence tomography (EDI-OCT), and OCTA.
  • Choriocapillaris status was assessed in areas of macular atrophy using OCTA.

Main Results:

  • OCTA revealed persisting but rarefied choriocapillaris in 80% of GA eyes with RPE atrophy.
  • In contrast, 100% of STGD eyes showed complete disappearance of choriocapillaris in atrophic areas (P < 0.0001).
  • FA and ICGA showed distinct patterns of hyperfluorescence and hypofluorescence between GA and STGD, with a 'dark choroid' sign more prevalent in STGD.

Conclusions:

  • OCTA demonstrates significant differences in choriocapillaris integrity between GA and STGD.
  • STGD is characterized by extensive choriocapillaris loss, while GA shows a more preserved, albeit rarefied, choriocapillaris network within atrophic areas.