Pathologic Insights From Integrated Imaging of Reticular Pseudodrusen in Age-Related Macular Degeneration

PURPOSE: The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluorescence, and fluorescein angiography (integrated confocal scanning laser ophthalmoscopy fundus imaging) features of reticular pseudodrusen and eye-tracked Spectralis high-resolution spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany). METHODS: Twenty-two consecutive patients with reticular pseudodrusen were prospectively enrolled and evaluated regarding confocal scanning laser ophthalmoscopy fundus imaging and eye-tracked SD-OCT findings. RESULTS: Integrated fundus imaging revealed a "target" aspect of most reticular pseudodrusen in the 42 included eyes (22 patients; 12 women, 10 men; mean age 81.38 ± 6.47 years). On fundus autofluorescence and infrared reflectance, the center of most reticular pseudodrusen appeared as an area of isoautofluorescence/reflectance surrounded by halos of reduced autofluorescence/reflectance. Similarly, on fluorescein angiography, the center of reticular pseudodrusen appeared as an area of decreased fluorescence surrounded by a faint halo of increased fluorescence. Spectral domain optical coherence tomography showed a well-defined round or triangular hyperreflective deposit localized between, externally, the retinal pigment epithelium layer, and, internally, the external limiting membrane or the outer plexiform layer. Moreover, SD-OCT showed the loss of both outer segment/retinal pigment epithelium interface and inner segment/outer segment interface over the hyperreflective lesions, as well as an abrupt interruption of both these interfaces at the border of the hyperreflective lesions. CONCLUSION: The peculiar confocal scanning laser ophthalmoscopy fundus imaging and tracked SD-OCT of reticular pseudodrusen suggest the presence of central lipofuscin-like retinal deposits localized above the retinal pigment epithelium. These findings give insights to other possible aspects of age-related retinal changes.