Fig. 6.1
Neovascularization type 1 en face SS-OCT. An 80-year-old male diagnosed with neovascularization type 1 in his right eye. In the fundus photograph, changes in retinal pigment epithelium (RPE) and subretinal fluid, superior to the fovea, are shown (a) and choroidal neovascularization is confirmed in fluorescein angiography (b). At the level of RPE (c), en face scan shows a granulate hyperreflective area just above a dark area that corresponds with a RPE detachment associated to the neovascular complex. A hyperreflective area represents the neovascular lesion in choriocapillaris (d), Sattler’s (e), and Haller’s layers (f) level
Fig. 6.2
Neovascularization type 2 en face SS-OCT. An 81-year-old female diagnosed with neovascularization type 2 in the left eye. A neovascular membrane associated with a subretinal fibrotic area with a macular hemorrhage is observed in fundus photograph (a). Fluorescein angiography confirms the neovascular complex with an extensive macular area of leakage (b). En face SS-OCT at retinal pigment epithelium (RPE) level shows hyporeflective changes corresponding with the area of leakage and a darker area corresponding with the macular hemorrhage (c). The corresponding areas of the neovascular complex in choriocapillaris (d), Sattler’s (e), and Haller’s (f) are seen with hyperreflective changes
RPE en face images revealed pathologic alterations in all the studied eyes. Changes in the RPE were classified into two groups: group 1, related to the neovascular lesion or group 2, surrounding the neovascular lesion. The extent of the neovascularization was determined using a multimodal imaging study, including FA, ICGA, and SS-OCT images. All the eyes had RPE defects within the neovascular area, and most of them (76%) showed a hyporeflective lesion. Forty-seven percent of the eyes had a defect surrounding the neovascular lesion, which was hyperreflective in 39% and hyporeflective in 61% of the cases. All the eyes showed changes in the choriocapillaris in en face imaging, and nearly 50% of them presented hyperreflective or hyporeflective alterations. The normal capillary pattern was interrupted at the neovascularization area in all the cases, considering the choriocapillaris the layer just behind the RPE.
Sattler and Haller’s layers showed no changes in a few eyes corresponding to early (Fig. 6.3) and small neovascular membranes as determined by FA with minimal retinal anatomic distortion on B-scan SS-OCT and type 3 choroidal neovascularization (CNV). The rest of the patients showed mostly hyperreflective changes at these layers. No differences were found between the neovascular complex area, horizontal and vertical diameters, measured by en face SS-OCT and FA [1].
Fig. 6.3
En face SS-OCT in neovascular AMD. A recently diagnosed neovascular AMD with subtle changes is shown in fundus photograph (a). A neovascular complex is confirmed in fluorescein angiography, with most of the leakage temporal in the macular area (b). En face SS-OCT at retinal pigment epithelium level shows mottled hyperreflective changes at the foveal and perifoveal area, with a surrounding hyporeflective halo (c). The choriocapillaris level presents mottled hyporeflective changes at the center of the macula (d). No changes in the vascular patter of deeper layers are present in this patient (e, f)
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