SUB RETINAL PIGMENT EPITHELIUM HYPOREFLECTIVE SPACES PRECEDING LARGE DRUSEN COLLAPSE.

Abstract

To describe and study hyporeflective subretinal pigment epithelium (RPE) spaces in large drusen and drusenoid pigment epithelial detachment before collapse. Retrospective longitudinal study enrolled patients with large and very large drusen caused by intermediate age-related macular degeneration. The following optical coherence tomography parameters were assessed: drusen size (maximum width and height), optical coherence tomography biomarkers of RPE atrophy, presence of intraretinal and subretinal fluid, acquired vitelliform lesion, and sub-RPE regions of hyporeflectivity within the pigment epithelial detachment compartment. Of the 50 eyes from 41 patients (mean age 77.1 ± 9 years, 78% women) with large and very large drusen, 16 eyes progressed to collapse. Eyes with sub-RPE hyporeflective spaces (n = 8 eyes, 50%) were associated with greater drusen width and height than those without sub-RPE hyporeflective spaces. At the collapse visit, eyes with sub-RPE hyporeflective spaces displayed poorer visual acuity and greater incomplete RPE and outer retinal atrophy and complete RPE and outer retinal atrophy length than eyes without sub-RPE hyporeflective spaces ( P = 0.004 and P = 0.04, respectively). Sub-RPE hyporeflective spaces are a novel optical coherence tomography finding of large and very large drusen that collapse to atrophy. Progressive RPE dysfunction and failure may lead to reduced drusenoid material formation and progressive degenerative hydration of the large drusen before collapse, but this awaits confirmation with histopathological analysis.