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Linear and planar reflection artifacts on swept-source and spectral-domain optical coherence tomography due to hyperreflective crystalline deposits

  • Retinal Disorders
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Abstract

Purpose

To describe novel spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) linear and planar reflection artifacts produced by hyperreflective crystalline deposits (HCD).

Methods

Imaging from 10 eyes with HCD producing linear and planar artifacts on OCT was retrospectively analyzed. All eyes had SD-OCT (Spectralis HRA + OCT, Heidelberg Engineering, Germany) and SS-OCT angiography (PLEX Elite 9000, Carl Zeiss Meditec, Inc., Dublin, CA) acquired on the same day. The horizontal extent of planar artifacts and the corresponding HCD on B-scans was measured using a digital caliper. Artifact features from HCD in eyes with non-neovascular age-related macular degeneration (AMD) were analyzed and compared to those seen in two eyes with the “onion sign,” an OCT signature previously shown to represent cholesterol crystals (CC) in the sub-retinal pigment epithelium-basal laminar space of eyes with neovascular AMD. A third eye with the “onion sign” was imaged with dense B-scan (DB)-OCTA.

Results

Ten eyes of ten patients (77.4 ± 8.7 years) with HCD were analyzed. On SS-OCTA, HCD produced linear artifacts of high signal intensity passing through the HCD and spanning the entire scan depth. On SD-OCT, HCD produced planar artifacts located anterior to both the retina and a hyporeflective space representing normal vitreous signal. The horizontal extent of the artifact did not differ significantly from the corresponding HCD on OCT B-scans (P = 0.62). The OCT artifacts produced by the “onion sign” appeared similar to those of HCD. The additional eye with neovascular AMD imaged with DB-OCTA was characterized by a single, vertical, linear false-flow signal crossing retinal layers.

Conclusions

To the authors’ knowledge, this is the first description of SD- and SS-OCT/OCTA artifacts corresponding to both HCD and the “onion sign.” These artifacts are likely due to highly reflective CC previously shown on histology to correspond to both of these OCT signatures.

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Funding

This work was supported by The Macula Foundation, Inc., New York, NY.

Author information

Authors and Affiliations

  1. Vitreous Retina Macula Consultants of New York, New York, NY, USA

    Serena Fragiotta, Pedro Fernández-Avellaneda, Mark P. Breazzano, Lawrence A. Yannuzzi & K. Bailey Freund

  2. LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA

    Serena Fragiotta, Pedro Fernández-Avellaneda, Mark P. Breazzano, Lawrence A. Yannuzzi & K. Bailey Freund

  3. Department of Ophthalmology, New York University School of Medicine, New York, NY, USA

    Serena Fragiotta, Pedro Fernández-Avellaneda, Mark P. Breazzano, Lawrence A. Yannuzzi & K. Bailey Freund

  4. Department of Medico–Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, Rome, Italy

    Serena Fragiotta

  5. Department of Ophthalmology, Basurto University Hospital, Bilbao, Spain

    Pedro Fernández-Avellaneda

  6. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Mark P. Breazzano & Lawrence A. Yannuzzi

  7. Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA

    Christine A. Curcio

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  1. Serena Fragiotta
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  2. Pedro Fernández-Avellaneda
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  3. Mark P. Breazzano
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  4. Lawrence A. Yannuzzi
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  5. Christine A. Curcio
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  6. K. Bailey Freund
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Correspondence to K. Bailey Freund.

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Conflict of interest

Serena Fragiotta declares that she has no conflict of interest. Pedro Fernández-Avellaneda declares that he has no conflict of interest. Mark P. Breazzano declares that he has no conflict of interest. Lawrence A. Yannuzzi declares that he has no conflict of interest. Christine A. Curcio receives research funding from Heidelberg Engineering and Hoffman La Roche; Department of Ophthalmology and Visual Science, University of Alabama at Birmingham receives institutional support from EyeSight Foundation of Alabama and Research to Prevent Blindness, Inc. K. Bailey Freund is a consultant to Genentech, Optovue, Zeiss, Heidelberg Engineering, Allergan, and Novartis. He receives research funding from Genentech/Roche.

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Fragiotta, S., Fernández-Avellaneda, P., Breazzano, M.P. et al. Linear and planar reflection artifacts on swept-source and spectral-domain optical coherence tomography due to hyperreflective crystalline deposits. Graefes Arch Clin Exp Ophthalmol 258, 491–501 (2020). https://doi.org/10.1007/s00417-019-04565-y

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