Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration

Abstract Outer retinal tubulations (ORT) are a relatively new finding characterizing outer retinal atrophy. The main aim of the present study was to describe ORT development in advanced age-related macular degeneration (AMD) and to assess its relationship with disease’s severity. Patients with advan...

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Autores principales:	Alessandro Arrigo, Emanuela Aragona, Ottavia Battaglia, Andrea Saladino, Alessia Amato, Federico Borghesan, Adelaide Pina, Francesca Calcagno, Rashid Hassan Farah, Francesco Bandello, Maurizio Battaglia Parodi
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0e88b212be3042cb8e226dbc4bab3168
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spelling	oai:doaj.org-article:0e88b212be3042cb8e226dbc4bab31682021-12-02T17:55:03ZOuter retinal tubulation formation and clinical course of advanced age-related macular degeneration10.1038/s41598-021-94310-52045-2322https://doaj.org/article/0e88b212be3042cb8e226dbc4bab31682021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94310-5https://doaj.org/toc/2045-2322Abstract Outer retinal tubulations (ORT) are a relatively new finding characterizing outer retinal atrophy. The main aim of the present study was to describe ORT development in advanced age-related macular degeneration (AMD) and to assess its relationship with disease’s severity. Patients with advanced AMD characterized either by macular neovascularization or geographic atrophy, showing signs of outer retinal disruption or retinal pigment epithelium atrophy on structural optical coherence tomography (OCT) at the inclusion examination were prospectively recruited. All the patients underwent complete ophthalmologic evaluation, structural OCT scans and fundus autofluorescence imaging. The planned follow-up was of 3-years. Main outcome measures were ORT prevalence, mechanism of ORT formation, mean time needed for complete ORT formation, best-corrected visual acuity (BCVA), definitely decreased autofluorescence (DDAF) area, questionably decreased autofluorescence (QDAF) area, retinal layer thickness, foveal sparing, number of intravitreal injections. We also assessed the possible role of external limiting membrane (ELM) and Müller cells in ORT pathogenesis. Seventy eyes (70 patients) were included; 43 showed dry AMD evolving to geographic atrophy, while 27 displayed the features of wet AMD. Baseline BCVA was 0.5 ± 0.5 LogMAR, decreasing to 0.9 ± 0.5 LogMAR at the 3-year follow-up (p < 0.01). We detected completely formed ORT in 26/70 eyes (37%), subdivided as follows: 20 eyes (77%) wet AMD and 6 eyes (23%) dry AMD (p < 0.01). ORT took 18 ± 8 months (range 3–35 months) to develop fully. We described the steps leading to ORT development, characterized by progressive involvement of, and damage to the photoreceptors, the ELM and the RPE. Eyes displaying ORT were associated with a smaller QDAF area, less retinal layers damage and lower rate of foveal sparing than eyes free of ORT (p < 0.01). We also described pigment accumulations simulating ORT, which were detected in 16/70 eyes (23%), associated with a greater loss of foveal sparing, increased DDAF area and smaller QDAF area at the 3-year follow-up (p < 0.01). In conclusion, this study provided a description of the steps leading to ORT development in AMD. ELM and Müller cells showed a role in ORT pathogenesis. Furthermore, we described a subtype of pigment hypertrophy mimicking ORT, evaluating its clinical utility.Alessandro ArrigoEmanuela AragonaOttavia BattagliaAndrea SaladinoAlessia AmatoFederico BorghesanAdelaide PinaFrancesca CalcagnoRashid Hassan FarahFrancesco BandelloMaurizio Battaglia ParodiNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Alessandro Arrigo Emanuela Aragona Ottavia Battaglia Andrea Saladino Alessia Amato Federico Borghesan Adelaide Pina Francesca Calcagno Rashid Hassan Farah Francesco Bandello Maurizio Battaglia Parodi Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
description	Abstract Outer retinal tubulations (ORT) are a relatively new finding characterizing outer retinal atrophy. The main aim of the present study was to describe ORT development in advanced age-related macular degeneration (AMD) and to assess its relationship with disease’s severity. Patients with advanced AMD characterized either by macular neovascularization or geographic atrophy, showing signs of outer retinal disruption or retinal pigment epithelium atrophy on structural optical coherence tomography (OCT) at the inclusion examination were prospectively recruited. All the patients underwent complete ophthalmologic evaluation, structural OCT scans and fundus autofluorescence imaging. The planned follow-up was of 3-years. Main outcome measures were ORT prevalence, mechanism of ORT formation, mean time needed for complete ORT formation, best-corrected visual acuity (BCVA), definitely decreased autofluorescence (DDAF) area, questionably decreased autofluorescence (QDAF) area, retinal layer thickness, foveal sparing, number of intravitreal injections. We also assessed the possible role of external limiting membrane (ELM) and Müller cells in ORT pathogenesis. Seventy eyes (70 patients) were included; 43 showed dry AMD evolving to geographic atrophy, while 27 displayed the features of wet AMD. Baseline BCVA was 0.5 ± 0.5 LogMAR, decreasing to 0.9 ± 0.5 LogMAR at the 3-year follow-up (p < 0.01). We detected completely formed ORT in 26/70 eyes (37%), subdivided as follows: 20 eyes (77%) wet AMD and 6 eyes (23%) dry AMD (p < 0.01). ORT took 18 ± 8 months (range 3–35 months) to develop fully. We described the steps leading to ORT development, characterized by progressive involvement of, and damage to the photoreceptors, the ELM and the RPE. Eyes displaying ORT were associated with a smaller QDAF area, less retinal layers damage and lower rate of foveal sparing than eyes free of ORT (p < 0.01). We also described pigment accumulations simulating ORT, which were detected in 16/70 eyes (23%), associated with a greater loss of foveal sparing, increased DDAF area and smaller QDAF area at the 3-year follow-up (p < 0.01). In conclusion, this study provided a description of the steps leading to ORT development in AMD. ELM and Müller cells showed a role in ORT pathogenesis. Furthermore, we described a subtype of pigment hypertrophy mimicking ORT, evaluating its clinical utility.
format	article
author	Alessandro Arrigo Emanuela Aragona Ottavia Battaglia Andrea Saladino Alessia Amato Federico Borghesan Adelaide Pina Francesca Calcagno Rashid Hassan Farah Francesco Bandello Maurizio Battaglia Parodi
author_facet	Alessandro Arrigo Emanuela Aragona Ottavia Battaglia Andrea Saladino Alessia Amato Federico Borghesan Adelaide Pina Francesca Calcagno Rashid Hassan Farah Francesco Bandello Maurizio Battaglia Parodi
author_sort	Alessandro Arrigo
title	Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
title_short	Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
title_full	Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
title_fullStr	Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
title_full_unstemmed	Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
title_sort	outer retinal tubulation formation and clinical course of advanced age-related macular degeneration
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/0e88b212be3042cb8e226dbc4bab3168
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Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration

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