File number: 60167


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    • By Dhaivat Shah
      Sankara Nethralaya
      Co-author(s): Dr Rahul Singh, Dr Ravin Punamia
    • Uploaded on Aug 5, 2020.
    • Last modified by Caroline Bozell on Aug 6, 2020.
    Appears in
    Imaging marvels
    retinal pigment epithelium, outer retina, macular scar
    Miss Anjum Zafar Khan
    Imaging device
    Optical coherence tomography system
    Choithram Netralaya
    A 54-year-old healthy male presented to us with a decreased vision in right eye since past 8 years. The patient gave a history of bleed in right eye before 8 years for which some intravitreal injection was given; post which there no major visual improvement. No details or documentation was available regarding the same. His BCVA in the right eye was 5/60. Fundus examination revealed a sharply demarcated hypopigmented patch over the macula with mild posterior excavation suggestive of macular scar. OCT image shows foveal thinning with loss of Retinal pigment epithelium and outer retinal layers (RORA). There are 2 types of RORAs, complete and incomplete. Complete RORA and incomplete RORA are entities defined by various imaging modalities describing atrophy of the retinal pigment epithelial and the outer retinal layers. OCT imaging defines incomplete RORA (iRORA) as a region of signal hyper transmission into the choroid and a corresponding zone of attenuation ordisruption of the RPE (<250um) and evidence of overlying photoreceptor degeneration (<250um). There should not be any RPE tear associated with it. OCT imaging describes complete RORA (cRORA) based on 4 inclusion criteria. These include, area of hypertransmission of more than 250um, zone of attenuation or disruption of the RPE of more than 250um in diameter, evidence of overlying photoreceptor degeneration and absence of scrolled RPE or other signs of an RPE tear. Other modalities used to define these include fundus autoflourescence(FAF), near infrared reflectance(NIR) and color fundus photograph(CFP). On CFP, it shows a sharply demarcated hypopigmented of >250um size with better visibility of choroidal vessels. FAF shows a hypo autoflourescent patch with sharply demarcated borders of size >250um, the colour of which is similar to that of the optic nerve head or retinal blood vessels excluding any pigmentation or artefact. On NIR, it shows a hyperreflective area with sharply demarcated borders of >250um size excluding any artefact. RORA can be seen in conditions like geographical atrophy in ARMD, central areolar choroidal dystrophy, atrophy secondary to anti-VEGF treatment. References: 1. Sadda SR, Guymer R, Holz FG, et al. Consensus Definition for Atrophy Associated with Age-Related Macular Degeneration on OCT: Classification of Atrophy Report 3 [published correction appears in Ophthalmology. 2019 Jan;126(1):177]. Ophthalmology. 2018;125(4):537-548. 2. Guymer RH, Rosenfeld PJ, Curcio CA, et al. Incomplete Retinal Pigment Epithelial and Outer Retinal Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 4. Ophthalmology. 2020;127(3):394-409. 3. Eng VA, Rayess N, Nguyen HV, Leng T. Complete RPE and outer retinal atrophy in patients receiving anti-VEGF treatment for neovascular age-related macular degeneration. PLoS One. 2020;15(5):e0232353.

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