Letter to the Editor
Outer retinal tubulation analysis in cases of macular dystrophy
Análisis de la tubulización de la retina externa en las distrofias maculares
R. Dolz-Marcoa,
, R. Gallego-Pinazoa, M.D. Pinazo-Duránb,c, J.F. Arévalod,e, L.A. Yannuzzif, M. Díaz-Llopisa,c
Corresponding author
a Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
b Opthalmology Research Unit Santiago Grisolía, University Hospital Doctor Peset, Valencia, Spain
c Faculty of Medicine, University of Valencia, Valencia, Spain
d Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
e King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
f Vitreous Retinal Macula Consultants of New York, LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, USA
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B) Son más evidentes en la imagen de autofluorescencia. C) La OCT muestra una atrofia central del EPR y de las capas externas de la retina hasta la membrana limitante externa, lo que produce un efecto ventana con aumento secundario de la reflectividad coroidea (flechas negras). En el borde de la atrofia aparece una lesión redondeada con pared hiperreflectiva que corresponde a la ORT (flecha blanca).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Dolz-Marco, R. Gallego-Pinazo, M.D. Pinazo-Durán, J.F. Arévalo, L.A. Yannuzzi, M. Díaz-Llopis" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Dolz-Marco" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gallego-Pinazo" ] 2 => array:2 [ "nombre" => "M.D." "apellidos" => "Pinazo-Durán" ] 3 => array:2 [ "nombre" => "J.F." "apellidos" => "Arévalo" ] 4 => array:2 [ "nombre" => "L.A." "apellidos" => "Yannuzzi" ] 5 => array:2 [ "nombre" => "M." 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Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, USA" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la tubulización de la retina externa en las distrofias maculares" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2056 "Ancho" => 3049 "Tamanyo" => 437097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Color retinography of a 56-year-old patient with Stargardt disease, exhibiting significant macular atrophy area with fleck-type lesions around it. (B) The lesions are more evident in the autofluorescence image. (C) OCT exhibits central RPE and external retinal layer atrophy up to the external limiting membrane, producing window effect with secondary increase of choroidal reflectiveness (black arrows). At the edge of the atrophy a rounded lesion appears with a hyper-reflective wall corresponding to the ORT (white arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Macular dystrophies are a heterogeneous group of diseases characterized either by retina pigment epithelium (RPE) atrophy or by the deposit of substances –mainly lipofuscin above or below the RPE. Outer retinal tubulation (ORT) was described recently in tomographic images as pseudo-cystic spaces surrounded by a hyper-reflective wall located in the outer retinal layers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> We have analyzed the prevalence and characteristics of ORT in spectral domain optic coherence tomography (SD-OCT) by means of a retrospective review of 61 eyes of 32 patients diagnosed with macular dystrophy. The SD-OCT images were assessed in order to determine the presence and location of ORT, the integrity of the external limiting membrane (ELM), the joint of the internal and external photoreceptor segments (IS/OS) and the apex of the photoreceptor external segments (COST). The patients included in the study (12 males and 20 females) were diagnosed with adult vitelliform foveomacular dystrophy (19 eyes of 10 patients), Stargardt disease (14 eyes of 7 patients), pattern dystrophy (12 eyes of 7 patients), retinoschisis linked to chromosome X (8 eyes of 4 patients) and cone dystrophy (8 eyes of 4 patients).</p><p id="par0010" class="elsevierStylePara elsevierViewall">ORT was evidenced in 13 eyes (21.3%). When considering only cases with external retina disruption, ORT was found in 50% of cases with ELM disruption, and 34.2% of cases with disruption in IS/OS, and 24.5% of cases with atrophic changes in the external retina (Stargardt disease, retinoschisis linked to chromosome X and cone dystrophy) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). ORT was not observed in dystrophies characterized by lipofuscin deposits.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">ORT appears to be a frequent finding in SD-OCT of macula dystrophies with atrophic changes in the cytoarchitecture of the external retina and could constitute a late event in retinal degeneration, closely associated to ELM disruption. New studies with a higher number of patients must be carried out to assess the usefulness of this finding in the follow-up and prognostic evaluation of these patients as well as for its possible use in monitoring the neuroprotective effect of new therapies in development.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Dolz-Marco R, et al. Análisis de la tubulización de la retina externa en las distrofias maculares. Arch Soc Esp Oftalmol. 2013;88:161–2.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2056 "Ancho" => 3049 "Tamanyo" => 437097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Color retinography of a 56-year-old patient with Stargardt disease, exhibiting significant macular atrophy area with fleck-type lesions around it. (B) The lesions are more evident in the autofluorescence image. (C) OCT exhibits central RPE and external retinal layer atrophy up to the external limiting membrane, producing window effect with secondary increase of choroidal reflectiveness (black arrows). At the edge of the atrophy a rounded lesion appears with a hyper-reflective wall corresponding to the ORT (white arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outer retinal tubulation: a novel optical coherence tomography finding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.A. Zweifel" 1 => "M. Engelbert" 2 => "K. Laud" 3 => "R. Margolis" 4 => "R.F. Spaide" 5 => "K.B. Freund" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archophthalmol.2009.326" "Revista" => array:6 [ "tituloSerie" => "Arch Ophthalmol" "fecha" => "2009" "volumen" => "127" "paginaInicial" => "1596" "paginaFinal" => "1602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20008714" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal pseudocysts in age-related geographic atrophy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.Y. Cohen" 1 => "L. Dubois" 2 => "S. Nghiem-Buffet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2010.02.019" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2010" "volumen" => "150" "paginaInicial" => "211" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20537310" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000008800000004/v1_201306181844/S2173579413000662/v1_201306181844/en/main.assets" "Apartado" => array:4 [ "identificador" => "8723" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000008800000004/v1_201306181844/S2173579413000662/v1_201306181844/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579413000662?idApp=UINPBA00004N" ]
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