Integrated Confocal Scanning Laser Ophthalmoscopy Imaging And Corresponding Spectral Domain Optical Coherence Tomography Of Basal Laminar Drusen

Purpose:To analyze the integrated confocal scanning laser ophthalmoscopy (cSLO) fundus and angiographic imaging and corresponding (eye-tracked) spectral domain optical coherence tomography (SD-OCT) features of basal laminar drusen (BLD). Methods:Twenty-one consecutive patients with BLD were submitted to cSLO fundus and angiographic imaging (infrared reflectance [IR], fundus autofluorescence [FAF], near-infrared autofluorescence [NIA], fluorescein angiographic [FA], and indocyanine green angiography [ICGA]) and eye-tracked SD-OCT. Results:A total of 42 eyes were included for analysis. BCVA ranged from 20/20 to 20/400. In 5/42 eyes, cSLO imaging and corresponding SD-OCT showed coincident vitelliform macular detachment, and in 9/42 eyes showed coincident geographic atrophy (GA). The typical BLD, intensely staining on early FA phase ("stars-in-the-sky" appearance in the fundus), appeared as "sawtooth" RPE elevation on SD-OCT. Some "atypical" BLD appeared, on early FA and ICGA frames, as hyper-fluoresecent lesions surrounded by faint hypo-fluoresecent halos. These lesions, that became intensely hyper-fluorescent in the late FA and ICGA phases, appeared, on SD-OCT, as small, confluent "dome-shaped" RPE elevations. Interestingly, some BLD were not visualized on SD-OCT scans, neither as "sawtooth" nor as "dome-shaped" RPE elevations. These lesions appeared as less intensely staining on both FA and ICGA, from the early until the late phase, yet still distinguishable when compared with a BLD-free region. Conclusions:The integrated cSLO fundus and angiographic imaging, and corresponding SD-OCT, allows highlighting different features of within BLD-containing regions and may give insights on the pathology of these lesions.