DOI: 10.1097/IAE.0b013e3181c96a15
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PMID: 20139800
Issn Print: 0275-004X
Publication Date: 2010/03/01
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Excerpt
There were a myriad of brightly reflective spots of various configurations seen throughout all layers of the retina on OCT. The first pattern observed was that of a highly hyperreflective dot deep in the retina, immediately surrounded by an area of low reflectance, and next surrounded by an area of intermediate reflectance (Figure 2A, arrows). We hypothesize that this complex represents a crystal that has been surrounded or encapsulated by retinal pigment epithelium cells. These encapsulated elements were visible on fundus photography but were not brightly refractile (Figure 1, A-C, left vertical line).
Brightly reflective plaques were located on top of Bruch membrane (Figure 2A, arrowheads) and were partially encapsulated in some cases (Figure 2B, arrow). These plaques were highly refractile and easily visible on fundus photography (Figure 1, A-C, right vertical line). Some choroidal vessels exhibited coating with yellow refractile material (Figure 1A). Optical coherence tomography showed that this material was likely accumulated at the level of the choroid or Bruch membrane (not shown). Finally, other highly reflective spots on OCT were observed in the inner retina but were not encapsulated (Figure 2C, arrow).
The exact composition of the crystals in Bietti crystalline retinopathy remains elusive, but previous studies have suggested that they arise from defects in fatty acid metabolism.1–3 The combination of fundus photography and spectral domain-OCT in this study shows new and interesting features about the localization and response to crystals in this disease.
