Long-term Follow-up of Outer Retinal Tubulation Documented by Eye-Tracked and En Face Spectral-Domain Optical Coherence Tomography

Abstract

Outer retinal tubulation (ORT) is a rearrangement of the photoreceptor layer in response to retinal injury.^1,2 Seen clinically with spectral-domain optical coherence tomography (SD-OCT) and confirmed on histopathologic sections, these rosette-like structures occur in a variety of retinal disorders characterized by photoreceptor disruption.^2-5 On SD-OCT, ORT appears as round or ovoid hyporeflective structures with hyperreflective margins. The margins are believed to represent the inner segment–outer segment junction of the photoreceptor cells or the ellipsoid portion of the photoreceptor inner segment.⁶ These tubules often contain hyperreflective material thought to represent deranged photoreceptor outer segments.^1,2 A branching pattern of the tubes may be detected with curved en face SD-OCT. Owing to a cystic-like appearance on OCT B-scans, ORT may be confused with cystoid macular edema related to leakage from choroidal neovascularization or other retinal diseases. We describe a patient who was treated with anti–vascular endothelial growth factor therapy for neovascular age-related macular degeneration (AMD) during a 6-year follow-up period. Eye-tracked and curved en face SD-OCT scans during 3 years of follow-up documented persistence of the ORT structures with evidence of gradual photoreceptor loss.