Autofluorescence imaging findings in long-standing chorioretinal folds

Abstract

Background: Chorioretinal folds typically involve the choroid, Bruch membrane, retinal pigment epithelium (RPE), and sometimes overlying neurosensory retina. von Winning hypothesized that the alternate banding pattern of choroidal folds shown by fluorescein angiography is explained by RPE density. To our knowledge, autofluorescence imaging of chorioretinal folds has not been previously described.

Methods: Case report.

Patient: A 47-year-old healthy hyperopic man had best-corrected visual acuity of 20/30 in the right eye and 20/25 in the left eye. Posterior segment examination revealed bilateral chorioretinal folds with subtle streaks of RPE hyperpigmentation and hypopigmentation emanating from both optic nerve heads.

Results: Early-phase fluorescein angiography revealed the characteristic pattern of alternating light and dark bands. Autofluorescence imaging disclosed a similar pattern as well as peripapillary mottling. The alternating patterns of light and dark bands observed using autofluorescence imaging and fluorescein angiography were found to be precisely in register but inverted.

Conclusions: Autofluorescence imaging noninvasively demonstrates the pathognomonic pattern of alternating light and dark bands shown by fluorescein angiography diagnostic of choroidal folds but in an inverse fashion. This observation provides independent support of von Winning's hypothesis regarding the etiopathogenesis of the banding pattern.

Fig. 1

A, Color photograph of the left fundus demonstrates predominantly horizontal chorioretinal folds, most prominent in the macula, with subtle peripapillary changes of the retinal pigment epithelium. Findings for the right eye were similar. B, Early-phase fluorescein angiogram of the left eye demonstrates a characteristic pattern of alternating light and dark bands, diagnostic of chorioretinal folds. Linear beadlike areas of hypofluorescence are present around the optic nerve and macula. Findings for the right eye were similar. C, Autofluorescence image of the left eye also demonstrates an alternating pattern of light and dark bands as well as linear beadlike areas of hyperautofluorescence in a distribution similar to that on the angiogram. Findings for the right eye were similar. D, Resulting image after the autofluorescence image (C) is superimposed over the early-phase fluorescein angiogram (B) and aligned in register. E, Resulting image after inverting the autofluorescence image. F, Magnified view of the area in the box in E showing the overlap between the inverted autofluorescence image (on left side) and the fluorescein angiogram (on right side), demonstrating precise alignment but inversion of the alternating banding pattern.