High-speed ultrahigh-resolution OCT of Bruch's membrane in membranoproliferative glomerulonephritis type 2

Abstract

Membranoproliferative glomerulonephritis (MPGN) type 2 is characterized by electron-dense deposits in the glomerular basement membrane and drusen-like deposits in Bruch's membrane. Over time, atrophic changes in the retina and retinal pigment epithelium occur, which can progress to choroidal neovascularization (CNV). This report describes a patient with MPGN type 2 who developed progressive loss of vision secondary to CNV. High-speed ultrahigh-resolution optical coherence tomography (UHR-OCT) showed an irregular Bruch's membrane that measured 10 μm beneath the foveal center. High-speed UHR-OCT can potentially be used to analyze Bruch's membrane in secondary ocular manifestations of diseases such as MPGN type 2 and primary retinal diseases such as age-related macular degeneration.

Figure 1

(A) Fundus photograph of the right eye shows a large disciform scar and scarring from prior subretinal hemorrhages and laser treatments (black arrow). (B) Fundus photograph of the left eye shows retinal pigment epithelium changes in the macula and extrafoveal hemorrhages (white arrow). Drusen-like deposits are visible throughout posterior pole.

Figure 2

High-speed ultrahigh-resolution OCT image of the left eye shows detachment of the retinal pigment epithelium and an irregular and prominent Bruch’s membrane seen as a hyperreflective line just below the level of the retinal pigment epithelium (white arrow) measuring 10 μm beneath the fovea, 9 μm at 1 mm temporal to the fovea, and 13 μm at 1 mm nasal to the fovea. Scale bar = 300 μm.

Figure 3

(A) Fundus photograph of the left eye shows chronic retinal pigment epithelium changes with new areas of extrafoveal hemorrhage and fluid (white arrow). (B) Fundus autofluorescence of the left eye shows scattered drusen-like deposits. (C) Indocyanine green angiography of the left eye did not show any definitive choroidal neovascularization. (D) OCT of the left eye obtained using the commercially available spectral-domain system revealed subretinal fluid nasally, pigment epithelial detachments (white arrow), and features consistent with choroidal neovascularization (black arrow).

Figure 4

(A) Fundus photograph of the left eye shows continued central pigmentary changes in the macula (white arrow), flat extrafoveal hemorrhage and fluid, and pigment and drusen-like deposits in the periphery. (B) Fundus autofluorescence of the left eye shows drusen-like deposits. (C) OCT image of the left eye using the commercially available spectral-domain system showed numerous drusen-like deposits and pigment epithelial detachments (white arrow) with no evidence of fluid. (D) Higher magnification of the OCT image shows a detached retinal pigment epithelium (RPE) and a prominent Bruch’s membrane (white arrow) seen as a hyperreflective line just below the level of RPE that measured 9 μm beneath the fovea, 8 μm at 1 mm temporal to the fovea, and 12 μm at 1 mm nasal to the fovea using the linear measurement tool available on the spectral-domain OCT system. The retinal pigment epithelium (black arrow) is detached from Bruch’s membrane. Scale bar = 10 μm.