Photoreceptor inner segment ellipsoid band integrity on spectral domain optical coherence tomography

Abstract

Spectral domain optical coherence tomography cross-sectional imaging of the macula has conventionally been resolved into four bands. However, some doubts were raised regarding authentication of the existence of these bands. Recently, a number of studies have suggested that the second band appeared to originate from the inner segment ellipsoids of the foveal cone photoreceptors, and therefore the previously called inner segment-outer segment junction is now referred to as inner segment ellipsoidband. Photoreceptor dysfunction may be a significant predictor of visual acuity in a spectrum of surgical and medical retinal diseases. This review aims to provide an overview and summarizes the role of the photoreceptor inner segment ellipsoid band in the management and prognostication of various vitreoretinal diseases.

Keywords: age relate macular degeneration; diabetic macular edema; external limiting membrane; inner segment-outer segment junction; macular hole; spectral domain optical coherence tomography.

Figure 1

Normal Heidelberg spectral domain optical coherence tomography (SD-OCT) with intact external limiting membrane (ELM), photoreceptor inner segment ellipsoid band (ISel), and retinal pigment epithelium (RPE).

Figure 2

Macular hole with disrupted ISel and ELM. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 3

Epiretinal membrane showing photoreceptor ISel disruption (red arrow). Abbreviation: ISel, inner segment ellipsoid.

Figure 4

Myopic foveoschisis showing disruption of ISel band (red arrow) and ELM. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 5

Choroidal neovascular membrane showing disruption of the photoreceptor ISel band, ELM, and RPE (red arrow). Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane; RPE, retinal pigment epithelium.

Figure 6

Submacular hemorrhage in neovascular AMD. Notes: (A) large subretinal hemorrhage; (B) partial resolution of the subretinal hemorrhage with hemorrhagic pigment epithelium detachment and the ISel band could not be discerned; (C) restoration of the photoreceptor ISel band (blue arrow) with residual pigment epithelium detachment (red arrow). Abbreviations: AMD, age-related macular degeneration; ISel, inner segment ellipsoid.

Figure 7

Diabetic macular edema showing disruption of both photoreceptor ISel band and ELM (red arrow), large cystic spaces, and serous detachment. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane; S, superior; N, nasal; I, inferior; T, temporal.

Figure 8

Spectral domain optical coherence tomography (SD-OCT) showing various grades of ELM and ISel band disruption. Notes: (A) grade 0, no disruption of ELM and ISel; (B) grade 1, ELM disrupted, ISel intact (arrow head); and (C) grade 2, both ELM and ISel disrupted. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 9

Central retinal vein occlusion associated with macular edema showing large cystic spaces associated with photoreceptor ISel band disruption (red arrow). Abbreviations: ISel, inner segment ellipsoid; S, superior; N, nasal; I, inferior; T, temporal.

Figure 10

Macular telangiectasia showing juxtafoveal disruption of ISel band and ELM (red arrow). Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 11

Acute central serous chorioretinopathy showing serous detachment with pigment epithelium detachment. Note: Integrity of ISel band and ELM could not be discerned. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 12

Chronic central serous chorioretinopathy showing disruption of ISel band and ELM (red arrow), and serous detachment and fibrin collection (blue arrow). Note: Proliferating retinal pigment epithelial cells can also be seen. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane; S, superior; N, nasal; I, inferior; T, temporal.

Figure 13

Stargardt’s disease showing disruption of ISel band, increased foveal pit with hyperreflectivities at the level of retinal pigment epithelium, suggestive of flecks. Abbreviation: ISel, inner segment ellipsoid.

Figure 14

Punctate inner choroidopathy showing disruption of photoreceptor ISel band and ELM (red arrow). Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 15

Solar retinopathy showing disruption of photoreceptor ISel band with intact ELM (red arrow). Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 16

Uveitis associated with macular edema showing discontinuous photoreceptor ISel band and ELM (red arrow), and cystic spaces with serous detachment. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane; S, superior; N, nasal; I, inferior; T, temporal.

Figure 17

VKH disease after treatment with intravenous methylprednisolone showing (A) subretinal fluid, (B) resolving subretinal fluid, and (C) residual subretinal fluid. Note: The integrity of ISel band and ELM has not been restored yet. Abbreviations: VKH, Vogt-Koyanagi-Harada; ISel, inner segment ellipsoid; ELM, external limiting membrane.

Figure 18

Choroidal hemangioma showing disruption of photoreceptor ISel band, ELM (red arrow) and serous detachment. Abbreviations: ISel, inner segment ellipsoid; ELM, external limiting membrane.