|Year : 2020 | Volume
| Issue : 10 | Page : 2238-2239
Orange ring sign: A novel finding on multicolor imaging in eyes with idiopathic choroidal neovascular membrane
Rupak Roy, Kumar Saurabh, Sugandha Goel
Department of Vireo-Retina, Aditya Birla SankaraNethralaya, Kolkata, West Bengal, India
|Date of Submission||01-Dec-2019|
|Date of Acceptance||17-Apr-2020|
|Date of Web Publication||23-Sep-2020|
Dr. Rupak Roy
Aditya Birla SankaraNethralaya, 147, Mukundapur, E.M. Bypass, Kolkata - 700 099, West Bengal
Source of Support: None, Conflict of Interest: None
Keywords: Idiopathic CNVM, infrared reflectance, multicolor imaging, near-infrared autofluorescence
|How to cite this article:|
Roy R, Saurabh K, Goel S. Orange ring sign: A novel finding on multicolor imaging in eyes with idiopathic choroidal neovascular membrane. Indian J Ophthalmol 2020;68:2238-9
|How to cite this URL:|
Roy R, Saurabh K, Goel S. Orange ring sign: A novel finding on multicolor imaging in eyes with idiopathic choroidal neovascular membrane. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 31];68:2238-9. Available from: https://www.ijo.in/text.asp?2020/68/10/2238/295696
Choroidal neovascular membrane (CNVM) in patients below 50 years of age without any secondary pathology is considered to be idiopathic CNVM (iCNV). These membranes are usually unilateral and visual outcomes are more favorable than CNVM due to age-related macular degeneration (AMD) or myopia. Multicolor imaging (MCI) is a novel noninvasive retinal imaging modality that has been described in AMD. MCI of iCNV has not yet been described in the literature. Therefore, in the present study, we aimed to describe a characteristic ring sign on MCI with iCNV.
A 48-year-old female patient presented with a diminution of vision in the left eye for 1 month. Best-corrected visual acuity (BCVA) was 6/9 in the right eye and 6/60 in the left eye. Fundus [Figure 1]a of the left eye showed a greyish membrane at the macula. Spectral-domain Optical Coherence Tomography (SD-OCT) [Figure 1]b showed subretinal CNVM with subfoveal late leakage on fundus fluorescein angiography (FFA) [Figure 1]c. MCI [Figure 1]d showed a characteristic orange ring with green core. The ring was better picked up in infrared reflectance (IR) [Figure 1]e, near-infrared autofluorescence (IRAF) [Figure 1]g as compared to blue autofluorescence (BAF) [Figure 1]f. MCI (Heidelberg Spectralis) (30°) was obtained during OCT scanning before doing FFA.
|Figure 1: Color fundus photograph of the left eye showing greyish membrane at the macula (blue arrow) (a), SD-OCT line scan through the lesion (b) showing subretinal CNVM (blue arrow) with subfoveal late leakage (blue arrow) on FFA (c), Multicolor imaging (d) showing a characteristic orange ring (blue arrow) with green core (white arrow in inset) corresponding to CNVM. The ring was better picked up in infrared reflectance (e) and near-infrared autofluorescence (g) as compared to blue autofluorescence (f) (blue arrows).|
Click here to view
| Discussion|| |
Lida et al. have described three stages of iCNV based on OCT. Subsequently, Toju et al. reported ring-shaped hyperautofluorescence surrounding iCNV on IRAF. Our case had an orange ring with the green core on MCI and corresponding to a white ring in IR. Lesions at RPE level or having high melanin content are usually picked up by IR and usually appear red or orange in composite multicolor image. Similarly, RPE proliferation which has higher melanin content led to an orange ring on MCI. Any elevated lesions appear greenish on MCI. Thus, the green core corresponded to neovascular material. Furthermore, the ring sign may act as an excellent diagnostic clue in addition to other imaging pointers. Thus, it helps in prognosticating and treatment planning if the correct diagnosis is made.
Ms Moupiya Das and Ms Marina Parveen (ophthalmic photographers).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ho AC, Yannuzzi LA, Pisicano K, DeRosa J. The natural history of idiopathic subfoveal choroidal neovascularization. Ophthalmology 1995;102:782-9.
Lindblom B, Andersson T. The prognosis of idiopathic choroidal neovascularization in persons younger than 50 years of age. Ophthalmology 1998;105:1816-20.
Graham KW, Chakravarthy U, Hogg RE, Muldrew KA, Young IS, Kee F. Identifying features of early and late age-related macular degeneration: A comparison of multicolor versus traditional color fundus photography. Retina 2018;38:1751-8.
Iida T, Hagimura N, Sato T, Kishi S. Optical coherence tomographic features of idiopathic submacular choroidal neovascularization. Am J Ophthalmol 2000;130:763-8.
Toju R, Iida T, Sekiryu T. Near-infrared autofluorescence in patients with idiopathic submacular choroidal neovascularization. Am J Ophthalmol 2012;153:314-9.