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The pearl necklace sign: a novel spectral domain optical coherence tomography finding in exudative macular disease.
[coats disease]
To
report
a
novel
spectral
domain
optical
coherence
tomography
finding
in
exudative
macular
disease
,
called
the
pearl
necklace
sign
.
A
retrospective
case
series
of
21
eyes
(
20
patients
)
with
chronic
exudative
maculopathy
resulting
from
age-related
macular
degeneration
,
diabetic
macular
edema
,
branch
retinal
vein
occlusion
,
retinal
arterial
macroaneurysm
,
and
Coats
disease
.
Spectral
domain
optical
coherence
tomography
images
were
carefully
evaluated
and
correlated
with
color
fundus
photography
,
near-infrared
reflectance
,
and
fluorescein
angiography
.
A
unique
spectral
domain
optical
coherence
tomography
macular
finding
of
hyperreflective
dots
in
a
contiguous
ring
around
the
inner
wall
of
cystoid
spaces
in
the
outer
plexiform
layer
of
the
retina
that
the
authors
refer
to
as
the
pearl
necklace
sign
was
seen
in
all
patients
.
Visual
acuity
ranged
from
20
/
30
to
hand
motions
.
The
cystoid
spaces
and
the
hyperreflective
dots
resolved
in
certain
cases
after
anti-
vascular
endothelial
growth
factor
therapy
and
/
or
focal
macular
laser
,
but
tended
to
recur
.
Because
the
pearl
necklace
configuration
can
be
found
adjacent
to
hard
exudates
in
the
outer
plexiform
layer
,
the
authors
speculate
that
the
hyperreflective
material
is
composed
of
lipoproteins
or
lipid-laden
macrophages
.
This
novel
spectral
domain
optical
coherence
tomography
sign
gives
further
insight
into
the
development
and
progression
of
hard
lipoprotein
exudates
in
exudative
maculopathy
.