This 80YO female was 20/200 in her right eye due to central macular atrophy from atrophic age-related macular degeneration (AMD).
Triton swept-source optical coherence tomography showed outer retinal tubulation (ORT) in the outer retinal layers. The extent of these tubular structures was best visualized on en face imaging.
Learning Points:
Outer retinal tubulation, initially described by Zweifel et al (Arch Ophthalmol 2009;127;1596-1602), is a neurodegenerative condition of the photoreceptors and Muller cells associated with atrophy affecting the outer retina and retinal pigment epithelium, including advanced AMD and inherited retinal diseases.
ORT is often seen overlying inactive macular neovascularization in the setting of ongoing anti-VEGF therapy and should not be confused with exudative fluid or cysts, which lack a hyperreflective border.
The outer hyperreflective band likely represents inner segment mitochondria undergoing fission and translocation toward the nucleus (Litts et al Retina 2018;38;445-461).
