[Fundus autofluorescence in patients with hereditary macular dystrophies, malattia leventinese, familial dominant and aged-related drusen]

Retro mode illumination for detecting and quantifying the area of geographic atrophy in non-neovascular age-related macular degeneration

PURPOSE

To evaluate the ability of retro mode illumination imaging for quantifying atrophy compared to confocal color fundus photography (c-CFP), green light fundus autofluorescence (G-FAF), blue light fundus autofluorescence (B-FAF) using the scanning laser ophthalmoscope (SLO) Mirante device by Nidek (Nidek Co., Ltd, Gamogori, Japan).

METHODS

Eyes with clinical evidence of geographic atrophy (GA) associated with non-neovascular age-related macular degeneration, evaluated at the Doheny Eye Centers-UCLA and Hospital Sacco Milan, were included in this prospective, cross-sectional study. All eyes were imaged with multiple retinal imaging modalities using the SLO Nidek Mirante device: c-CFP, G-FAF, B-FAF, retro mode illumination deviated-right (RMDR), and deviated-left (RMDL). Masked graders measured the GA lesion on each modality and inter-modality and inter-grader repeatability were assessed.

RESULTS

The mean (SD) area of GA measured 9.76 (3.82) mm², 9.75 (3.91) mm², 9.76 (3.92) mm², 9.82 (3.87) mm², and 9.81 (3.86) mm² using c-CFP, G-FAF, B-FAF, RMDR, and RMDL, respectively (p = 0.2). Inter-modality correlation was high (Pearson's r > 0.9 and p < 0.0001). Agreement between graders was excellent for all modalities.

CONCLUSIONS

Retro mode imaging demonstrated good agreement for measuring GA compared to other imaging modalities, with a high level of repeatability. Given that retro mode imaging uses infrared light and is comfortable, it may prove to be a useful tool for the assessment of GA in the clinic.

Fundus autofluorescence imaging in age-related macular degeneration

Fundus autofluorescence (FAF) is a noninvasive imaging technology that provides information on the distribution of lipofuscin within the retinal pigment epithelial cells. Progressive accumulation of lipofuscin within retinal pigment epithelial cells is involved in the pathogenesis of age-related macular degeneration (AMD). Fundus autofluorescence imaging using a confocal scanning laser ophthalmoscope is a useful technique to identify high-risk characteristics in patients with nonexudative AMD. It gives also some valuable knowledge and clues in differantial diagnosis of exudative age-related macular degeneration. This review comprises an introduction to fundus autofluorescence, a review of FAF imaging in AMD, and the recent classification of geographic atrophy (GA) and early AMD phenotypes by the Fundus Autofluorescence in Age-related Macular Degeneration Study. The association of phenotype and atrophy progression and choroidal neovascularization development are also summarized.

Drusen characteristics revealed by spectral-domain optical coherence tomography and their corresponding fundus autofluorescence appearance in dry age-related macular degeneration

PURPOSE

To analyze the relationship between drusen morphology revealed by spectral-domain optical coherence tomography (SD-OCT) and corresponding fundus autofluorescence (FAF) features of the same drusen using the Heidelberg Retina Angiograph 2 (HRA2), in patients with dry age-related macular degeneration (AMD).

METHODS

Dry AMD patients were imaged with SD-OCT and HRA2 on the same day. SD-OCT B scans were then precisely overlaid onto the HRA2 images, and the SD-OCT morphological characteristics of the drusen were correlated with the corresponding FAF appearance. The analyzed morphological features of the drusen included: size, status of the inner segment/outer segment (IS-OS) junctional layer above the drusen, shape of the drusen, internal reflectivity, homogeneity and presence of overlaying hyperreflective foci. The FAF characteristics of each druse were rated as hyperautofluorescent, hypoautofluorescent or normally autofluorescent. Spearman's correlation coefficient was used to analyze the correlation between the 2 primary outcomes: SD-OCT morphology of the drusen and their autofluorescent appearance.

RESULTS

431 drusen in 32 eyes of 16 dry AMD patients were evaluated. Of the 7 morphological characteristics assessed by SD-OCT, only drusen size and the status of the IS-OS layer above the drusen were strongly correlated with the autofluorescent appearance (r = 0.78, p < 0.001, and r = 0.58, p < 0.001, respectively). The strength of correlation with other features appeared less robust: homogeneity (r = 0.38; p = 0.001), shape (r = 0.29; p = 0.004), reflectivity (r = 0.28; p = 0.004) and presence of overlaying foci (r = 0.25; p = 0.12).

CONCLUSIONS

Autofluorescent changes most strongly correlate with drusen size and disruption of the IS-OS layer and may be useful as an additional functional-morphological feature by which drusen and their impact upon overlying photoreceptors may be judged.

Fundus autofluorescence imaging: review and perspectives

Fundus autofluorescence (FAF) imaging is a novel imaging method that allows topographic mapping of lipofuscin distribution in the retinal pigment epithelium cell monolayer as well as of other fluorophores that may occur with disease in the outer retina and the subneurosensory space. Excessive accumulation of lipofuscin granules in the lysosomal compartment of retinal pigment epithelium cells represents a common downstream pathogenetic pathway in various hereditary and complex retinal diseases, including age-related macular degeneration. FAF imaging has been shown to be useful with regard to understanding of pathophysiologic mechanisms, diagnostics, phenotype-genotype correlation, identification of predictive markers for disease progression, and monitoring of novel therapies. FAF imaging gives information above and beyond that obtained by conventional imaging methods, such as fundus photography, fluorescein angiography, and optical coherence tomography. Its clinical value coupled with its simple, efficient, and noninvasive nature is increasingly appreciated. This review summarizes basic principles and FAF findings in various retinal diseases.

Mapping of central visual function by microperimetry and autofluorescence in patients with Best's vitelliform dystrophy

PURPOSE

To evaluate retinal sensitivity and fixation patterns in patients with Best's dystrophy by microperimetry (MP) and to correlate the results with static perimetry and retinal morphology seen by autofluorescence (AF).

METHODS

Central 10 degrees visual fields in 11 patients with Best's dystrophy (VA: 0.5+/-0.38) were recorded by the Octopus M2 TOP program and by MP (MP1, Nidek Technologies). AF was recorded by HRA (Heidelberg Engineering).

RESULTS

High correlation (R=0.75, -0.76, -0.48) was found between static perimetry (MS, MD and CLV indices) and MP. Based on MP and AF results, three groups of patients were formed. Patients in the first two groups fixated inside the central nonuniform hypo- and hyperfluorescent AF ring area, next to relative (Group 1) or absolute scotoma (Group 2). Inner parts of the retina close to the fovea were most affected, whereas regions closer to the periphery of the 10 degrees visual field showed near normal function. As the disease progressed, there was an evident shift of fixation to preferential retinal locus (PRL) in eight eyes with visual acuity 0.2 or less (Group 3). Fixation shift was superior in four eyes, temporal in two eyes, and nasal in two eyes.

CONCLUSION

MP enabled a highly sensitive topographic monitoring of retinal function, showing central or pericentral fixation in the early stages, until loss of central function, in eyes with VA 0.2 or less, caused evident shift of fixation to PRL. PRL was never situated inside the central uniform hypofluorescent area, but corresponded with the hyperfluorescent ring seen with AF imaging.

Occupational corneal argyrosis in art silver solderers

PURPOSE

To determine the value of confocal and specular microscopy in the examination of corneal argyrosis in art silver solderers.

METHODS

Six patients with corneal argyrosis underwent a complete physical and ophthalmologic examination. Specular microscopy was performed in three cases, and in vivo confocal microscopy in four cases. Ultrasound biomicroscopy and corneal topography were performed in three cases. A conjunctival specimen of one patient was examined histologically in paraffin sections.

RESULTS

Slit-lamp examination showed gray, diffuse opacities in the deep corneal stroma. Confocal microscopy showed highly reflective deposits with a granular pattern anterior to the corneal endothelium and hypereflective keratocyte nuclei with visible cytoplasm in the anterior stroma. Specular microscopy demonstrated round white bodies anterior to the corneal endothelium. Silver deposits were not found histologically.

CONCLUSIONS

Silver solderers with long-term exposure to silver compounds are at high risk of developing corneal argyrosis. We conclude that specular microscopy and in vivo confocal microscopy provided important information for the diagnosis of corneal argyrosis.

Photodynamic therapy with verteporfin in mallatia leventinese

OBJECTIVE

To describe a case of a patient with documented genetic mallatia leventinese who developed a classic choroidal neovascular membrane and underwent photodynamic therapy (PDT) with verteporfin (Visudyne; CIBA Vision Corp., Duluth, GA).

DESIGN

Interventional case report.

INTERVENTION

The patient underwent a complete ophthalmologic evaluation and fluorescein angiography. Photodynamic therapy with verteporfin was performed.

MAIN OUTCOME MEASURES

Clinical and angiographic records were analyzed for evidence of changes in visual acuity, clinically evident subretinal fluid and the extent of fluorescein leakage from choroidal neovascularization (CNV).

RESULTS

Three weeks after treatment, a fluorescein angiogram showed closure of the neovascular membrane, no evident subretinal fluid was seen, and visual acuity had improved from 20/60- to 20/40. Nine weeks after the application, fluorescein angiography demonstrated a microscopic hyperfluorescent spot at the site of the previously active CNV at which a small area of shallow subretinal fluid was observed, and visual acuity was 20/50. Thirty-four weeks after PDT, visual acuity was 20/60, subretinal fluid resolved, and fluorescein angiography did not show any further changes.

CONCLUSIONS

Photodynamic therapy with verteporfin may be considered as a possible treatment in patients with mallatia leventinese who develop classic CNV.

Tamoxifen side effects, age-related macular degeneration (AMD) or cancer associated retinopathy (CAR)?

PURPOSE

Differential diagnosis of maculopathies can be difficult but is important if patients also suffer from other diseases such as breast cancer treated with antiestrogens. The main possible diagnoses, especially in the elderly, are age-related macular degeneration, tamoxifen and cancer-associated retinopathy (CAR).

METHODS

We describe an 84-year-old patient with breast and colon cancer, who complained of a decrease in visual acuity after treatment with low-dose antiestrogens. She underwent a general ophthalmological investigation, perimetry and electroretinographic examination with multifocal (m-ERG) and flash-electroretinogram (flash-ERG).

RESULTS

Visual acuity was reduced to 1/50 and 0.3. The ophthalmological examination was normal, except for extensive bilateral maculopathy with shining crystalline deposits, central and peripheral visual field defects, slightly affected scotopic and photopic potentials in the flash-ERG, and an abnormal m-ERG.

CONCLUSIONS

The findings are expected with age-related macular degeneration with crystalline drusen, but also with CAR. Even if the single and total dosage of antiestrogens given to the patient is sufficient to cause tamoxifen retinopathy, this diagnosis can be excluded because, in tamoxifen retinopathy unlike in the case presented here, the deposits are not distributed in all retinal layers.