急性Vogt-小柳-原田病眼底自发荧光观察

目的:对急性期Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada,VKH)患者的眼底自发荧光(fundusauto fluorescence,FAF)特征进行观察。方法:对9例18眼急性期VKH患者进行眼底荧光血管造影、眼底自发荧光成像检查,并对结果进行比较。结果:急性期VKH眼底检查见多囊状浆液性视网膜脱离。FFA检查早期可见色素上皮水平多发性点状荧光素渗漏,晚期形成多囊状的荧光素积存。FAF检查见浆液性视网膜脱离区呈低自发荧光;低自发荧光区内,尚可见环形或半环形高自发荧光,与FFA渗漏点位置对应。VKH恢复期水肿消退后视网膜复位,黄斑区可见色素紊乱。FAF检查见自发荧光分布基本恢复至正常状态,但黄斑区出现一些点状高自发荧光颗粒散在分布。结论:FAF技术为临床医生研究VKH提供了一种活体观察视网膜色素上皮(RPE)细胞代谢和功能改变的手段。但有关FAF在VKH的应用价值尚需进一步研究。     

中心性浆液性脉络膜视网膜病变的两种眼底自发荧光特征观察

背景 眼底自发荧光(AF)成像是一种新的非侵人性眼底荧光检测技术,可利用共焦激光扫描检眼镜获得两种眼底AF,包括脂褐素相关的AF(FAF)和黑色素相关的近红外AF(NIA).目的 探讨中心性浆液性脉络膜视网膜病变(CSC)患者眼底FAF和NIA两种AF特征.方法 对CSC患者23例28眼进行FAF、NIA和荧光素眼底血管造影(FFA)检查,其中急性期CSC 15例17眼,慢性迁延性CSC 8例11眼.结果 急性期CSC患者FFA荧光素渗漏点AF改变有3种特征:(1)AF增强,包括FAF增强2眼,占11.76％;NIA增强4眼,占23.53％.(2)无AF,包括FAF 10眼,占58.82％;NIA 13眼,占76.47％.(3)AF正常,包括FAF 5眼,占29.42％;NIA 0眼.视网膜浆液性脱离区AF改变有2种特征:(1)AF减弱,包括FAF减弱12眼,占70.59％;NIA减弱10眼,占58.82％.(2)AF增强,包括FAF增强5眼,占29.41％;NIA增强7眼,占41.18％.慢性迁延性CSC患者AF像中,FFA检查视网膜色素上皮(RPE)渗漏点位置表现为无AF,部分无AF点在相应位置的FFA像未见RPE渗漏点,而N1A像中所见的无AF点常常多于FAF.慢性CSC视网膜浆液性脱离区常表现为颗粒样无AF、AF增强及AF减弱等多种AF改变并存的复合病灶,并且AF像显示的异常荧光范围常常大于对应的FFA显示的异常荧光区.结论 AF技术为研究CSC提供了一种活体观察RPE细胞代谢和功能改变的手段.     

眼底自发荧光技术在部分视网膜疾病中的应用进展

眼底自发荧光(fundus autofluorescence,FAF)技术是近几年发展起来的一项新技术,它能够显示视网膜色素上皮内脂褐素的含量与分布,主要反映视网膜色素上皮细胞的功能及代谢情况.观察视网膜疾病不同时期FAF的分布情况及其强度变化,有助于早期诊断、观察疗效及评价疾病预后.本文对FAF的基本原理及其在部分视网膜疾病中的临床应用进展作一综述.     

视网膜与视网膜色素上皮联合错构瘤的多模式影像分析

目的:观察视网膜与视网膜色素上皮联合错构瘤(CHRRPE)的多模式影像特征。方法:采用横断面研究,纳入2013年3月至2019年7月在云南省第二人民医院诊断为CHRRPE的患者16例16眼,收集患者彩色眼底照相、光相干断层扫描(OCT)、血流成像OCT(OCTA)、眼底炫彩成像、眼底自发荧光(FAF)、荧光素眼底血管造...     

拓展眼底自身荧光临床研究的广度和深度,提升其应用研究水平

眼底自身荧光(FAF)主要来源于视网膜色素上皮(RPE)细胞内堆积的代谢产物脂褐质,是活体条件下评价RPE活性与形态学改变的重要检测下具.作为一种无损伤、可重复、简便快捷的检测手段,FAF结合其他眼底形态与功能检测方法,可从RPE结构和功能变化的角度为部分常见眼底疾病提供辅助诊断依据.在逐步认识各种眼底疾病FAF表现特...     

共焦扫描激光检眼镜测定眼底自体荧光的研究进展和应用

用共焦扫描激光检眼镜(cSLO)测定眼底自体荧光(FAF)是近10年来出现的技术,它利用脂褐素的光学特性成像,反映视网膜色素上皮细胞的功能和感光细胞的状态,对多种眼底病的病因研究、临床诊断、分期分型、预后判断发挥重要作用。本文就FAF的定义、cSLO的测定原理以及该技术的研究进展和临床应用进行综述。     

ARMD的光学相干断层成像分析

本文给出了一种老年性黄斑变性(age-related macular degeneration,ARMD)的早期诊断方法,在ARMD的发展过程中出现的各种病理改变如玻璃膜疣、脉络膜视网膜地图状萎缩、视网膜色素上皮萎缩、脉络膜新生血管、视网膜色素上皮/神经上皮脱离等,用光学相干断层成像技术(optical coherence tomography,OCT)对其进行图像分析。     

眼底自发荧光检查在特发性黄斑裂孔诊断及视力预后判定中的应用

眼底自发荧光(fundus autofluorescence,FAF)作为一种操作简便、非侵入性的成像技术,可通过判断视网膜中脂褐质及黑色素的变化,以高/低荧光呈现视网膜功能状况。特发性黄斑裂孔(idiopathic macular hole,IMH)的FAF图像表现为黄斑裂孔高荧光区及孔周围的环形低荧光。术后裂孔完全闭合,高荧光区消失,否则表现为持续高荧光状态。FAF图像表现与相干光断层扫描图像及视力有相关性。(国际眼科纵览,2020,44:413-418)     

眼底自发荧光影像及其临床应用进展

眼底自发荧光（FAF）影像是近二十年来开展的一项技术。它能够反映视网膜色素上皮（RPE）细胞的功能,也可以作为临床上RPE细胞代谢活力的一个指标。动态观察眼底自发荧光,可以监测病情的进展,判断疾病预后,结合进一步的基础实验研究,正确了解视网膜脉络膜病变的发病机制。本文就眼底自发荧光的原理,分布和检测方法及在临床应用的新进展作一综述。     

眼底自发荧光技术在湿性年龄相关性黄斑变性诊断中的应用

湿性年龄相关性黄斑变性是年龄相关性黄斑变性的晚期阶段,可导致80％以上患者重度视力丧失,目前临床上诊断主要依靠相干光断层扫描和荧光素眼底血管造影等形态学检查手段,而眼底自发荧光(fundus autofluorescence,FAF)成像技术作为一种非侵入性检测手段,能反应脂褐质的分布及视网膜色素上皮层的活性,已逐渐成为湿性年龄相关性黄斑变性诊治中的观测指标之一.     

Chloroquine retinopathy: lipofuscin- and melanin-related fundus autofluorescence,optical coherence tomography and multifocal electroretinography

Purpose To evaluate melanin-related near-infrared fundus autofluorescence (NIA, excitation 787 nm, emission > 800 nm), lipofuscin-related fundus autofluorescence (FAF, excitation 488 nm, emission >500 nm), optical coherence tomography (OCT), and multifocal electroretinography (mfERG) in patients with chloroquine (CQ) retinopathy. Methods Two patients with progressed CQ retinopathy underwent clinical examination, ISCEV mfERG evaluation, and FAF and NIA imaging using a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2) with either a 30° or wide-angle field-of-view. OCT3 imaging was performed in one of these patients. Results In the foveola, FAF and NIA were relatively normal. Parafoveal loss of retinal pigment epithelium (RPE) was indicated by absent FAF and NIA. An area of reduced FAF and NIA surrounded the parafoveal region of RPE loss. In the adjacent area, FAF was increased and increased NIA marked the peripheral border of increased FAF. Wide-field imaging revealed increased FAF in association with retinal vessels. Retinal thickness was markedly reduced in the OCT predominantly in the parafoveal region. Visual field loss and mfERG amplitude reduction corresponded to areas with increased or reduced FAF and NIA. Conclusion Patterns of FAF and NIA indicate different stages of pathophysiologic processes involving lipofuscin and melanin in the RPE. Combined retinal imaging and functional testing provides further insights in the pathogenesis and development of retinal degenerative disease. An association of CQ retinopathy with retinal vessels architecture is hypothesized.     

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.     

Fundus autofluorescence imaging of retinal dystrophies

Fundus autofluorescence (FAF) is a non-invasive imaging technique that enables the visualization of lipofuscin changes in the retinal pigment epithelium. This study aims to illustrate the spectrum of FAF changes in a variety of retinal dystrophies. For this purpose, we examined patients with retinal dystrophies such as Stargardt disease, Best vitelliform macular dystrophy, and retinal dystrophies associated with mutations in the peripherin/RDS gene. All retinal dystrophies were confirmed by molecular genetic analysis. A broad range of characteristic FAF patterns was observed. Our results indicate that FAF imaging constitutes a useful additive tool in the diagnosis and follow-up of various retinal dystrophies.     

Fundus autofluorescence imaging findings in retinal pigment epithelial tear

PURPOSE: Retinal pigment epithelial (RPE) tear is a clinical and angiographic entity, which usually occurs in association with pigment epithelial detachments (PED), in the context of neovascular age-related macular degeneration (ARMD). The recording of fundus autofluorescence (FAF) has been introduced as a technique of retinal imaging, allowing the in vivo assessment of the integrity of RPE. The authors describe the FAF imaging findings in a patient with RPE tear. METHODS: Observational case report. RESULTS: A 70-year-old woman developed RPE tear after the application of photodynamic therapy for choroidal neovascularization associated with PED. The diagnosis of the RPE tear was confirmed by fluorescein angiography (FA) and indocyanine green angiography (ICGA). FAF imaging revealed absence of autofluorescence at the area which was denuded of RPE, while at the area where the RPE was rolled, a heterogeneous signal of FAF was recorded. The intensity of the signal in that area was, on average, not different from the normal background FAF signal expected in an unaffected RPE/photoreceptor complex. CONCLUSIONS: The authors report the FAF imaging findings in a patient with RPE tear. These findings can be interpreted from the ability of FAF imaging to access in vivo the integrity of RPE, and correlate well with the histopathology of this clinical entity. FAF imaging, as a fast and noninvasive technique, may be a useful modality, alternative to FA and ICGA, in the diagnosis and evaluation of such cases. Moreover, it may contribute to a more detailed phenotyping of the various clinical pictures associated with neovascular ARMD.     

脉络膜厚度与年龄相关性黄斑变性发病关系的研究进展

年龄相关性黄斑变性(ARMD)是一种慢性的、进行性的黄斑视网膜退行性疾病,是目前中老年人的主要致盲性眼病,其发展过程和发病机制复杂。研究表明,脉络膜厚度在ARMD不同分期和分类中均有显著变化。鉴于脉络膜是一种能够快速改变血流的血管结构,脉络膜厚度的变化可能主要是由脉络膜血流的变化引起的。并且,脉络膜的异常血流灌注可进一步损害视网膜色素上皮细胞的功能,导致视网膜色素上皮层缺氧、缺血,最终诱发ARMD。目前,越来越多的人意识到脉络膜厚度的测量在ARMD的诊断和治疗中的重要性,因此本文将针对脉络膜厚度和脉络膜血流在ARMD病程和治疗后的改变以及相关发病机制进行综述,这可能为ARMD发病提供新的预测指标,并为开发新的ARMD治疗方法提供新的目标。     

脂褐素与年龄相关性黄斑变性

年龄相关性黄斑变性(ARMD)是引起中老年人视力丧失的首要原因,其确切病因尚未明了,故治疗效果不佳。脂褐素随着年龄增长在视网膜色素上皮的积累是眼睛老化的标志,通过光化学作用等影响正常视网膜色素上皮细胞的功能,与ARMD的发生发展有一定联系。本文就脂褐素及其与ARMD的关系进行综述。     

Fundus autofluorescence imaging

Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.     

Age related macular degeneration surgery

Age related macular degeneration (ARMD) is a disease in which the retinal pigment epithelium (RPE) is damaged in the central retinal area. In the exudative form, the vision loss is due to choroidal neovascularization, while in the nonexudative or atrophic form, there is a vision loss because of the retinal pigment epithelium atrophy. Treatment which proved to be efficient in lowering the risk of severe vision loss in the exudative form includes laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and as surgical treatment, the controversial subretinal membrane extraction. In all these situations the RPE is damaged by the disease itself and by the therapeutic procedure too. Retinal translocation is a surgical procedure that intends to remove the neurosensory retina from an area with damaged RPE to an healthy RPE area, through a 360 degrees retinotomy or through a limited one. This paper present some ARMD cases treated by subretinal membrane extraction and one by limited retinal translocation. The question which is still remaining is which are the risks and benefits for the following treatment procedures: laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and surgical approach?     

cSLO-Fundusautofluoreszenz-Imaging

BACKGROUND: Fundus autofluorescence (FAF) originates from age- and disease-dependent accumulation of lipofuscin in the lysosomal compartment of the retinal pigment epithelium (RPE). FAF imaging is a noninvasive method to detect intrinsic RPE fluorescence in vivo. We describe features of a novel confocal scanning laser ophthalmoscope (cSLO) for FAF imaging and compare images to the previous cSLO system.METHODS: FAF images were obtained with a cSLO using an optically pumped solid state laser (OPSL) instead of an argon laser for generation of excitation light at 488 nm. For detection of emitted FAF signals >500 nm a barrier filter was used.RESULTS: The novel cSLO allows FAF imaging with a resolution of up to 5 microm/pixel to delineate normal and pathological features in various retinal pathologies including early-stage and advanced atrophic or neovascular age-related macular degeneration, macular edema, and retinal dystrophies. Further technical improvements include an internal fixation target and an enlarged optical focus adaption range.CONCLUSIONS: Improved image quality using the novel cSLO for FAF imaging is of clinical relevance for diagnosis and precise phenotyping of retinal diseases. This method may also be useful to monitor therapeutic effects targeting RPE lipofuscin accumulation as a common pathogenetic pathway in various degenerative and hereditary retinal diseases.