年龄相关性黄斑变性玻璃膜疣的F-10共焦激光扫描检眼镜retro-mode成像检查

目的:探讨F-10共焦激光扫描检眼镜(cSLO)retro-mode成像在年龄相关性黄斑变性(AMD)玻璃膜疣检查中的应用价值.方法:回顾性病例研究.选取 2015-10/2016-12于我院眼科门诊确诊的AMD患者67例67眼和对侧67眼的临床资料纳入研究.所有患者均行眼底彩色照相、光学相干断层扫描(optical coherence tomography,OCT)和F-10cSLOretro-mode成像检查.对比观察单侧AMD患者患眼玻璃膜疣的眼底彩色照相、OCT及retro-mode成像图像特征,并计算分析retro-mode成像与眼底彩色照相及OCT对单侧AMD患者对侧眼玻璃膜疣的检出率.结果:F-10cSLOretro-mode成像能够清晰显示单侧AMD患者患眼一些在眼底彩色照相和OCT检查中并未出现的玻璃膜疣病灶.在67例单侧AMD患者对侧眼,retro-mode成像发现玻璃膜疣56眼(84%),眼底彩色照相发现玻璃膜疣36眼(54%),OCT发现玻璃膜疣48眼(72%),差异有统计学意义(χ2=14.31,P<0.05).两两分别比较,retro-mode成像对玻璃膜疣的检出率显著高于眼底彩色照相,差异有统计学意义(χ2=13.87,P′<0.0125);而retro-mode成像与OCT比较对玻璃膜疣的检出率差异无统计学意义(χ2=2.75,P′>0.0125).结论:F-10cSLOretro-mode成像作为一种非侵入性的检查方法,能够有效地检测AMD玻璃膜疣.     

萎缩型老年性黄斑变性的吲哚青绿和荧光素眼底血管造影观察

目的 观察和评价萎缩型老年性黄斑变性(age-related macular degeneratioin, AMD)的荧光素眼底血管造影(fundus fluoresce in angiography, FFA)与吲哚青绿血管造影(indocyanine green angiography, ICGA)图像特征和对比检查的应用价值。 方法 回顾分析73例萎缩型AMD患者95只眼的彩色眼底照相、FFA和ICGA检查资料，其中包括视网膜色素上皮(retinal pigment epithelium, RPE)色素脱失与萎缩19例26只眼、玻璃疣15例30只眼和39例单侧渗出性AMD患者的对侧眼39只。 结果 26只RPE色素脱失与萎缩的眼中，24只色素脱失眼 FFA表现为晚期斑片状强荧光，ICGA表现为斑片状强弱相间荧光；地图状萎缩2只眼，FFA表现为斑片状强荧光，ICGA表现为边界清晰的弱荧光内见脉络膜毛细血管缺损，仅有脉络膜大血管。8只硬性玻璃疣眼FFA表现为强荧光，ICGA表现为持续斑点状 强荧光；16只软性玻璃疣眼FFA表现为强荧光，ICGA表现为持续性斑片状强弱相间荧光；6只同时有软性和硬性玻璃疣眼FFA表现为强荧光，ICGA表现为斑点状强弱相间荧光。当玻璃疣ICGA表现为弱荧光时，FFA所见到的玻璃疣的数量及范围较ICGA 所见者更多更大；当玻璃疣ICGA表现为强荧光时，FFA检查所见到的玻璃疣的数量及范围较ICGA所见更少。单侧渗出型AMD对侧39只眼中，ICGA检查发现32只眼、FFA检查发现31只眼有玻璃疣及RPE色素脱失与萎缩的异常荧光。 结论 ICGA与FFA同步检查为观察萎缩型AMD的眼底图像特征提供了完善的检查手段。 （中华眼底病杂志，2003，19：79-82）     

眼底血管造影联合频域光相干断层扫描同步检查法对渗出性老年性黄斑变性脉络膜新生血管的诊断价值

目的 观察眼底血管造影联合频域光相干断层扫描（OCT）同步检查（HRA+频域OCT系统）在渗出性老年性黄斑变性（AMD）脉络膜新生血管（CNV）中的诊断价值。方法 连续临床病例横断面研究设计。对采用国际标准视力表、裂隙灯显微镜、直接或间接检眼镜检查确诊的42例渗出性AMD患者眼底有活动性病变的50只眼进行HRA+频域OCT检查。50只眼均进行了荧光素眼底血管造影（FFA）及频域OCT同步检查,其中15只眼还同时进行了FFA、吲哚青绿血管造影（ICGA）和频域OCT同步检查。以眼底血管造影能否清楚显示CNV 边界将CNV分为4种类型:典型性CNV、部分典型性CNV、隐匿性CNV、CNV 瘢痕化。整合图像中将CNV的OCT图像特征分为3种类型：视网膜色素上皮（RPE）下型、视网膜下型、混合型。FFA及ICGA检查按常规方法进行,利用实时定位频域OCT断层扫描技术定位CNV,图像采集设定为通过强荧光区的放射状和格栅样断面,每帧图像为7 μm 断层,放射状为30°间隔,格栅状为10横向10纵向扫描线。根据FFA、 ICGA检查结果和OCT图像特征对CNV进行分型,着重对CNV的FFA、ICGA、OCT形态进行图像整合分析。结果 50只眼均定位检查到CNV。典型性CNV 4只眼,占8%。部分典型性CNV 11只眼,占22%。隐匿性CNV 32只 眼,占64%。其中,纤维血管性色素上皮脱离型27只眼,晚期无源性渗漏5只眼。CNV 瘢痕化3只眼,占6%。OCT检查结果显示,RPE下型4只眼,占8%,表现为CNV生长于RPE光带下;视网膜下型16只眼,占32%,表现为在RPE和脉络膜毛细血管层光带中断,有弧形高光反射组织通过中断处向视网膜下突起生长;混合型30只眼,占60%,表现为CNV既占有RPE下空间又占有视网膜空间。结论 HRA联合频域OCT系统的图像整合技术能较好地对CNV进行分型和性质的判断,为临床治疗提供有价值的参考。     

单侧湿性型老年性黄斑变性对侧眼的吲哚青绿血管造影观察

目的 探讨单侧湿性型老年性黄斑变性(age-related macular degeneration,AMD)对侧眼的吲哚青绿血管造影(indocyanine green angiography,ICGA)特征及其临床意义。 方法 对70例一眼为湿性型AMD的患者对侧眼作眼底彩色照相、荧光素眼底血管造影(fundus fluorescein angiography,FFA)以及ICGA检查,并对其眼底荧光图像进行比较和分析。 结果 对侧眼的ICGA特征有：①玻璃膜疣可呈现弱荧光、强荧光及正常荧光等表现;②14只眼ICGA中晚期出现强荧光斑;③13只眼呈现有一个或多个片状脉络膜充盈缺损;④18只眼ICGA中晚期出现簇状强荧光小点。 结论 ICGA能较好评价单侧湿性型AMD对侧眼病变损害程度,并有助于寻找发生渗出性改变的危险因素。 (中华眼底病杂志, 1999, 15: 216-218)     

光学相干断层成像、共焦激光断层扫描和视网膜厚度分析在老年性黄斑变性检查中的对比研究

目的探讨光学相干断层成像(OCT)、共焦激光断层扫描(HRT)、视网膜厚度分析(RTA)检测老年性黄斑变性(AMD)不同类型病变的价值,为AMD早期诊断、病程预后及治疗提供依据。方法对AMD患者63例(97只眼)(萎缩型AMD65只眼、渗出型AMD32只眼)进行OCT、HRT、RTA检查,其中玻璃膜疣41只眼,地图状萎缩24只眼,脉络膜新生血管(CNV)22只眼,视网膜色素上皮脱离(PED)10只眼。结果(1)玻璃膜疣检测阳性率依次为OCT、RTA及HRT,OCT发现色素上皮层的局限性增厚,HRT检测未见明显异常,RTA显示黄斑区视网膜不同程度增厚。(2)地图状萎缩检测阳性率依次为OCT、HRT及RTA。OCT发现神经上皮及色素上皮层不同程度变薄,HRT可发现有视网膜局部的凹陷并可发现板层孔,RTA未发现有显著特征性改变。(3)CNV检测阳性率依次为OCT、RTA及HRT。OCT在CNV有特征性改变,HRT显示视网膜的隆起,RTA显示视网膜的局部增厚。(4)PED检测阳性率无显著性差异(F=8.400,P=0.136)。OCT在PED有特征性改变,并可区分浆液性及渗出性PED,HRT显示视网膜的隆起,RTA显示视网膜的增厚。结论对比三种技术,在鉴别AMD各型病变中OCT灵敏性及特异性最高。而三种技术间的协同作用在本研究中未发现有显著的统计学意义,待加大样本后再行分析。     

大胶质玻璃膜疣

患者女性, 41岁。因体检发现眼底异常, 就诊于吉林大学第一医院眼科。眼部检查:视力双眼均为1.0, 双眼前节未见异常;双眼眼底黄斑区多发大小和质地均匀、黄色圆形玻璃膜疣样病变(精粹图片1)。双眼眼底自发荧光检查:黄斑区散在颗粒样弱自发荧光被环形强自发荧光包绕(精粹图片2)。双眼相干光层析成像术检查:黄斑区视网膜色素上皮多处突起, 其下方呈均匀中等信号(精粹图片3)。临床诊断:双眼大胶质玻璃膜疣。     

黄斑玻璃膜疣预防性激光治疗后视功能变化

目的 研究预防性激光治疗大的黄斑玻璃膜疣后视功能的变化.方法 双眼黄斑部有多个(>10个)大的(直径>63μm)玻璃膜疣者16例.随机选择1只眼行激光治疗,氪黄激光"C"型光凝其黄斑区.另外1只眼不治疗而作为对照.随访治疗组和对照组最佳矫正视力、黄斑光敏度、彩色眼底像和眼底荧光造影.结果 激光治疗组8只眼玻璃膜疣减少,7只眼玻璃膜疣无明显变化,1只眼玻璃膜疣增加.对照组0只眼玻璃膜疣减少,10只眼玻璃膜疣无明显变化,6只眼玻璃膜疣增加.最佳矫正视力和黄斑光敏度,治疗组没有变化,对照组下降.结论 氪黄激光对大的黄斑玻璃膜疣预防性治疗可以促进玻璃膜疣吸收,并使其视功能保持稳定.     

50岁以上患者黄斑区视网膜浆液性色素上皮脱离的相干光断层扫描特征分析

目的 探讨50岁以上患者黄斑区视网膜浆液性色素上皮脱离(FED)的相干光断层扫描(OCT)图像特征.方法 回顾分析2003年6月至2007年8月50岁以上患者出现黄斑区浆液性PED的37例(50只眼)临床资料,患者均进行经黄斑区OCT检测,观察其图像特征,并结合眼底彩色照相、荧光素眼底血管造影(FFA),部分病例行吲哚菁绿血管造影(ICGA)检查结果 进行分析.结果 根据本文所选病例的OCT特征,将50岁以上患者出现黄斑区浆液性PED脱离分为3种:单纯性PED者14只眼(28%),玻璃膜疣样PED者26只眼(52%),合并神经上皮层脱离的PED者10只眼(20%).单纯性PED见于部分萎缩型年龄相关性黄斑变性(AMD)9只眼(18%)、特发性浆液性PED者5只眼(10%);玻璃膜疣样PED见于部分黄斑玻璃膜疣样病变26只眼(52%);合并神经上皮层脱离的FED见于部分复发性/迁延性中心性浆液性脉络膜视网膜病变(CSC)6只眼(12%)、视网膜下血管病变病例4只眼(8%).结论 50岁以上患者发生黄斑区浆液性PED可能是早期和基础性的老年性改变,其进一步的变化将导致脉络膜和视网膜的损害.OCT能够发现无明显临床症状的浆液性PED,清晰地显示PED形态,准确地测量PED范围,简化随访过程,有利于年龄相关性黄斑病变的早期诊断和治疗.     

老年黄斑变性玻璃膜疣的吲哚菁绿血管造影

目的：探讨老年黄斑变性（AMD）玻璃膜疣的吲哚菁绿血管造影（ICGA）特征及其临床意义。方法：对10例16眼早期AMD患者进行眼底荧光血管造影（FFA）及ICGA。结果：⑴FFA早期玻璃膜疣为透见荧光,后期部分呈现着色现象。⑵ICGA早期可见脉络膜充盈迟缓或不规则,后期可见脉络膜渗漏高荧光区、点状强荧光及斑状强荧光团。玻璃膜疠为遮蔽荧光。此外可见涡状静脉异常。结论：AMD早期即有明显的脉络膜循环紊乱及可疑非活动性新生血管生成。对AMD患者进行FFA和ICGA眼底血管对照检查,对了解AMD的发病机理,及早发现潜在的脉络膜新生血管,以尽早给予适当的预防性治疗均有重要意义。     

渗出型老年黄斑变性患者眼底相干光断层成像结果分析

目的：了解渗出型老年黄斑变性（age-related macular degeneration,AMD）患者的眼底相干光断层成像（optical coherence tomography,OCT）特征。方法：对经常规检查、荧光素眼底血管造影（fundus fluorescein angiography,FFA）、吲哚青绿脉络血管造影（indocyanine green angiography,ICGA）确诊的渗出型AMD患者38例（42只眼）行眼底OCT检查,分析其图像资料,并与其FFA和ICGA检查结果进行比较。结果：OCT图像特征：典型纤维性新生血管膜34只眼,浆液性视网膜神经上皮脱离38只眼,视网膜神经纤维层脱离合并层间水肿8只眼,出血性和浆液性视网膜色素上皮（retinal pigment epithelium,RPE）脱离分别为11只眼和9只眼。结论：渗出型AMD患者眼底OCT图像特征为典型的纤维性新生血管膜合并浆液性视网膜神经上皮脱离、视网膜神经纤维层脱离、浆液性和出血性RPE脱离。上述图像特点证实和补充了FFA和ICGA检查结果,有助于渗出型AMD的诊断和评价。     

萎缩性黄斑变性的眼底自发荧光特征

背景年龄相关性黄斑变性（AMD）的早期诊断和治疗至关重要。以往对AMD的诊断主要参照荧光素眼底血管造影（FFA）和光学相干断层扫描（OCT）,但眼底自发荧光技术（FAF）无需注射造影剂,大大优化了诊断过程。目的观察萎缩性AMD的FAF特征。方法28例39眼萎缩性AMD按照陈松的分类方法进行分组,应用激光共焦扫描检眼镜HRA2获得所有患者的FAF平均图像,并与眼底照相或FFA结果进行比较。结果萎缩性AMD的FAF信号异常增高或降低区域与眼底的改变可能对应或不对应。萎缩性AMD萎缩前期FAF改变包括轻微改变、局灶性、片状、线性、花边样、网状和斑点状增强等7种形态。萎缩性AMD萎缩期地图状萎缩区呈边界清晰的低FAF区,其交界区表现为正常FAF、FAF带状增强或弥漫性增强;非地图状萎缩呈边界不清的低FAF区,其交界区FAF弥漫性增强。结论FAF成像技术为萎缩性AMD的诊断提供了一种新的非侵入性检查手段。     

Fundus autofluorescence and fate of glycoxidized particles injected into subretinal space in rabbit age-related macular degeneration model

Purpose  Abnormal fundus autofluorescence (FAF) is associated with the incidence or progression of dry and wet age-related macular degeneration (AMD). We previously developed a rabbit AMD model with drusen and type-1 choroidal neovascularization (CNV) that mimics the accumulation of lipofuscin using artificial glycoxidized particles. The objective of the current study was to investigate in vitro effects of glycoxidized particles on retinal pigment epithelial (RPE) cells, and the FAF and fate of injected particles in this model. Methods  Glycoxidized particles were prepared by a 4-day incubation of water-in-oil emulsions of serum albumin and glycolaldehyde to allow glycoxidation and consequent cross-linking. After particles were added in the culture medium of confluent human RPE cells, cell viability, adhesion activity, and proliferation activity were assessed by cell counting. In anesthetized rabbits, 250 μg of glycoxidized particles were injected into the subretinal space to induce experimental AMD. FAF measurement and angiography with sodium fluorescein and indocyanine green were performed periodically using the Heidelberg Retina Angiograph 2 (HRA2). The eyes enucleated, and the lung and the spleen, excised at week 4 or 12, were histologically evaluated by light and fluorescence microscopy. Results  Glycoxidized particles phagocytosed did not impair the cell viability, adhesion, and proliferation of RPE cells, as compared with RPE cells in controls. HRA2 showed different patterns of abnormal FAF in the area with the implanted glycoxidized particles, similar to pathological FAF patterns in aging human eyes with or without AMD. Histologic examination showed accumulated glycoxidized particles and large lipofuscin granules with green autofluorescence in and under the RPE and at the margins of or beneath drusen, possibly associated with abnormal FAF. In addition, some particles were detected in the lung and the spleen. Conclusions  Glycoxidized particles phagocytosed might stay in RPE cells without any acute biological reaction. Our rabbit model of AMD simulated abnormal FAF patterns observed in aging human eyes with or without AMD. Glycoxidized particles phagocytosed by RPE cells could be deposited on Bruch’s membrane in rabbits, possibly excreted in part into choroidal circulation. This model may be useful for understanding various patterns of abnormal FAF histologically, and for elucidating the pathogenesis of AMD. Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, FL, USA, May 9 2007. Supported in part by German Research Community (DFG) grant WI 880/9–1 and by a 2006 Grant-in-Aid for Scientific Research No. 18591929 from Japan Society for the Promotion of Science.     

Fundus Autofluorescence in Optic Disc Drusen: Comparison of Confocal Scanning Laser Ophthalmoscope and Standard Fundus Camera

We have evaluated fundus autofluorescence (FAF) imaging in optic disc drusen (ODD). After a detailed ophthalmological examination, 28 eyes of 16 patients were evaluated by FAF imaging using a confocal scanning laser ophthalmoscope and a standard fundus camera. ODD displayed bright nodular autofluorescence. Increased FAF was observed using both the scanning laser ophthalmoscope and the fundus camera. However, high quality images with precise localization of hyaline material at the optic nerve head were only possible using FAF imaging with the confocal scanning laser ophthalmoscope. FAF images obtained using the fundus camera revealed only brightness at the optic nerve head without any detail except when maximum flash intensity was used. We conclude that FAF imaging may be used as a non-invasive, safe and rapid ancillary test for the confirmation of the diagnosis of drusen of the optic disc.     

Classification of fundus autofluorescence patterns in early age-related macular disease

PURPOSE: To describe and classify patterns of abnormal fundus autofluorescence (FAF) in eyes with early nonexudative age-related macular disease (AMD). METHODS: FAF images were recorded in eyes with early AMD by confocal scanning laser ophthalmoscopy (cSLO) with excitation at 488 nm (argon or OPSL laser) and emission above 500 or 521 nm (barrier filter). A standardized protocol for image acquisition and generation of mean images after automated alignment was applied, and routine fundus photographs were obtained. FAF images were classified by two independent observers. The kappa statistic was applied to assess intra- and interobserver variability. RESULTS: Alterations in FAF were classified into eight phenotypic patterns including normal, minimal change, focal increased, patchy, linear, lacelike, reticular, and speckled. Areas with abnormal increased or decreased FAF signals may or may not have corresponded to funduscopically visible alterations. For intraobserver variability, kappa of observer I was 0.80 (95% confidence interval [CI]0.71-0.89) and of observer II, 0.74. (95% CI, 0.64-0.84). For interobserver variability, kappa was 0.77 (95% CI, 0.67-0.87). CONCLUSIONS: Various phenotypic patterns of abnormal FAF can be identified with cSLO imaging. Distinct patterns may reflect heterogeneity at a cellular and molecular level in contrast to a nonspecific aging process. The results indicate that the classification system yields a relatively high degree of intra- and interobserver agreement. It may be applicable for determination of novel prognostic determinants in longitudinal natural history studies, for identification of genetic risk factors, and for monitoring of future therapeutic interventions to slow the progression of early AMD.     

周边部视网膜病变相关区域的自发荧光表现

目的 观察周边部视网膜病变相关区域的自发荧光(AF)表现.方法 42例周边部视网膜病变患者60只眼纳入本研究.所有患者均经全景眼底视网膜照相和荧光素眼底血管造影(FFA)检查确诊.应用共焦激光眼底血管造影仪HRAⅡ行黑色素相关近红外自发荧光(NIA)及脂褐质相关自发荧光(FAF)检查,分别采用波长为795、488 nm的激光激发成像.记录9张/s,由共焦激光眼底血管造影仪HRAⅡ自动合成高分辨影像视野为55°,像素为822×768的最终AF像.将AF像是否可见眼底血管及相关视网膜组织成像的影像判断为有、无价值AF像.病变区域是否出现符合正常血管和视网膜组织的荧光表现判断为正常、异常荧光.通过与图像背景灰度比较,将异常荧光分级为无荧光、弱荧光和强荧光,观察周边部视网膜病变相关区域的AF表现.对比分析NIA和FAF检查AF像均呈异常荧光表现者的异常荧光分级的一致性.结果 60只眼中,获取有价值AF像者53只眼,占88.33%;获取无价值AF像者7只眼,占11.67%.NIA检查显示,获取有价值AF像的53只眼中正常荧光28只眼,占52.83%;呈片状、圆点斑状、条带状异常荧光25只眼,占47.17%.FAF检查显示,获取有价值AF像的53只眼中正常荧光2只眼,占3.77%;呈片状或与色素分布较为一致或沿血管分布的异常荧光51只眼,占96.23%.两种检查均呈异常荧光表现的25只眼中,异常荧光分级一致者18只眼,占72.00%;异常荧光分级不一致者7只眼,占28.00%.结论 周边部视网膜病变相关区域存在不同程度的AF表现.

Abstract：

Objective To observe the autofluorescence (AF) manifestation in related lesions of periphery retinopathy. Methods Sixty eyes of 42 patients with periphery retinopathy underwent the examination of Optomap fundus photograph (200°) and fundus fluorescein angiography (FFA). The HRA Ⅱ melanin-related near-infrared fundus autofluorescence (NIA, excitation 795 nm) and lipofuscin-related fundus autofluorescence (FAF, excitation 488 nm) were measured for all the patients. The AF was recorded with nine images per second, and then a final AF image with 55° view and 822 × 768 pixel was generated by the HRA. AF images can be valuable or valueless if there was or was not visible blood vessels and related retinal tissues on the image. AF from lesion regions can be normal or abnormal fluorescence comparing to the normal vascular and retinal tissue AF. The abnormal fluorescence was divided into no AF, weak AF and strong AF relative to the background grayscale. The grading consistency of abnormal fluorescence based on FAF and NIA examination was comparatively analyzed. Results Valuable AF images were captured in 53/60 eyes (88. 33%)and valueless AF images were captured in 7/60 eyes (11.67%). Among 53 eyes with valuable AF image, NIA showed normal fluorescence in 28 eyes (52. 83%), abnormal fluorescence with sheet-like, dot-shaped or stripped in 25 eyes (47.17%); FAF showed normal fluorescence in two eyes (3.77 % ), abnormal fluorescence with sheet-like, scattered along vessels or pigments in 51 eyes (96.23 % ).Twenty-five eyes with abnormal fluorescence were observed both in two examinations, including same grades in 18 eye (72.00%) and different grades in seven eyes (28.00%). Conclusion The AF manifestation with different levels exists in related lesions of periphery retinopathy.     

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。     

Multimodal imaging of dry age‐related macular degeneration

Purpose: The purpose of this study was to understand clinical significance of near‐infrared reflectance (NIR), blue fundus autofluorescence (FAF) and near‐infrared autofluorescence (NIA) in dry age‐related macular degeneration (AMD), by correlation with fluorescein angiography (FA) and cross‐sectional spectral domain optical coherence tomography (SD OCT). Methods: We evaluated 110 eyes (62 patients, mean age: 64 ± 8 years) diagnosed with dry AMD between January 2010 and December 2010, which underwent NIR (λ = 830 nm), FAF and FA (excitation λ = 488 nm; emission λ > 500 nm), NIA (excitation λ = 787 nm; emission λ > 800 nm), and simultaneous SD OCT scanning using a combined confocal scanning laser ophthalmoscope/SD OCT device (Spectralis HRA + OCT; Heidelberg Engineering, Heidelberg, Germany). Results: Drusen showed variable increased/decreased NIR, FAF, NIA and FA, which corresponded to variable increased/decreased thickness of the retinal pigment epithelium (RPE) and possible presence of subretinal deposits on SD OCT. Geographic atrophy (GA) was present in 43/110 eyes (39.0%) and showed increased NIR and fluorescence (FA), absent FAF and NIA, and loss of RPE on SD OCT. The hyperautofluorescence of the GA margin was never larger in FAF than that in NIA, while in 16.2% of cases, it was larger in NIA than that in FAF and corresponded to mild choroidal hyperreflectivity on SD OCT. Conclusions: Simultaneous recording of SD OCT scans provided ultrastructural data for the evaluation of NIR, FAF, NIA and FA in dry AMD. Near‐infrared autofluorescence might detect earlier than FAF areas of RPE cell loss at the GA margin.     

The value of autofluorescence imaging in diagnosis of retinal diseases

Results of fundus autofluorescence imaging using confocal scanning laser ophthalmoscope HRA II ("Heidelberg Engeneering", Heidelberg, Germany) are presented. 106 patients with various retinal and optic nerve conditions were examined. The following conditions were diagnosed using autofluorescence imaging: early stage of age-related macular degeneration, macular hard and soft drusen, signs of retinitis pigmentosa, senile macular hole, central serous chorioretinopathy and optic disc drusen.     

Fundus autofluorescence imaging compared with different confocal scanning laser ophthalmoscopes

BACKGROUND: With the advent of confocal scanning laser ophthalmoscopes (cSLO), fundus autofluorescence (FAF) resulting mainly from lipofuscin accumulation on the level of the retinal pigment epithelium can be visualised in vivo. Various cSLOs are available to document FAF. The authors analysed and compared results of FAF using three different instruments. METHODS: Eight eyes of eight normal volunteers and 18 eyes of 12 patients with different retinal diseases (age related macular degeneration, macular dystrophy, central serous retinopathy) were examined. FAF images were recorded from each subject with the Heidelberg retina angiograph (HRA), the Rodenstock cSLO (RcSLO) and the Zeiss Prototype SM 30-4024 (ZcSLO). For excitation an argon laser (488 nm) was used (barrier filter: HRA 500 nm; RcSLO 515 nm; ZcSLO 521 nm). 32 FAF images were aligned and averaged using the same software for all cSLOs. FAF distribution was measured and grey scale values as well as root mean square (RMS) contrast were compared. RESULTS: Mean age of all subjects was 55.5 (SD 21.4) years. The maximum grey scale value averaged across all eyes was 76.19 (39.34) for the HRA, 61.44 (22.12) for the ZcSLO and 37.0 (9.97) for the RcSLO. The RMS contrast was 0.46 (0.20) for the ZcSLO, 0.40 (0.12) for the HRA, and 0.13 (0.05) for the RcSLO. The differences between the cSLOs were statistically significant with higher grey scale levels and more contrast for the HRA and ZcSLO than the RcSLO (repeated measures ANOVA; p<0.0001). The differences between the HRA and the ZcSLO were not significant (post hoc comparisons; p<0.05). CONCLUSIONS: All cSLOs allow clinically useful FAF imaging in retinal diseases. However, grey scale levels and contrast were much lower on the RcSLO. Therefore, RcSLO images appear much darker than HRA or ZcSLO images. Furthermore, not all cSLOs have a fixed photodetector gain and a standardised value for the argon laser amplification, which is mandatory for an absolute comparison of FAF imaging results.     

Fundus autofluorescence in patients with age-related macular degeneration and high risk of visual loss

PURPOSE: To describe fundus autofluorescence (AF) patterns and their change over time in patients with age-related macular degeneration (AMD) and high risk of visual loss participating in the drusen laser study (DLS). DESIGN: Randomized clinical trial. METHODS: The study population consisted of 29 patients (35 eyes) participating in the DLS, which is a prospective, randomized, controlled clinical trial of prophylactic laser therapy in patients with AMD and high risk of neovascular complications. The intervention consisted of 16 eyes having prophylactic laser and 19 receiving no treatment. The main outcome measures were changes in the distribution of drusen and AF. Patients were reviewed for a median follow-up or 24 months (range 12-36 months). RESULTS: At baseline, four patterns of fundus AF were recognized: focal increased AF (n = 18), reticular AF (n = 3), combined focal and reticular AF (n = 2), and homogeneous AF (n = 12). At last follow-up, fundus AF remained unchanged in 15 untreated (78%) and in seven treated (43%) eyes. In only one untreated eye, focal areas of increased AF returned to background levels and were no longer detectable at last follow-up, compared with six treated eyes. This difference was statistically significant (P =.03). Only large foveal soft drusen (drusenoid pigment epithelium detachments) consistently corresponded with focal changes in AF, whereas no obvious correspondence was found between small soft drusen located elsewhere and changes in AF. CONCLUSION: The lack of obvious correspondence between the distribution of drusen and of AF found in this study appears to indicate that drusen and AF represent independent measures of aging in the posterior pole.