年龄相关性黄斑变性患者眼底玻璃膜疣的自发荧光特征

目的 探讨非渗出性年龄相关性黄斑变性(AMD)患者眼底玻璃膜疣的自发荧光特征.方法 回顾性病例系列研究.对明确诊断的63例(78只眼)非渗出性AMD患者的临床资料进行回顾性分析.所有患者均采用海德堡共焦激光眼底扫描仪(HRA2-cSLO)拍摄眼底玻璃膜疣自发荧光图像,同时与Kowa Nonmyd 7型眼底照相机和频域相干光断层扫描仪(OCT)拍摄的眼底彩色照片和三维OCT图像进行对比观察,分析AMD患者眼底玻璃膜疣自发荧光特征.结果 63例(78只眼)非渗出性AMD患者眼底玻璃膜疣的自发荧光图像并不与眼底彩色照片和频域OCT图像显示的玻璃膜疣病灶完全吻合.78只眼中,仅有68只眼显示异常自发荧光,根据这些异常自发荧光的形态特点可将其分为7种类型,即微小病变型、局部融合型、线条型、斑片型、花边型、斑驳型及散在不均一型;其余10只眼在彩色眼底照片上显示很小的点状或簇状玻璃膜疣,但用HRA2-cSLO拍摄其眼底荧光图像时并未显示异常自发荧光,而表现为均匀一致型似正常眼底的自发荧光.此外,15例患者的双眼均出现异常自发荧光,且其中13例双眼的自发荧光类型不对称,说明患者双眼的眼底病变程度和范围不对称.结论 HRA2-cSLO可清晰拍摄非渗出性AMD患者眼底玻璃膜疣的异常自发荧光图像,形态各异的自发荧光图像可反映AMD发展的不同程度,动态监测异常自发荧光图像特征对评估AMD的发生、发展具有重要的临床意义.

Fundus autofluorescence patterns of drusen in age-related macular degeneration

Objective To investigate the characteristics of fundus autofluorescence (FAF) patterns of drusen in patients with nonexudative age-related macular degeneration ( AMD). Methods It was a retrospective case series study. Spatial distribution and intensity of FAF of 63 cases (78 eyes) with nonexudative AMD were recorded using a confocal scanning laser ophthalmoscopy ( cSLO, Heidelberg Retina Angiograph 2, HRA2, Heidelberg, Germany), the excitation light used was at 488 run (argon laser), emission light at 514 nm (barrier filter) , and fundus field-of-view at 30-degrees. Color fundus photographs were obtained with Kowa Nonmyd 7. Three-dimensional fundus images were captured by spectral domain optical coherence tomography (Topcon, 3D OCT-1000, Japan). Results The FAF changes did not correlate topographically with visible fundus changes and 3D-OCT images in 78 eyes with drusen in nonexudative AMD. The majority of these eyes (68 out of 78) showed abnormal FAF signal of drusen at the posterior pole, which could be classified into seven different patterns according to their different features: minimal, focal confluent, linear, patchy, lace-like, speckled and scattered changes. In the remaining 10 eyes, the small lesions presented in color fundus photos were not detected in FAF examination. Therefore, a homogeneous background signal similar to the normal fundus was obtained by FAF examination. In addition, IS patients exhibited abnormal autofluorescence in both eyes, 13 of them showed asymmetrical FAF changes, indicating that asymmetrical lesions might be presented. Conclusions Various patterns of abnormal FAF can be clearly imaged with HRA2-cSLO in nonexudative AMD, reflecting different stages of this disease. Periodic observation of drusen with FAF examination is of great clinical value in the estimation of occurrence and development of AMD.