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Klin Monbl Augenheilkd 2013; 230(11): 1135-1141
DOI: 10.1055/s-0032-1328636
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Fundusautofluoreszenz bei der trockenen Form der altersbedingten Makuladegeneration – Bedeutung für die Prognose

Fundus Autofluorescence in Dry AMD – Impact on Disease Progression
C. N. Vidinova
1   Department of Ophthalmology, Military Medical Academy, Sofia, Bulgaria
,
P. T. Gouguchkova
2   Retina, Eye Hospital “Pro Light”, Sofia, Bulgaria
,
K. N. Vidinov
3   Department of endocrine ophthalmology, Medical University – Sofia, Sofia, Bulgaria
› Author Affiliations
Further Information

Publication History

eingereicht 23 December 2012

akzeptiert 26 March 2013

Publication Date:
11 September 2013 (online)

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Zusammenfassung

Hintergrund: Fundusautofluoreszenz ist eine neue Technik, welche die Verteilung von Lipofuszin am Augenhintergrund darstellt und dadurch eine Beurteilung des Zustands des RPE ermöglicht. Ziel unserer Untersuchung ist es, die diagnostischen Möglichkeiten von OCT RTvue wie auch von Autofluoreszenz in der Beurteilung der Entwicklung der trockenen AMD zu untersuchen.

Material und Methoden: Es wurden in diese prospektive Studie 37 AMD-Patienten einbezogen: 22 mit trockener Form von AMD mit Drusen und 15 mit Drusen und geografischer Atrophie. Die Patienten wurden nach dem allgemeingültigen Verfahren inklusive OCT und Autofluoreszenz untersucht. In allen Fällen wurden die Programme: HD Line, Cross Line, EMM5 am OCT RTVue durgeführt. Die Autofluoreszenzuntersuchung wurde mit der Hilfe der Funduskamera Canon CX1 gemacht.

Ergebnisse: Bei Patienten mit trockener AMD und Drusen fanden sich im OCT typische Anhebungen an dem Bereich der RPE. Auf den Autofluoreszenzbildern zeigten sich verschiedene Typen pathologischer Autofluoreszenz. Die konfluierende retikulare Autofluoreszenz ist mit dem Risiko einer subretinalen Neovaskularisationsmembran assoziiert. Auf den OCT-Abbildungen von Patienten mit geografischer Atrophie fand sich eine signifikante Verdünnung der Netzhaut, deren Progression mit dem EMM5-Programm beurteilt werden konnte. Wichtig für die Prognose war die Autofluoreszenz an der Grenze atrophischer/gesunder Netzhaut. Diffuse verstärkte Autofluoreszenz in diesem Bereich wurde als ein Merkmal zukünftiger Entwicklung einer geografischen Atrophie gesehen.

Schlussfolgerung: Unsere Ergebnisse weisen darauf hin, dass OCT in Kombination mit Autofluoreszenz die Beurteilung der Progression der trockenen AMD ermöglicht. Pathologische Autofluoreszenz an der Grenze von atrophischen Läsionen ist ein bedeutendes Merkmal der Krankheitsaktivität. Obwohl sowohl OCT als auch Autofluoreszenz wichtige Informationen über den Zustand des RPE liefern, ist die Autofluoreszenz wichtiger für die Prognose der zukünftigen Entwicklung einer RPE-Atrophie.

Abstract

Background and Purpose: Fundus autofluorescence is a novel technique that gives us information about the RPE cells by evaluating the distribution of lipofuscin in the retina. The purpose of our study was to evaluate the diagnostic abilities of OCT, RTVue and fundus autofluorescence in predicting the progression of dry AMD.

Material and Methods: In our study 37 dry AMD patients were enrolled: 22 of them with druses and 15 with developed geographic atrophy. They all underwent complete ophthalmological examinations including OCT and autofluorescence. We used the RTVue OCT programmes HD line, Cross line, EMM5 and EMM5 progression in all cases. The autofluorescence was recorded with the help of the Canon CX1 fundus camera.

Results: OCT images in the AMD patients with dry AMD and large druses showed typical undulations in the RPE/choroid line and occasionally drusenoid detachment of the RPE. Autofluorescence showed different patterns. The confluent reticular autofluorescence was associated with the development of neovascular membranes. In geographic atrophy patient OCTs showed diminished retinal thickness measured with EMM5. On autofluorescence the findings at the border zone atrophic/normal retina were of particular importance. The diffuse increased autofluorescence in that area was considered to be a sign for further atrophy progression.

Conclusion: Our results point out that OCT in combination with autofluorescence is important in following the progression of dry AMD. Pathological autofluorescence at the border of atrophic lesions is an important sign for disease activity. Although both OCT and autofluorescence visualise the changes in RPE, autofluorescence is of key importance in predicting the development of the disease.

Schlüsselwörter

altersbedingte Makuladegeneration (AMD) - OCT - Autofluoreszenz - Retina

Key words

age-related macular degeneration (AMD) - OCT - autofluorescence - retina
 

  • Literatur

  • 1 Bird AC, Bressler NM, Bressler SB et al. An international classification and grading system for age-related maculopathy and age related macular degeneration. The international ARM Epidemiological Study group. Surv Ophthalmol 1995; 39: 367-374
    Google Scholar
  • 2 Blumenkranz MS, Russell SR, Robey MG et al. Risk factors in age-related maculopathy complicated by choroidal neovascularization. Ophthalmology 1986; 93: 552-558
    PubMedGoogle Scholar
  • 3 Delori FC, Goger DG, Dorey CK. Age-related accumulation and spatial distribution of lipofuscin in RPE of normal subjects. Invest Ophthalmol Vis Sci 2001; 42: 1855-1866
    PubMedGoogle Scholar
  • 4 Holz FG, Bellmann C, Margaritidis M et al. Patterns of increased in vivo fundus autofluorescence in junctional zone of geographic atrophy of the retinal pigment epithelium associated with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999; 237: 145-152
    CrossrefPubMedGoogle Scholar
  • 5 Lang GK, Gareis O, Lang GE et al. Augenheilkunde. 4.. Aufl. Stuttgart, New York: Thieme; 2006: 311-317
    Google Scholar
  • 6 Bressler NM, Silva JC, Bressler SB et al. Clinicopathologic correlation of drusen and retinal pigment epithelial abnormalities in age-related macular degeneration. Retina 1994; 14: 130-142
    CrossrefPubMedGoogle Scholar
  • 7 Green WR. Clinicopathologic studies of treated choroidal neovascular membranes: a review and report of two cases. Retina 1991; 11: 328-356
    CrossrefPubMedGoogle Scholar
  • 8 Campochiaro PA, Morgan KM, Conway BP et al. Spontaneous involution of subfoveal neovascularization. Am J Ophthalmol 1990; 109: 668-675
    PubMedGoogle Scholar
  • 9 Frank RN, Das A, Weber ML. A model of subretinal neovascularization in the pigmented rat. Curr Eye Res 1989; 8: 239-247
    CrossrefPubMedGoogle Scholar
  • 10 Hsu JK, Thomas MA, Ibanez H et al. Clinicopathologic studies of an eye after submacular membranectomy for choroidal neovascularization. Retina 1995; 15: 43-52
    PubMedGoogle Scholar
  • 11 Kwak N, Okamoto N, Wood JM et al. VEGF is major stimulator in model of choroidal neovascularization. Invest Ophthalmol Vis Sci 2000; 41: 3158-3164
    PubMedGoogle Scholar
  • 12 Lambert HM, Capone jr. A, Aaberg TM et al. Surgical excision of subfoveal neovascular membranes in age-related macular degeneration. Am J Ophthalmol 1992; 113: 257-262
    PubMedGoogle Scholar
  • 13 Lafaut BA, Bartz-Schmidt KU, Vanden Broecke C et al. Clinicopathological correlation in exudative age related macular degeneration: histological differentiation between classic and occult choroidal neovascularization. Br J Ophthalmol 2000; 84: 239-243
    CrossrefPubMedGoogle Scholar
  • 14 Lopez PF, Grossniklaus HE, Lambert HM et al. Pathologic features of surgically excised subretinal neovascular membranes in age-related macular degeneration. Am J Ophthalmol 1991; 112: 647-656
    PubMedGoogle Scholar
  • 15 Delori FC, Goger DG, Dorey CK. Age-related accumulation and spatial distribution of lipofuscin in RPE of normal subjects. Invest Ophthalmol Vis Sci 2001; 42: 1855-1866
    PubMedGoogle Scholar
  • 16 Miller H, Miller B, Ryan SJ. The role of retinal pigment epithelium in the involution of subretinal neovascularization. Invest Ophthalmol Vis Sci 1986; 27: 1644-1652
    PubMedGoogle Scholar
  • 17 Mori K, Duh E, Gehlbach P et al. Pigment epithelium-derived factor inhibits retinal and choroidal neovascularization. J Cell Physiol 2001; 188: 253-263
    CrossrefPubMedGoogle Scholar
  • 18 Shaikh S, Olson JC, Richmond PP. Retinal pigment epithelial tears after intravitreal bevacizumab injection for exudative age-related macular degeneration. Indian J Ophthalmol 2007; 55: 470-472
    CrossrefPubMedGoogle Scholar
  • 19 Delori FC, Fleckner MR, Goger DG et al. Autofluorescence distribution associated with drusen in age-related macular degeneration. Invest Ophthalmol Vis Sci 2000; 41: 496-504
    PubMedGoogle Scholar
  • 20 Von Ruckmann A, Fitzke FW. In vivo autofluorescence in macular dystrophies. Arch Ophthalmol 1997; 115: 609-615
    CrossrefPubMedGoogle Scholar
  • 21 Wing GL, Blanchard GC, Weiter JJ. The topography and age relationship of lipofuscin concentration in the retinal pigment epithelium. Invest Ophthalmol Vis Sci 1978; 17: 601-607
    PubMedGoogle Scholar
  • 22 Arend OA, Weiter JJ, Goger DG et al. [In vivo fundus fluorescence measurements in patients with age related macular degeneration.]. Ophthalmologe 1995; 92: 647-653
    PubMedGoogle Scholar
  • 23 Holz FG, Bellmann C, Staudt S et al. Fundus autofluorescence and development of geographic atrophy in age related macular degeneration. Invest Ophthalmol Vis Sci 2001; 42: 1051-1056
    PubMedGoogle Scholar
  • 24 Schmitz-Valckenberg S, Bindewald-Wittich A, Dolar-Szczasny J et al. Correlation between the area of increased autofluorescence surrounding geographic atrophy and disease progression in patients with AMD. Invest Ophthalmol Vis Sci 2006; 47: 2648-2654
    CrossrefPubMedGoogle Scholar
  • 25 Bellmann C, Jorzik J, Spatial G et al. Symmetry of bilateral lesions in geographic atrophy in patients with age-related macular degeneration. Arch Ophthalmol 2002; 120: 579-584
    CrossrefPubMedGoogle Scholar
  • 26 Sunness JS, Gonzalez-Baron J, Applegate CA et al. Enlargement of atrophy and visual acuity loss in geographic atrophy form of age-related macular degeneration. Ophthalmology 1999; 106: 1768-1779
    CrossrefPubMedGoogle Scholar
  • 27 Hofman P, Van Blijswik B, Gaillard P. Endothelial cell hypertrophy induced by vascular endothelial growth factor in the retina: new insights into the pathogenesis of capillary nonperfusion. Arch Ophthalmol 2001; 119: 861-866
    CrossrefPubMedGoogle Scholar
  • 28 Costa RA, Jorge R, Calucci D et al. Intravitreal bevacizumab for choroidal neovascularization caused by AMD (IBeNA Study): results of a phase 1 dose-escalation study. Invest Ophthalmol Vis Sci 2006; 47: 4569-4578
    CrossrefPubMedGoogle Scholar
  • 29 Rosa RH, Thomas MA, Green WR. Clinicopathologic correlation of submacular membranectomy with retention of good vision in a patient with age-related macular degeneration. Arch Ophthalmol 1996; 114: 480-487
    CrossrefPubMedGoogle Scholar
  • 30 Schmidt-Erfurth U, Miller JW, Sickenberg M et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of retreatments in a phase 1 and 2 study. Arch Ophthalmol 1999; 117: 1177-1187
    CrossrefPubMedGoogle Scholar
  • 31 Bindewald A, Schmitz-Valckenberg S, Jorzik J et al. Classification of abnormal fundus autofluorescence patterns in the junctional zone of geographic atrophy in patients with age related macular degeneration. Br J Ophthalmol 2005; 89: 874-878
    CrossrefPubMedGoogle Scholar
  • 32 Holz FG, Bindewald-Wittich A, Fleckenstein M et al. Progression of geographic atrophy and impact of fundus autofluorescence patterns in age-related macular degeneration. Am J Ophthalmol 2007; 143: 463-472
    CrossrefPubMedGoogle Scholar
  • 33 Schmitz-Valckenberg S, Bultmann S, Dreyhaupt J et al. Fundus autofluorescence and fundus perimetry in the junctional zone of geographic atrophy in patients with age–related macular degeneration. Invest Ophthalmol Vis Sci 2004; 45: 4470-4476
    CrossrefPubMedGoogle Scholar