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
› Institutsangaben
Weitere Informationen

Publikationsverlauf

eingereicht 23. Dezember 2012

akzeptiert 26. März 2013

Publikationsdatum:
11. September 2013 (online)

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.

 
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