Ординатура / Офтальмология / Английские материалы / Atlas of Fundus Autofluorescence Imaging_Holz, Schmitz-Valckenberg, Spaide, Bird_2007

170 Felix Roth, Frank G. Holz

Fig. 13.2a–c  Colour, optical coherence tomography, and corresponding fundus autofluorescence (FAF) image of a further detachment of the retinal pigment epithelium with increased FAF intensity over the lesion (possible RAP lesion)

172 Felix Roth, Frank G. Holz

Fig. 13.3a–d  Colour, optical coherence tomography, fluorescein angiogram, and corresponding fundus autofluorescence (FAF) image showing a large detachment of the retinal pigment epithelium with intermediate FAF signal and a surrounding halo of decreased autofluorescence signal in the presence of a RAP lesion

Fig 13.4  Variation of fundus autofluorescence (FAF) signal in the presence of a detachment of the retinal pigment epithelium over time. a Corresponding increased FAF and dark halo at baseline. b After 6 months, the autofluorescence signal decreases in the area of the detachment while the border becomes brightly autofluorescent

174 Felix Roth, Frank G. Holz

Fig. 13.5a–c  Colour, indocyanine green angiogram, and corresponding fundus autofluorescence (FAF) image showing a detachment of the retinal pigment epithelium due to age-related macular degeneration, with decreased FAF signal over the lesion. Note the choroidal neovascular membrane at the inferior nasal part of the lesion

176 Felix Roth, Frank G. Holz

Fig. 13 6a–c  Colour, fluorescein angiogram, and corresponding fundus autofluorescence (FAF) image of a detachment of the retinal pigment epithelium, showing a cartwheel pattern with corresponding hyperpigmented lines and diminished FAF signal between those lines

Samantha S. Dandekar, Alan C. Bird

14.1 Introduction

Choroidal neovascularization (CNV) is a common cause of visual loss in patients with age-related macular degeneration (AMD) and represents the growth of subret­ inal new vessels in the macular region (Fig. 14.1) [1]. Central visual loss subsequently occurs following exudation and haemorrhage from the new vessel complex. It occurs in the setting of early age-related maculopathy, including drusen and pigment changes that consist of changes in the retinal pigment epithelium (RPE) and Bruch’s membrane [8, 18, 20]. Blood vessels derived from the choroid extend through Bruch’s membrane and into the sub-RPE space [9]. Lesions can be extrafoveal (edge >200 µm from the centre of the foveal avascular zone [FAZ]), juxtafoveal (1–199 µm from the FAZ), or subfoveal, where neovascularization occurs under the FAZ [3, 4].

The most recent theory of CNV development is that it occurs in response to the release of angiogenic stimuli from the RPE, including vascular endothelial growth factor (VEGF) [21, 30, 31]. Studies investigating the response of anti-VEGF treatments in CNV have had very encouraging results and further exemplify the import­ ance of diagnosing lesions in their early stages [17, 19, 22]. The importance of the RPE in CNV development implies that fundus autofluorescence (FAF) imaging may be useful in its assessment. FAF imaging has allowed us to evaluate the integrity and metabolism of the RPE during ageing and ocular disease, its justification being based on the observations of Delori (see Chap. 2) [6, 25, 26, 32].

The assessment of the integrity of the RPE in CNV development may be import­ ant for two reasons. First, it may influence the behaviour of the choroidal new vessel complex, and second, visual acuity may be determined by whether the RPE maintains its physiological function [2, 33]. Unlike in geographic atrophy (GA), where FAF has been shown to be decreased in areas of RPE and photoreceptor loss and increased at the junctional zone (see Chap. 12), autofluorescence has been less well characterized in CNV [11].