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

224 Richard F. Spaide

Fig. 16.5  a Color fundus photograph of the left eye showing yellow-white dis­ coloration in the macular area extending from the optic nerve temporal to the fovea in a patient with acute syphilitic posterior placoid chorioretinitis. There is accumulation of yellowish material superotemporal to the fovea (arrowheads). b In the early-phase fluorescein angiogram, there was early blockage in the area of the yellowish material and at the temporal margin of the lesion. c In the latephase fluorescein angiogram, there was staining of the lesion and optic nerve head. d The autofluorescence photograph shows hyperautofluorescence of the yellow clumps of material (arrowheads correspond to those in image a and a generalized increase in autofluorescence of the lesion. Small hypoautofluo­ rescent points can be seen (arrows in inset). (From Matsumoto Y, Spaide RF. Autofluorescence imaging of acute syphilitic posterior placoid chorioretinitis. Retina, in press)

Fig. 16.6  a Follow-up of patient illustrated in Fig. 16.5, 4 months after treat­ ment. Color fundus photograph of the left eye shows granularity of the pigmen­ tation at the level of the retinal pigment epithelium and yellowish accumula­ tion of material mimicking the material seen in Fig. 16.1a. b The red-free image shows the accumulated subretinal material. c Fluorescein angiogram shows a transmission defect in the region of the previous placoid change with small ar­ eas of blockage secondary to the subretinal yellowish material. d Autofluores­ cence photography shows that the yellowish material was hyperautofluorescent, the borders of which are more distinct than in the past

226 Richard F. Spaide

Fig. 16.7  a Color fundus photograph of the right eye showing a yellow-white placoid lesion that was more yellow and opaque at the outer borders in the mac­ ula, particularly superonasal to the fovea in this patient with acute syphilitic posterior placoid chorioretinitis. There were no yellow clumps of material, but there appeared to be atrophy or depigmentation at the level of the retinal pig­ ment epithelium inferior to the fovea. b In the early phases of the fluorescein angiogram there was a slight transmission defect inferior to the fovea. c In the late phase of the fluorescein angiogram there was staining of the placoid lesion, particularly superonasal to the fovea, as well as staining of the optic nerve head. d The autofluorescence photograph demonstrates a hyperautofluorescence cor­ responding with the yellow-white placoid discoloration in the macula. Hypoau­ tofluorescent dots are present inferior to the fovea in the region of the transmis­ sion defect (From Matsumoto Y, Spaide RF. Autofluorescence imaging of acute syphilitic posterior placoid chorioretinitis. Retina, in press)

Fig. 16.8  a Follow-up of patient illustrated in Fig. 16.7, 2 months after treat­ ment. Color fundus photograph of the right eye shows some persistent de­ pigmentation inferior to the fovea. b,c The fluorescein angiogram shows mild staining of the disc and a transmission defect in the inferior macular area in the right eye. d Autofluorescence photography shows nearly complete resolution of the hyperautofluorescence with no change in the hypoautofluorescent dots

228 Richard F. Spaide

Fig. 16.9  a,b Color fundus photographs showing an asymmetrical presentation of multifocal choroiditis and panuveitis. The left eye has numerous chorioretinal scars and choroidal neovascularization. c,d The fluorescein angiogram shows subtle window defects in the right eye and larger scars in the left. The left eye has an area of choroidal neovascularization. Note the subtle blocking around the border of the choroidal neovascularization, probably secondary to envelop­ ing hyperplastic retinal pigment epithelium seen in profile. e,f The indocyanine green angiogram shows some choroidal involvement in the left eye but does not show any involvement of the right eye. The choroidal neovascularization is poorly imaged in the left eye. g,h Autofluorescence photography shows innu­ merable hypoautofluorescent spots in the right eye. The left eye has both large and small hypoautofluorescent spots. Note that the outer border of the choroi­ dal neovascularization (corresponding to the hypofluorescent boundary seen in image d is hyperautofluorescent

230 Richard F. Spaide

16.10  a,b The color fundus photograph of this 52-year-old patient with mul­ tifocal choroiditis shows bilateral chorioretinal scars and bilateral choroidal neovascularization. The patient was on systemic mycophenolate mofetil, tacro­ limus, and prednisone. He had an old area of choroidal neovascularization in the left eye. In the right eye he had a more recent onset of choroidal neovas­ cularization and was aggressively treated with intravitreal triamcinolone and bevacizumab. c,d The fluorescein angiogram of the right eye shows regressed choroidal neovascularization with no leakage. The left eye has a large area of choroidal neovascularization associated with retinal vascular and optic disc leakage. e Autofluorescence photography of the right eye shows several hypo­ autofluorescent spots and several contiguous areas of choroidal neovasculariza­ tion. f There is a large neovascular lesion in the left eye highlighted by hyper­ autofluorescence. Note the small ringlike areas of hyperautofluorescence nasal to the disc, probably indicative of small foci of choroidal neovascularization (From Haen SP, Spaide RF. Fundus autofluorescence in multifocal choroiditis and panuveitis. In preparation)

232 Richard F. Spaide

Fig. 16.11  a Color photograph of the right involved fundus showing yellowish drusen-like material at the outer border of the lesion in a patient with acute zonal occult outer retinopathy. b Fluorescein angiography shows a transmis­ sion defect in the central portion of the lesion and blocking where the yellowish material accumulated (arrows). The indocyanine green angiogram in the early (c) and middle phases (d) of the sequence shows hypofluorescence within the lesion (arrows) without diminution of the fluorescence of the underlying larger choroidal vessels, suggesting the presence of choriocapillaris atrophy (From Spaide RF. Collateral damage in acute zonal occult outer retinopathy. Am J Ophthalmol. 2004;138:887–889)

Fig. 16.12  Autofluorescence photograph of acute zonal occult outer retinopa­ thy. The autofluorescence photograph shows intense hyperautofluorescence at the outer border of the lesion corresponding to the yellowish drusen-like mate­ rial, consistent with the accumulation of large amounts of lipofuscin. The cen­ tral portions of the lesion were hypoautofluorescent, consistent with atrophy of the retinal pigment epithelium