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

266 Richard F. Spaide

Fig. 17.5  a,b Comparison of the right and left eyes shows that the area of detachment caused by central serous chorioretinopathy is frankly yellow. c,d Green monochromatic photographs highlight the differences in reflectivity between the two eyes. e,f The serous detachment is hyperautofluorescent. g Optical coherence tomography shows a thick accumulation of material on the outer surface of the retina

268 Richard F. Spaide

Fig. 17.6  a This patient was being treated with corticosteroids and developed chronic central serous chorioretinopathy. Note the large accumulation of yellowish subretinal material, which was evident on green monochromatic photography (b). The fluorescein angiogram (c) shows chronic leakage with blocking by the overlying yellow material

270 Richard F. Spaide

17.7  This patient had chronic subretinal fluid in the macular region and relative hypoautofluorescence centrally. The accumulation on the outer retina was relatively thin. The visual acuity was 20/40

Fig. 17.8  This patient had chronic central serous chorioretinopathy leading to severely decreased acuity in the right eye. In his left eye he had chronic subretinal fluid in the nasal macula but recently had increasing symptoms associated with an increase in the amount of subretinal fluid. Note the recent advent of the descending tracts, which are largely hyperautofluorescent. (From Spaide RF, Klancnik JM Jr. Fundus autofluorescence and central serous chorioretinopathy. Ophthalmology. 2005;112:825–833)

272 Richard F. Spaide

Fig. 17.9  Proposed mechanism of subretinal autofluorescence in central serous chorioretinopathy­ . a The leak causes a circumscribed elevation of the macula. b The elevated retina is no longer in contact with the retinal pigment epithelium. Shed photoreceptors are not phagocytosed. c Increasing accumulation of degenerated, shed photoreceptors creates an increasing amount of reaction products that are autofluorescent. Macrophages invade the area, attempting to phagocytose the accumulated material. d With chronic detachment the photoreceptors eventually atrophy, leading to a decrease in the subretinal accumulation. Note the concurrent atrophy of the underlying retinal pigment epithelium

274 Richard F. Spaide

Fig. 17.10  This 68-year-old man had a 6-month history of central serous chorioretinopathy before this examination. a He had a serous neurosensory detachment of the macula (arrows) and a small amount of yellow submacular material (arrowhead). b He had a leak at the level of the retinal pigment epithelium in the temporal macula. c There was persistence of the leak when the patient was examined 1.5 years later, with increased accumulation of yellow submacular material (d). When examined 5.5 years after presentation, the patient continued to have a large unilateral ovoid area of submacular material similar to that seen in adult-onset foveomacular vitelliform dystrophy (e) (Modified from Spaide RF. Deposition of yellow submacular material in central serous chorioretinopathy resembling adult-onset foveomacular vitelliform dystrophy. Retina. 2004;24:301–304)