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

296 Richard F. Spaide

Fig. 17.22  a This 67-year-old had a retinal detachment repaired with cryopexy and a 360° buckle. He had flattening of the retina with persistence of subretinal fluid under the fovea of the right eye. The monochromatic photograph shows the fovea in the right eye to be lighter that the fovea in the left. c,d The right eye showed slight hyperautofluorescence of the central macula in the right eye as compared with the left. e Optical coherence tomography shows accumulation of material on the outer retina in the area of detachment

298 Richard F. Spaide

Fig. 17.23  a,b Six months after the photograph in Fig. 17.22 was taken, the patient had a more discrete light spot in the center of the fovea in the right eye as compared with the left. c,d The yellow material was hyperautofluorescent. e Optical coherence tomography showed that the yellow material corresponded to an accumulation in the subretinal space. If the right eye had been examined without knowledge of the previous ocular history, a diagnosis of adult-onset foveomacular dystrophy would have been considered

300 Richard F. Spaide

Fig. 17.24  a,b This patient had an acute loss of visual acuity secondary to acute exudative polymorphous vitelliform maculopathy. The color photograph demonstrates the bilateral subretinal collections of yellowish material formed with resorption of the subretinal fluid. There are numerous discrete blebs superiorly. The central macula had a collapse of the subretinal material to form a gravitating accumulation of a large amount of the yellow material inferiorly, while the superior macula is relatively devoid of the material. c,d The overall background choroidal fluorescence was decreased, but the yellowish material blocked the background choroidal fluorescence. e,f The yellowish material was highly autofluorescent

302 Richard F. Spaide

Fig. 17.25  a This 47-year-old-woman, the mother of the patient in Fig. 17.26, had an abnormal electro-oculogram that was measured after her daughter was diagnosed with vitelliform macular dystrophy type 2. Based on the family history, the mother was an obligate carrier. She did not have any abnormalities as noted by red-free photography (a), fluorescein angiography (b), autofluorescence photography (c), or optical coherence tomography (d)

Fig. 17.26  a This 14-year-old patient had a typical vitelliform lesion. b The deposition of the yellowish material was not homogeneous within the lesion, as seen by red-free monochromatic photography. c The autofluorescence photograph shows hyperautofluorescence of the material with the same pattern seen in image b. d Optical coherence tomography shows deposition of material on the outer retina with a clear subretinal space below. (From Spaide RF, Noble K, Morgan A, Freund KB. Vitelliform macular dystrophy. Ophthalmology. 2006;113:1392–1400)

304 Richard F. Spaide

Fig. 17.27  a,b This 6.5-year-old with vitelliform macular dystrophy type 2 had deposition of yellowish material in the macular region of both eyes. Note that the material is not uniformly distributed and that there are areas where the material is denser. c,d The autofluorescence photographs taken on a prototype system show increased autofluorescence corresponding to the denser areas of deposition seen in the red-free monochromatic pictures. (From Spaide RF, Noble K, Morgan A, Freund KB. Vitelliform macular dystrophy. Ophthalmology. 2006;113:1392–1400)

Fig. 17.28  Progression of lesion development. The same patient in Fig. 17.27 is shown 4 years later. a The macular lesion is larger. The color photograph alludes to the complexity of the lesion. There is a fluid level (large arrow) with yellowish material in the inferior portion of the lesion and relatively transparent fluid superiorly. In the superior portion of the lesion, alteration in the color at the level of the retinal pigment epithelium (RPE) is evident (small arrow). The visual acuity was 20/25. b The red-free monochromatic photograph shows the fluid level between the yellowish material and the relatively transparent fluid superiorly. It does not resolve the whitish placoid change at the level of the RPE seen in image a. c Fluorescein angiography shows increased fluorescence superiorly in the lesion and blocking inferiorly by the yellowish material. There was very slight leakage of fluorescein in the course of the fluorescein examination. d The autofluorescence photograph shows that the yellow material was intensely autofluorescent but that the placoid change at the level of the RPE was not. The photographic findings of images a–d suggest that the placoid change was fibrous metaplasia of the RPE, although neovascularization may be present as well. e An optical coherence tomography (OCT) scan taken vertically shows the dependent deposition of material in the subretinal space (arrows). f An OCT scan taken horizontally through the fovea shows a shaggy accumulation of material on the outer retina with underlying fluid that has no reflectivity (From Spaide RF, Noble K, Morgan A, Freund KB. Vitelliform macular dystrophy. Ophthalmology. 2006;113:1392–1400)