Ординатура / Офтальмология / Английские материалы / Fluorescence Angiography in Ophthalmlogy_Dithmar, Holz_2008

Fig. 4.2a–c. Geographic atrophy, seen here in a case of AMD, is characterized by a strong reduction in FAF, caused by an absence of vital RPE cells and their fluorescent lipofuscin. By contrast, as seen here, the borders of this atrophic area have an elevated

level of fluorescence a (colored areas in 3D image). Over a 5 year period, one can see that expansion of the atrophic area in this 67 year old patient occurred at the margins of the lesion where excessive accumulation of LF had previously been located b, c.

Fig. 4.3a–f. Three examples of fundus autofluorescence in the presence of the geographic atrophy of AMD. The atrophy itself shows a corresponding, strong reduction of the FAF signal as a consequence of absent vital RPE cells. One can see patterns of abnormally elevated autofluorescence in the margins of these lesions. While the example

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in a and b at the top shows a ribbon of elevated FAF signal at the margin, the two other examples below have a more diffusely distributed pattern of FAF outside the atrophic areas. Note that the variable FAF levels outside the atrophic areas are not accompanied by any visible changes in the fundus photographs.

Fig. 4.4a–f. Three additional examples of FAF images in three different patients with the geographic atrophy of AMD. One can see a pronounced intra-

individual left/right symmetry and marked inter-in- dividual variability in the appearance of the atrophic areas and their margins of elevated FAF.

Fig. 4.5a–f. Examples of reticulated drusen both without a, b and with c–f associated geographic atrophy. Reticulated drusen can be easily identified

in FAF images. They can be accompanied by both hyperand hypo-intense areas of autofluorescence.

Fig. 4.6a–f. In cases of fundus flavimaculatus, or Stargardt’s disease, there are characteristic yellow flecks at the level of the RPE with increased autofluorescence due to an excess accumulation of lipofuscin a–d. The lowest pair of images e, f are from a case of late onset Stargardt’s disease with a confirmed AB- CA4-mutation (67 years old; first symptoms after the

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age of 50). There is a central zone of atrophy with a corresponding central area of diminished autofluorescence, due to an absence of RPE cells. The appearance mimics the geographic atrophy of age-related macular degeneration, but a clear distinction can be made by the peripheral presence of typical yellow flecks with elongated (pisciform) shapes.