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Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001

.pdf

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<<< < Предыдущая 44 45 46 47 48 49 50 51 52 53 54 5556 / 8756 57 58 59 60 61 62 63 64 65 66 67 68 > Следующая >>>

Atrophic AMD

Progression

Initially drusen and non-specific RPE changes

Late RPE (geographic) atrophy

Atrophic AMD

Fluorescein angiogram

Management

Hyperfluorescence from RPE window defect

Low-vision aids if appropriate

Signs of Pigment epithelial detachment

Circumscribed, dome-shaped elevation Sub-RPE fluid may be clear or turbid

FA of pigment epithelial detachment


Early, well-defined	Progressive increase in	No increase in size of lesion
hyperfluorescence	hyperfluorescence

ICG angiogram of pigment epithelial detachment


Early, well-defined	Later, thin surrounding	No increase in size of lesion
hypofluorescence	hyperfluorescent ring	No increase in size of lesion
hypofluorescence	hyperfluorescent ring

Possible subsequent course of PED

Spontaneous resolution

Geographic atrophy

CNV

RPE rip

Choroidal neovascularization (CNV)

•Less common than atrophic AMD but more serious

•Metamorphopsia is initial symptom

•Most lesions are not visible clinically

Suspicious clinical signs


Pinkish-yellow subretinal lesion	Subretinal blood or lipid
with fluid

Angiographic classification of CNV

Well-defined (classical)

Occult

• Extrafoveal > 200 m from centre of	•	Poorly defined
FAZ	•	Poorly defined
FAZ
• Juxtafoveal < 200 m from centre of	•	Obscured by PED, blood or exudate
FAZ	•	Obscured by PED, blood or exudate
FAZ
• Subfoveal - involving centre of FAZ

FA of classical CNV


Very early ‘lacy’ filling	Leakage into subretinal	Late staining
pattern	space and around CNV

ICG angiogram in PED with occult CNV


PED is hypofluorescent	CNV is hyperfluorescent (hot spot)

<<< < Предыдущая 44 45 46 47 48 49 50 51 52 53 54 5556 / 8756 57 58 59 60 61 62 63 64 65 66 67 68 > Следующая >>>

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