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Ординатура / Офтальмология / Английские материалы / Scanning Laser Imaging of the Retina Basic Concepts and Clinical Applications_Theelen_2011

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1

Scanning Laser Imaging

of the Retina

Basic Concepts and Clinical Applications

Thomas Theelen

2

COVER IMAGE

Fundus autofluorescence dynamics by photopigment bleaching. During recording of shortwavelength fundus autofluorescence on a dark-adapted, healthy eye a continuous increase of the autofluorescence signal can be observed. More photons pass the light-adapted retina than the dark-adapted retina. Consequently, an increasing number of fluorophores of the retinal pigment epithelium are excited during bleaching and a stronger signal is observed. Therefore, fundus autofluorescence should always be measured on the bleached retina so that reliable fluorescence signal intensities are obtained.

Printing of this thesis was supported by Heidelberg Engineering, Heidelberg, Germany.

Printed by QuickPrint, Nijmegen, the Netherlands

ISBN 978-90-9025843-0

© 2011, Thomas Theelen

All rights reserved. No parts of this publication may be reproduced, stored in a retrieval system of any nature, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission by the copyright holder.

Copyright exceptions:

All versions of the ImageJ software supplied on the CD (author: Wayne Rasband) are in the public domain. The ImageJ user manual (authors: Tiago A. Ferreira and Wayne Rasband) is a free content publication.

3

Scanning Laser Imaging

of the Retina

Basic Concepts and Clinical Applications

een wetenschappelijke proeve

op het gebied van de Medische Wetenschappen

Proefschrift

ter verkrijging van de graad van doctor aan de Radboud Universiteit Nijmegen

op gezag van de rector magnificus prof. mr. S.C.J.J. Kortmann volgens besluit van het college van decanen

in het openbaar te verdedigen op vrijdag 1 juli 2011 om 13.00 uur precies

door

Thomas Theelen

geboren op 29 juni 1967 te Aken, Duitsland

4

Promotoren

Prof. dr. C.B. Hoyng

Prof. dr. J.E.E. Keunen

Copromotor

Dr. B.J. Klevering

Manuscriptcommissie

Prof. dr. C.J.J. Tack (voorzitter) Prof. dr. G. Fernández

Prof. dr. W.M. Prokop

Prof. dr. R.T. Smith (Columbia University, New York City, VS) Prof. dr. G. Staurenghi (Università degli Studi di Milano, Italië)

5

To my beloved family

6

7

 

 

CONTENTS

List of abbreviations

9

Preface

 

11

Chapter 1 – General introduction

13

Chapter 2

– Confocal scanning laser ophthalmoscopy

23

Chapter 3

– Digital processing of retinal images

33

Chapter 4

– Near infrared reflectance imaging

49

4.1

Near infrared reflectance imaging in choroidal neovascularization

55

4.2Near-infrared reflectance imaging of neovascular age-related macular

 

degeneration

75

Chapter 5 – Fundus autofluorescence imaging

91

5.1

Analysis of visual pigment by fundus autofluorescence

103

5.2

Patients with Sjögren-Larsson syndrome lack macular pigment

119

5.3

Fundus autofluorescence imaging of retinal dystrophies

131

5.4Fundus autofluorescence in patients with inherited retinal diseases -

Patterns of fluorescence at two different wavelengths

147

Chapter 6

– Atlas of retinal scanning laser imaging

163

Chapter 7

– General discussion

205

Chapter 8

 

213

Summary

 

215

Samenvatting

217

Inhaltsangabe

219

Publications of the author

221

Curriculum vitae

227

Dankwoord

229

Color images

233

8

9

LIST OF ABBREVIATIONS

A2E

N-retinylidene-N-retinylethanolamine

ABCA4

ATP-binding cassette transporter A4 (gene)

AFVD

adult-onset foveomacular vitelliform dystrophy

AMD

age-related macular degeneration

AO

adaptive optics

Apo-E

apolipoprotein-E

AVI

audio video interleave (file format for videos)

BEST1

bestrophin-1 (gene)

BMP

bitmap file format (for images)

BVMD

Best vitelliform macular dystrophy

CACD

central areolar choroidal dystrophy

CNV

choroidal neovascularization

COL

collagen

cSLO

confocal scanning laser ophthalmoscope

FA

fluorescein angiography

FAD

flavin adenine dinucleotide

FAF

fundus autofluorescence

FAF488

fundus autofluorescence excited at 488 nm (blue)

FAF787

fundus autofluorescence excited at 787 nm (near-infrared)

FALDH

fatty aldehyde dehydrogenase

FF

fluorophore

FFA

fundus fluorescein angiography

GCL

ganglion cell layer

HRA

Heidelberg Retina Angiograph

ICGA

indocyanine green angiography

INL

inner nuclear layer

IPCV

idiopathic polypoidal choroidal vasculopathy

IPL

inner plexiform layer

JPEG

joint photographic experts group (file format for images)

10

JRE

Java runtime environment

LF

lipofuscin

MIDD

maternally inherited diabetes and deafness

MLF

melanolipofuscin

MP

macular pigment

MPD

multifocal pattern dystrophy simulating Stargardt disease / fundus flavimaculatus

MPOD

macular pigment optical density

MPR

macular pigment reflectometer

NFL

nerve fiber layer

NIR

near-infrared reflectance

NIR-FAF

fundus autofluorescence excited in the near infrared (787 nm)

OCT

optical coherence tomography

ONL

outer nuclear layer

OPL

outer plexiform layer

PR

photoreceptors

RAP

retinal angiomatous proliferation

RDS

retinal degeneration slow (gene)

RGB

red-green-blue (color channels of an image)

ROI

region of interest

RPE

retinal pigment epithelium

SLO

scanning laser ophthalmoscope

SLS

Sjögren-Larsson syndrome

STGD1

autosomal recessive Stargardt disease

SW-FAF

fundus autofluorescence excited at short wavelength (488 nm, blue)

TIFF

tagged image file format

VA

visual acuity

VEGF

vascular endothelial growth factor

VMD2

vitelliform macular dystrophy 2 (gene)

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