Holz Frank G, Bindewald-Wittich Almut, Fleckenstein Monika, Dreyhaupt Jens, Scholl Hendrik P N, Schmitz-Valckenberg Steffen
Department of Ophthalmology, University of Bonn, Bonn, Germany.
Am J Ophthalmol. 2007 Mar;143(3):463-72. doi: 10.1016/j.ajo.2006.11.041. Epub 2006 Dec 22.
To test if fundus autofluorescence (FAF) patterns around geographic atrophy (GA) have an impact on GA progression rates over time in atrophic age-related macular degeneration (AMD).
Prospective longitudinal multicenter natural history study.
Standardized digital FAF images were obtained from 195 eyes of 129 patients with GA using confocal scanning laser ophthalmoscopy (excitation 488 nm, emission >500 nm). Areas of GA were quantified and patterns of abnormal FAF in the junctional zone were classified. Repeated FAF images were obtained over a median follow-up period of 1.80 years (interquartile range [IQR], 1.28 to 3.34).
Areas of GA (median, 7.04 mm(2) at baseline; IQR, 3.12 to 10.0) showed a median enlargement of 1.52 mm(2)/year (IQR, 0.81 to 2.33). Progression rates in eyes with the banded (median 1.81 mm(2)/year) and the diffuse FAF pattern (1.77 mm(2)/year) were significantly higher compared to eyes without FAF abnormalities (0.38 mm(2)/year) and focal FAF patterns (0.81 mm(2)/year, P < .0001). Within the group of the diffuse pattern, eyes with a diffuse trickling pattern could be identified that exhibited an even higher spread rate (median 3.02 mm(2)/year) compared to the other diffuse types (1.67 mm(2)/year, P = .001).
The results indicate that distinct phenotypic FAF patterns have an impact on disease progression in eyes with atrophic AMD and may therefore serve as prognostic determinants. The findings underscore the relevance of FAF imaging and the pathogenetic role of excessive retinal pigment epithelium (RPE) lipofuscin (LF) accumulation in GA. Natural history data and identification of high-risk characteristics will be helpful to design interventional studies aiming at slowing the spread of atrophy.
检测萎缩性年龄相关性黄斑变性（AMD）中地图样萎缩（GA）周围的眼底自发荧光（FAF）模式是否会随时间影响GA的进展速度。
前瞻性纵向多中心自然史研究。
使用共焦扫描激光检眼镜（激发波长488nm，发射波长>500nm）从129例GA患者的195只眼中获取标准化数字FAF图像。对GA区域进行量化，并对交界区异常FAF模式进行分类。在中位随访期1.80年（四分位间距[IQR]，1.28至3.34）内重复获取FAF图像。
GA区域（基线时中位数为7.04mm²；IQR，3.12至10.0）每年中位数扩大1.52mm²（IQR，0.81至2.33）。与无FAF异常的眼（0.38mm²/年）和局灶性FAF模式的眼（0.81mm²/年，P<.0001）相比，带状（中位数1.81mm²/年）和弥漫性FAF模式的眼（1.77mm²/年）的进展速度明显更高。在弥漫性模式组中，可以识别出具有弥漫性细流模式的眼，其扩散速度（中位数3.02mm²/年）比其他弥漫性类型（1.67mm²/年，P=.001）更高。
结果表明，不同的表型FAF模式对萎缩性AMD患者的疾病进展有影响，因此可作为预后决定因素。这些发现强调了FAF成像的相关性以及视网膜色素上皮（RPE）脂褐质（LF）过度积累在GA中的致病作用。自然史数据和高危特征的识别将有助于设计旨在减缓萎缩扩散的干预性研究。
