Holz F G, Bellmann C, Margaritidis M, Schütt F, Otto T P, Völcker H E
Department of Ophthalmology, University of Heidelberg, Germany.
Graefes Arch Clin Exp Ophthalmol. 1999 Feb;237(2):145-52. doi: 10.1007/s004170050209.
To determine in vivo lipofuscin (LF)-induced topographic variations of fundus autofluorescence in eyes with geographic atrophy (GA) of the retinal pigment epithelium (RPE) associated with age-related macular degeneration (ARMD).
Fundus autofluorescence was examined with a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph) after excitation with an argon laser (488 nm) and detection of the emitted light above 500 nm. Fifty-seven eyes of 38 patients with uni- or multifocal GA associated with ARMD were studied. The findings were compared with 43 eyes with GA secondary to other etiologies, including juvenile macular dystrophies.
An increased autofluorescence outside the GA was observed in 47 (82.5%) of 57 eyes with GA associated with ARMD in contrast to 4 (9.3%) of 43 eyes with GA of other causes (P < 0.001). Three different patterns were noted: a continuous band at the margin with variable peripheral extension in 36 eyes (76.6%), a diffusely increased autofluorescence at the entire posterior pole in 6 eyes (12.8%), and small focal spots of increased autofluorescence in the junctional zone in 3 eyes (6.4%). Of 19 patients with bilateral GA, 17 (89.5%) had an identical pattern in both eyes.
The different patterns of autofluorescence in the presence of GA associated with ARMD may reflect variable forms of reactive changes in the surrounding RPE cells, and may indicate the extend of compromised RPE secondary to ageing changes in the outer retina, Bruch's membrane and choriocapillaris. Since GA spreads over time, increased LF accumulation in the junctional zone may precede cell death and may, therefore, be of prognostic value. Knowledge of the topographic variation in LF accumulation is important because heterogeneity may reflect underlying differences in cell kinetics, metabolism and biochemistry.
确定与年龄相关性黄斑变性（ARMD）相关的视网膜色素上皮（RPE）地图样萎缩（GA）眼中，体内脂褐素（LF）诱导的眼底自发荧光的地形变化。
使用共焦扫描激光眼底镜（海德堡视网膜血管造影仪），在氩激光（488 nm）激发并检测500 nm以上发射光后，检查眼底自发荧光。研究了38例单灶或多灶性GA合并ARMD患者的57只眼。将结果与43只继发于其他病因（包括青少年黄斑营养不良）的GA眼进行比较。
与43只其他原因导致GA的眼中的4只（9.3%）相比，57只ARMD相关GA眼中的47只（82.5%）在GA外部观察到自发荧光增加（P < 0.001）。观察到三种不同模式：36只眼（76.6%）在边缘有连续带且周边延伸可变，6只眼（12.8%）整个后极的自发荧光弥漫性增加，3只眼（6.4%）在交界区有小的自发荧光增强灶。19例双侧GA患者中，17例（89.5%）双眼模式相同。
与ARMD相关的GA存在时自发荧光的不同模式可能反映了周围RPE细胞反应性变化的不同形式，可能表明继发于视网膜外层、布鲁赫膜和脉络膜毛细血管衰老变化的RPE受损程度。由于GA会随时间扩散，交界区LF积累增加可能先于细胞死亡，因此可能具有预后价值。了解LF积累的地形变化很重要，因为异质性可能反映细胞动力学、代谢和生物化学的潜在差异。
