Fundus autofluorescence in central serous chorioretinopathy: association with spectral-domain optical coherence tomography and fluorescein angiography

and FA for identifying pathological abnormalities in CSC. The characteristics of IA AF in CSC were attributable to the modification of melanin in the RPE. IR- AIM: To evaluate the correlation among changes in fundus autofluorescence (AF) measured using infrared fundus AF (IR -AF) and short-wave length fundus AF (SW -AF) with changes in spectral -domain optical coherence tomography (SD -OCT) and fluorescein angiography (FA) in central serous chorioretinopathy (CSC). METHODS: Two hundred and twenty consecutive patients with CSC were included. In addition to AF, patients were assessed by means of SD -OCT and FA. Abnormalities in images of IA -AF, SW -AF, FA were analyzed and correlated with the corresponding outer retinal alterations in SD-OCT findings. RESULTS: Eyes with abnormalities on either IR-AF or SW-AF were found in 256 eyes (58.18%), among them 256 eyes (100%) showed abnormal IR -AF, but SW-AF abnormalities were present only in 213 eyes (83.20%). The hypo-IR-AF corresponded to accumulation of subretinal liquid, collapse of retinal pigment epithelium (APE) or detachment of APE with or without RPE leakage point in the corresponding area. The hyper -IR -AF corresponded to the area with loss of the ellipsoid portion of the inner segments and sub -sensory retinal deposits or focal melanogenesis under sensory retina. The hypo-SW-AF corresponded to accumulation of subretinal liquid or atrophy of RPE. The hyper -SW -AF associated with sub -sensory retinal deposits, detachment of RPE and focal melanogenesis. CONCLUSION: IR-AF was more sensitive than SW-AF AF should be used as a common diagnostic tool for identifying pathological lesion in CSC.

Evaluation of fundus autofluorescence patterns in age-related macular degeneration

AIM： To study the various morphological patterns of fundus autofluorescence （FAF） images in patients with age-related macular degeneration （AMD） in Indian population.METHODS： Totally 179 eyes of 104 patients with clinical diagnosis of AMD were recruited into the study. Autofluorescence images were captured using confocal scanning laser ophthalmoscope and the patterns of FAF were classified.RESULTS： Of 179 eyes, 27 （15.08%） were early AMD, 58 （32.41%） were intermediate AMD, 94 eyes （52.51%） were late AMD. Of 94 eyes with late AMD, 79 （84.04%） were neovascular AMD and 15 （15.96%） were central geographic atrophy. In eyes with early and intermediate AMD, 9 patterns of FAF were noted. Six patterns （normal, minimal change, focal increased, patchy increased, linear, reticular） were similar to that in the published classification. Two patterns （lacelike and speckled） described in the published classification were not found. Three new patterns （focal hypo-fluorescence, patchy hypo-fluorescence, mixed focal hypo-fluorescence and hyper-fluorescence） were detected. In eyes with neovascular AMD, 6 morphological patterns of FAF were noted. Two patterns （mixed hypo-fluorescence and hyper-fluorescence, central hypo-fluorescence with hyper-fluorescent rim） were similar to that in published classification. Two patterns （normal, near normal or normal background fluorescence in the centre of hypo-fluorescent area） described in the published classification were not found. Four new patterns （minimal change, hypo-fluorescent patch, central hypo-fluorescence with surrounding reticular, bull’s eye） were recognized. In eye with central geographic atrophy 5 morphological patterns were noted and these were similar to that in published classification.CONCLUSION： Phenotypic differences in the pattern of FAF exist in the study population compared to existing classification systems.

Green-light fundus autofluorescence in diabetic macular edema

AIM:To evaluate the role of central green-light fundus autofluorescence (FAF) in diabetic macular edema(DME). METHODS:A consecutive series of 92 study eyes with diabetic retinopathy were included. Out of those, 51 diabetic eyes had DME and were compared to 41 diabetic eyes without DME. In all subjects, green-light FAF images were obtained, quantified and classified into various FAF patterns. Cross-sectional optical coherence tomography (OCT) scans were obtained for evaluation of Inner/Outer segment (IS/OS) layer integrity, measurements of central RPE-IS/OS layer thickness as well as classification of DME into various subtypes. ·RESULTS:Meancentralgreen-lightFAFintensityofeyes with DME (1.289 ±0.140)log did not significantly differ from diabetic patients without DME (1.317 ±0.137)log. Most classifiable FAF patterns were seen in patients with cystoid DME. Mean central retinal thickness (CRT) of all study eyes with DME was (501.9±112.4)μm compared to (328.2±27.0)μm in diabetic patients without DME. Patients with DME had significantly more disrupted photoreceptor IS/OS layers than diabetic patients without DME (28/51 vs 5/41, P 【0.001). Mean RPE-IS/OS thickness of patients with DME (60.7±14.1)μm was significantly (P【0.001) lower than in diabetic eyes without DME (73.5 ±9.4)μm. Correlation analysis revealed non-significant correlations of green-light FAF intensity and OCT parameters in all subtypes of DME. ·CONCLUSION:Our results indicate a poor correlation of central green-light FAF intensity with CRT, IS/OS layer integrity or RPE-IS/OS layer thickness in diabetic patients with or without DME and its various subtypes. Thus, central green-light FAF is not suitable for detection of retinal thickening in DME.

The application of ultra-wide-field fundus autofluorescence in early metastatic choroidal tumor screening

I am Dr.Ke Yao,from Eye Center,the Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou,China.I write to present three cases with metastatic choroidal tumor using an ultra-wide-field scanning laser ophthalmoscope.

A deep learning model for generating fundus autofluorescence images from color fundus photography

Background:Fundus Autofluorescence(FAF)is a valuable imaging technique used to assess metabolic alterations in the retinal pigment epithelium(RPE)associated with various age-related and disease-related changes.The practical uses of FAF are ever-growing.This study aimed to evaluate the effectiveness of a generative deep learning(DL)model in translating color fundus(CF)images into synthetic FAF images and explore its potential for enhancing screening of age-related macular degeneration(AMD).Methods:A generative adversarial network(GAN)model was trained on pairs of CF and FAF images to generate synthetic FAF images.The quality of synthesized FAF images was assessed objectively by common generation metrics.Additionally,the clinical effectiveness of the generated FAF images in AMD classification was evaluated by measuring the area under the curve(AUC),using the LabelMe dataset.Results:A total of 8410 FAF images from 2586 patients were analyzed.The synthesized FAF images exhibited an impressive objectively assessed quality,achieving a multi-scale structural similarity index(MS-SSIM)of 0.67.When evaluated on the LabelMe dataset,the combination of generated FAF images and CF images resulted in a noteworthy improvement in AMD classification accuracy,with the AUC increasing from 0.931 to 0.968.Conclusions:This study presents the first attempt to use a generative deep learning model to create authentic and high-quality FAF images from CF images.The incorporation of the translated FAF images on top of CF images improved the accuracy of AMD classification.Overall,this study presents a promising approach to enhance largescale AMD screening.

Fundus autofluorescence characteristics in patients with diabetic macular edema

Background Diabetic macular edema （DME） is one of the major causes of visual impairment in patients with diabetes mellitus. DME shows a variety of clinical characteristics with unpredictable results to treatment. The purpose of this study was to investigate the characteristics of fundus autofluorescence （FAF） in DME, which is a rapid, noninvasive technique for fundus diseases. Methods A total of 18 patients （30 eyes） with clinically significant macular edema （CSME） were enrolled. FAF imaging was performed with a confocal scanning laser ophthalmoscope. Other ophthalmic examinations included best corrected visual acuity （BCVA）, MP-1 microperimetry, and spectral-domain optical coherence tomography （SD-OCT）. Main outcome measurements included BCVA, macular sensitivity （MS）, central retinal thickness （CRT）, central retinal volume （CRV）, the integrity of the inner segment-outer segment junction （IS/OS）, and the integrity of the external limiting membrane （ELM）. Results Among the 30 eyes, four eyes （13.3%） had normal foveal FAF and 26 eyes （86.7%） had abnormal FAF. Abnormal FAF was mainly divided into three types： cystoid increased FAF （iFAF） 16 eyes （53.3%）, spot iFAF six eyes （20%）, irregular decreased FAF （dFAF） four eyes （13.3%）. According to the FAF morphology, patients were categorized into four groups： normal, cystoid iFAF, spot iFAF, and irregular dFAE There was a significant difference in BCVA （P 〈0.001） and MS （P 〈0.05） among the four groups. The visual function of patients with spot iFAF and irregular dFAF was relatively poor. However, there was no difference in CRT （P=-0.186） and CRV （P=0.191） among the four groups. In the normal FAF group, the photoreceptor layers were mostly intact. Regarding the cystoid iFAF group, the photoreceptor layers were relatively intact, while in the other two groups, IS/OS and ELM were disrupted in most patients. No one had intact IS/OS or ELM layer. Conclusions FAF might reflect the damage of the retina and had a relationship with visual function as well as photoreceptor integrity, which gives new insight into the evaluation of DME. Dynamic FAF monitoring helps to better evaluate the disease progression of DME as well as visual function.

Characteristics of fundus autofluorescence in cystoid macular edema

Background Fundus autofluorescence （FAF） imaging is a fast and noninvasive technique developed over the last decade.The authors utilized fluorescent properties of lipofuscin to study the health and viability of the retinal pigment epithelium （RPE）-photoreceptor complex.Observing the intensity and distribution of FAF of various retinal diseases is helpful for ascertaining diagnosis and evaluating prognosis.In this study,we described the FAF characteristics of cystoid macular edema （CME）.Methods Sixty-two patients （70 eyes） with CME were subjected to FAF and fundus fluorescein angiography （FFA） by a confocal scanning laser ophthalmoscope （Heidelberg Retina Angiograph 2 （HRA2））.Characteristics of FAF images were compared with FFA images.Results FAF intensity in normal subjects was highest at the posterior pole and dipped at the fovea.All cases of CME showed fluorescein dye accumulated into honeycomb-like spaces in macular and formated a typical petaloid pattern or atypical petaloid pattern in the late phases of the angiography.Sixty-one eyes with CME on FAF images showed mild or moderate hyperautofluorescence petaloid pattern in fovea,the FAF patterns of these CME was perfectly corresponding with shape in their FFA images;nine eyes with CME secondary to exudative age related macular degeneration （AMD） showed expansion of the hypoautofluorescence without petaloid pattern in macula.Conclusion FAF imaging can be used as a new rapid,non-invasive and ancillary technique in the diagnosis of the majority of CME,except for AMD and small part of other fundus diseases.

Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy

AIM:To discuss and compare the fundus autofluorescence(FAF)and optical coherence tomography(OCT)in acute or chronic central serous chorioretinopathy(CSCR).METHODS:Medical records of 100 cases of CSCR were reviewed.Acute and chronic cases were evaluated according to the duration of decreased visual acuity,serous retinal detachment(RD)and focal leakage on fluorescein angiography(FA).Chi-square test was used for statistical analysis.RESULTS:Forty cases had acute and 60 cases had chronic CSCR.FAF showed focal hypo-autofluorescence in 34(85%)and iso-autofluorescence in 6(15%)of acute cases and hypo-autofluorescence in 51(85%),hyperautofluorescence in 6(10%)and iso-autofluorescence in3(5%)of chronic cases.OCT showed serous RD with distinct borders correlated with FAF findings(hypoautofluorescence)in all acute CSCR cases.In chronic CSCR group,OCT showed serous RD with indistinct borders correlated with FAF findings.The differences between the OCT and FAF findings of the two groups were significant(P=0.000).CONCLUSION:OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium,outer segments of photoreceptors and the components of serous RD.

Spectral-domain optical coherence tomography finding in cytomegalovirus retinitis in AIDS patients

AIM:To observe the findings of spectral domain optical coherence tomography(SD-OCT)scan in cytomegalovirus retinitis(CMVR).METHODS:Forty-six eyes of 33 patients with acquired immunodeficiency syndrome and CMVR were enrolled in the study.Complete ophthalmologic examinations,color fundus photography,SD-OCT and fundus autofluorescence(FAF)were performed for all patients at the first visit and each follow-up visit.Retinal necrosis in CMVR was analyzed on SD-OCT and classified into two types,the typical type and the atypical type.RESULTS:Forty-one eyes of active CMVR and 4 eyes of recurrent CMVR were classified into typical type,and 4 eyes with graying retinal lesion without hemorrhage or only punctate hemorrhage were classified into atypical type.In active stage of CMVR,the retina in typical type was significant thickened with hyperreflective lesion and full­thickness disruption of retinal architecture with enlarged vessel;while in atypical type,the retina was also destroyed in all layers but without thickening or slightly thinned.The choroid,vitreous and retinal vessels were not significantly involved.In healed stage,the retina was thin with destroyed layers in both types.In typical type,FAF showed mottled hypofluorescence mixed with punctuate hyperfluorescence.In atypical type,the retina showed some"cavity"in outer nuclear layer,and FAF showed mild hyperfluorescence.CONCLUSION:SD-OCT show different changes in the retina in typical type and atypical type of CMVR,which should be useful in assisting diagnosis and follow-up management of the disease.

Artificial intelligence for assessment of Stargardt macular atrophy

Stargardt disease(also known as juvenile macular degeneration or Stargardt macular degeneration)is an inherited disorder of the retina,which can occur in the eyes of children and young adults.It is the most prevalent form of juvenile-onset macular dystrophy,causing progressive(and often severe)vision loss.Images with Stargardt disease are characterized by the appearance of flecks in early and intermediate stages,and the appearance of atrophy,due to cells wasting away and dying,in the advanced stage.The primary measure of late-stage Stargardt disease is the appearance of atrophy.Fundus autofluorescence is a widely available two-dimensional imaging technique,which can aid in the diagnosis of the disease.Spectral-domain optical coherence tomography,in contrast,provides three-dimensional visualization of the retinal microstructure,thereby allowing the status of the individual retinal layers.Stargardt disease may cause various levels of disruption to the photoreceptor segments as well as other outer retinal layers.In recent years,there has been an exponential growth in the number of applications utilizing artificial intelligence for help with processing such diseases,heavily fueled by the amazing successes in image recognition using deep learning.This review regarding artificial intelligence deep learning approaches for the Stargardt atrophy screening and segmentation on fundus autofluorescence images is first provided,followed by a review of the automated retinal layer segmentation with atrophic-appearing lesions and fleck features using artificial intelligence deep learning construct.The paper concludes with a perspective about using artificial intelligence to potentially find early risk factors or biomarkers that can aid in the prediction of Stargardt disease progression.

Comparison between standard and wide-field autofluorescence in detection of retinal displacement after rhegmatogenous retinal detachment surgery

Purpose To analyse the differences between 30°blue autofluorescence(BAF30),55°blue autofluorescence(BAF55)and 200°green Ultra-Wide Field autofluorescence(UWF200)imaging to detect retinal displacement(RD)after vitrectomy surgery for rhegmatogenous retinal detachment(RRD).Methods This cross-sectional study considers forty-nine consecutive patients who underwent RRD surgery in the time period 4–8 months previous to image acquisition.The exclusion criteria contemplate previous retinal pathology,under 18-year-olds and non-assessable images in any of the 3 devices.These images were analysed by two masked graders that assessed either the presence or absence of retinal displacement.A third observer reviewed the images that presented discordance.Results A total of forty-nine patients were analysed.7 eyes were excluded due to poor quality in either of the imaging modalities.The final analysis included 42 eyes of forty-two patients with a mean age of 60.3​±​11.9 years.All patients underwent a 3 port 23-gauge pars plana vitrectomy as the technique of choice.Any grade of RD was detectable in 45.2% of images.It was similar between BAF30 and UWF200(42.9% of eyes).BAF55 showed RD to a lesser extent(38.1%).Agreement index between BAF30 and BAF55 was 0.901,0.903 between BAF30 and UWF200 and 0.803 between BAF55 and UWF200.Kappa agreement index between graders was 0.775 for BAF30,0.798 for BAF50 and 0.808 for UWF200 images.Conclusions All imaging modalities were able to detect RD after vitrectomy for RRD,with no inferiority of BAF30 and BAF55 over UWF200.