Background: Fundus autofluorescence (AF) is derived from the lipofuscin contained by the retinal pigment epithelial cells. Using a scanning laser ophthalmoscope, two- dimensional AF measurements of the ocular fundus c...Background: Fundus autofluorescence (AF) is derived from the lipofuscin contained by the retinal pigment epithelial cells. Using a scanning laser ophthalmoscope, two- dimensional AF measurements of the ocular fundus can be achieved. Directly after conventional photocoagulation and also after selective RPE laser treatment (SRT) with ophthalmoscopically non- visi- ble laser lesions, irradiated areas reveal reduced AF, indicating RPE damage. Since the green treatment laser beam could also be used for AF excitation, the aim of this study was to evaluate whether absolute measurements of AF can be performed, and also possible changes in AF detected, online during SRT. Methods: SRT was carried out by use of a frequency- doubled Nd:YLF laser (wavelength 527 nm, pulse duration 1.7 μ s, repetition rate 500 and 100 Hz, number of pulses 100 and 30, single pulse energy 50- 130 μ J) in vitro (porcine RPE; retinal spot size 160 μ m) and during patient treatment (retinal spot size 176 μ m). During irradiation, fluorescence light from the RPE was decoupled from the laser light inside the slit lamp and detected by a photomultiplier or photodiode at wavelengths above 550 nm. Additionally, temperature- dependent fluorescence intensity measurements of A2- E, the main fluorescent component of lipofuscin, were performed in a different in- vitro setup. Results: The intensity of AFdecreased over the number of applied pulses during laser irradiation, and this trend was more pronounced in porcine RPE samples than during human treatment. In vitro, the AF intensity decreased by about 22% ; however, only a weak signal was detected. When treating patients, the AF intensity was strong and the rate of decay of fluorescence intensity with number of pulses was greater when irradiating at 500 Hz than at the 100 Hz repetition rate. However, for both repetition rates the AF decay was merely up to 6- 8% over the number of pulses per laser spot. Fluorescence intensity of A2- E decreased linearly with increasing temperature at about 1% per 1° C and was completely reversible. Conclusions: Online measurements of AF d uring selective RPE laser treatment are possible and reveal a decay in AFas a function of the number of laser pulses applied to the RPE.If A2- E results can be transferred to RPE fluorescence, the AFdecay could be related to the temperature increase within the tissue during treatment. Further clinical studies- in SRT as well as in conventional laser photocoagulation- might be able to show online AF changes on different areas of the retina and on different pathologies. Due to the temperature dependence of the fluorescence, on- line AF measurements during laser treatments such as photocoagulation or TTT may be able to be used as a real- time method for temperature monitoring.展开更多
目的:研究家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)患者中双眼多灶性先天性视网膜色素上皮肥厚(congenital hypertrophy of the retinal pigment epithelium,CHRPE)患者的眼底荧光素血管造影(fundus fluoresceinangiogr...目的:研究家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)患者中双眼多灶性先天性视网膜色素上皮肥厚(congenital hypertrophy of the retinal pigment epithelium,CHRPE)患者的眼底荧光素血管造影(fundus fluoresceinangiography,FFA)的特点。方法:我们对22例有65处CHRPE病灶的FAP患者前瞻性进行FFA和眼底检查。结果:发现86%CHRPE病损面积>0.5个视盘直径,74%的CHRPE病变接近视网膜血管,视网膜血管有以下变化:46%CHRPE病变中出现毛细血管无灌注区,8%穿过病灶的视网膜血管部分阻塞,6%出现脉络膜视网膜吻合支,3%病变有毛细血管微血管瘤,5%可观察到脉络膜毛细血管,20%的脉络膜毛细血管出现在脱色素边缘晕环中。约10%的CHRPE病变眼底检查未发现,只能通过FFA观测到。结论:虽然通过眼底检查能诊断CHRPE,但有些病变仍需通过FFA确诊,其对此病变仍是非常有用的诊断方法。展开更多
A case of bilateral “drusenoid”pigment epithelial detachment that was studied with fundus fluorescein angiography and optical coherence tomography is described. Fundus fluorescein angiography depicted staining of th...A case of bilateral “drusenoid”pigment epithelial detachment that was studied with fundus fluorescein angiography and optical coherence tomography is described. Fundus fluorescein angiography depicted staining of the drusen without any sign of pooling of the dye, whereas optical coherence tomography displayed detachment of the retinal pigment epithelium. These findings remained unchanged during a 10-month period.展开更多
PURPOSE: To report the optical coherence tomography (OCT)-findings in two cases of presumed congenital simple retinal pigment epithelial (RPE) hamartoma. DESIGN: Observational case report. METHODS: Fundus examination,...PURPOSE: To report the optical coherence tomography (OCT)-findings in two cases of presumed congenital simple retinal pigment epithelial (RPE) hamartoma. DESIGN: Observational case report. METHODS: Fundus examination, fluorescein angiography, ultrasonography, and OCT were done on two cases of simple RPE hamartoma. RESULTS: A heavily pigmented solitary macular lesion was noted in the right eye of a 22-year old man and a 55-year-old woman. The young man had a foveal lesion and a vision of 10/200; the woman with eccentric lesion had a vision of 20/20. The lesions blocked fluorescence on angiogram; sonography showed hyper-reflective nodules. OCT demonstrated full-thickness retinal replacement, complete optical shadowing, and abrupt margins of the lesion in both the cases, and vitreomacular adhesion at the temporal margin of the foveal lesion. CONCLUSIONS: Congenital simple RPE hamartoma may rarely occur at the foveal center, resulting in poor visual acuity. OCT is a useful non-invasive adjunct for diagnosis of this rare tumor and may reveal additional features like vitreoretinal adhesion.展开更多
Purpose:To report two cases of retinal pigment epithelium(RPE)tears following intravitreal pegaptanib injections for occult choroidal neovascularization.Design:Noncomparative case series.Methods:The charts of two pati...Purpose:To report two cases of retinal pigment epithelium(RPE)tears following intravitreal pegaptanib injections for occult choroidal neovascularization.Design:Noncomparative case series.Methods:The charts of two patients with pigment epithelial tears after receiving intravitreal pegaptanib were reviewed.Approval from the institutional review board and informed consent were obtained before chart review.Fundus photos,intravenous fluorescein angiograms,and optical coherence tomography(OCT)were obtained before and after therapy confirmed the diagnosis.Results:Two patients had turbid pigment epithelial detachments(PEDs)and occult choroidal neovascular membranes(CNVMs)treated with intravitreal pegaptanib.Both patients developed RPE tears weeks following one intravitreal pegaptanib injection.Conclusions:This report describes the development of RPE tears after intravitreal pegaptanib injection.Caution should be taken in cases of turbid pigment epithelial detachments in the monocular patient when treatment with intravitreal pegaptanib is entertained.Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this devastating visual complication.展开更多
Purpose:To evaluate a novel technique for three-dimen-sional mapping of the retinal pigment epithelium(RPE)layer in patients with subfoveal choroidal neovascularization(CNV)-due to age-related macular degeneration.Met...Purpose:To evaluate a novel technique for three-dimen-sional mapping of the retinal pigment epithelium(RPE)layer in patients with subfoveal choroidal neovascularization(CNV)-due to age-related macular degeneration.Methods:Scanning with a recent generation retinal thickness analyzer(RTA)-was performed in consecutive patients undergoing fluorescein angiography.From a 3× 3mm area centered on the fovea,three-dimensional area maps of the RPE level were calculated by external spreadsheet software.Included were 18 eyes with classic CNV,18 eyes with occult CNV and 18 eyes from age-matched normal subjects.Repeatability was assessed by measuring 17 eyes with CNV 3 times.In ten additional patients,RTA imaging results were compared with cross-sections obtained by optical coherence tomography.Results:By both methods,distinctive changes in RPE level maps were observed in classic and occult CNV.In classic CNV with the lesion extending over the RPE,only focal irregularities in the anteriorly displaced RPE surface were observed.In contrast,mapping of occult CNV showed a more irregular displacement of the RPE layer.The RPE map standard deviation indicating surface irregularity differed statistically significantly between the groups,with coefficients of variance of 5.9% for controls,6.1% for classic and 8.8% for occult CNV(P< 0.001).Regarding repeatability,RPE level maps showed 1.2% coefficient of variance and an intra-class correlation coefficient of 0.87 for triplicate measurements in CNV patients.Conclusions:Topographic mapping of CNV lesions offers a fast,reproducible method for obtaining three-dimensional morphometric information on the RPE level and to quantify changes.展开更多
文摘Background: Fundus autofluorescence (AF) is derived from the lipofuscin contained by the retinal pigment epithelial cells. Using a scanning laser ophthalmoscope, two- dimensional AF measurements of the ocular fundus can be achieved. Directly after conventional photocoagulation and also after selective RPE laser treatment (SRT) with ophthalmoscopically non- visi- ble laser lesions, irradiated areas reveal reduced AF, indicating RPE damage. Since the green treatment laser beam could also be used for AF excitation, the aim of this study was to evaluate whether absolute measurements of AF can be performed, and also possible changes in AF detected, online during SRT. Methods: SRT was carried out by use of a frequency- doubled Nd:YLF laser (wavelength 527 nm, pulse duration 1.7 μ s, repetition rate 500 and 100 Hz, number of pulses 100 and 30, single pulse energy 50- 130 μ J) in vitro (porcine RPE; retinal spot size 160 μ m) and during patient treatment (retinal spot size 176 μ m). During irradiation, fluorescence light from the RPE was decoupled from the laser light inside the slit lamp and detected by a photomultiplier or photodiode at wavelengths above 550 nm. Additionally, temperature- dependent fluorescence intensity measurements of A2- E, the main fluorescent component of lipofuscin, were performed in a different in- vitro setup. Results: The intensity of AFdecreased over the number of applied pulses during laser irradiation, and this trend was more pronounced in porcine RPE samples than during human treatment. In vitro, the AF intensity decreased by about 22% ; however, only a weak signal was detected. When treating patients, the AF intensity was strong and the rate of decay of fluorescence intensity with number of pulses was greater when irradiating at 500 Hz than at the 100 Hz repetition rate. However, for both repetition rates the AF decay was merely up to 6- 8% over the number of pulses per laser spot. Fluorescence intensity of A2- E decreased linearly with increasing temperature at about 1% per 1° C and was completely reversible. Conclusions: Online measurements of AF d uring selective RPE laser treatment are possible and reveal a decay in AFas a function of the number of laser pulses applied to the RPE.If A2- E results can be transferred to RPE fluorescence, the AFdecay could be related to the temperature increase within the tissue during treatment. Further clinical studies- in SRT as well as in conventional laser photocoagulation- might be able to show online AF changes on different areas of the retina and on different pathologies. Due to the temperature dependence of the fluorescence, on- line AF measurements during laser treatments such as photocoagulation or TTT may be able to be used as a real- time method for temperature monitoring.
文摘目的:研究家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)患者中双眼多灶性先天性视网膜色素上皮肥厚(congenital hypertrophy of the retinal pigment epithelium,CHRPE)患者的眼底荧光素血管造影(fundus fluoresceinangiography,FFA)的特点。方法:我们对22例有65处CHRPE病灶的FAP患者前瞻性进行FFA和眼底检查。结果:发现86%CHRPE病损面积>0.5个视盘直径,74%的CHRPE病变接近视网膜血管,视网膜血管有以下变化:46%CHRPE病变中出现毛细血管无灌注区,8%穿过病灶的视网膜血管部分阻塞,6%出现脉络膜视网膜吻合支,3%病变有毛细血管微血管瘤,5%可观察到脉络膜毛细血管,20%的脉络膜毛细血管出现在脱色素边缘晕环中。约10%的CHRPE病变眼底检查未发现,只能通过FFA观测到。结论:虽然通过眼底检查能诊断CHRPE,但有些病变仍需通过FFA确诊,其对此病变仍是非常有用的诊断方法。
文摘A case of bilateral “drusenoid”pigment epithelial detachment that was studied with fundus fluorescein angiography and optical coherence tomography is described. Fundus fluorescein angiography depicted staining of the drusen without any sign of pooling of the dye, whereas optical coherence tomography displayed detachment of the retinal pigment epithelium. These findings remained unchanged during a 10-month period.
文摘PURPOSE: To report the optical coherence tomography (OCT)-findings in two cases of presumed congenital simple retinal pigment epithelial (RPE) hamartoma. DESIGN: Observational case report. METHODS: Fundus examination, fluorescein angiography, ultrasonography, and OCT were done on two cases of simple RPE hamartoma. RESULTS: A heavily pigmented solitary macular lesion was noted in the right eye of a 22-year old man and a 55-year-old woman. The young man had a foveal lesion and a vision of 10/200; the woman with eccentric lesion had a vision of 20/20. The lesions blocked fluorescence on angiogram; sonography showed hyper-reflective nodules. OCT demonstrated full-thickness retinal replacement, complete optical shadowing, and abrupt margins of the lesion in both the cases, and vitreomacular adhesion at the temporal margin of the foveal lesion. CONCLUSIONS: Congenital simple RPE hamartoma may rarely occur at the foveal center, resulting in poor visual acuity. OCT is a useful non-invasive adjunct for diagnosis of this rare tumor and may reveal additional features like vitreoretinal adhesion.
文摘Purpose:To report two cases of retinal pigment epithelium(RPE)tears following intravitreal pegaptanib injections for occult choroidal neovascularization.Design:Noncomparative case series.Methods:The charts of two patients with pigment epithelial tears after receiving intravitreal pegaptanib were reviewed.Approval from the institutional review board and informed consent were obtained before chart review.Fundus photos,intravenous fluorescein angiograms,and optical coherence tomography(OCT)were obtained before and after therapy confirmed the diagnosis.Results:Two patients had turbid pigment epithelial detachments(PEDs)and occult choroidal neovascular membranes(CNVMs)treated with intravitreal pegaptanib.Both patients developed RPE tears weeks following one intravitreal pegaptanib injection.Conclusions:This report describes the development of RPE tears after intravitreal pegaptanib injection.Caution should be taken in cases of turbid pigment epithelial detachments in the monocular patient when treatment with intravitreal pegaptanib is entertained.Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this devastating visual complication.
文摘Purpose:To evaluate a novel technique for three-dimen-sional mapping of the retinal pigment epithelium(RPE)layer in patients with subfoveal choroidal neovascularization(CNV)-due to age-related macular degeneration.Methods:Scanning with a recent generation retinal thickness analyzer(RTA)-was performed in consecutive patients undergoing fluorescein angiography.From a 3× 3mm area centered on the fovea,three-dimensional area maps of the RPE level were calculated by external spreadsheet software.Included were 18 eyes with classic CNV,18 eyes with occult CNV and 18 eyes from age-matched normal subjects.Repeatability was assessed by measuring 17 eyes with CNV 3 times.In ten additional patients,RTA imaging results were compared with cross-sections obtained by optical coherence tomography.Results:By both methods,distinctive changes in RPE level maps were observed in classic and occult CNV.In classic CNV with the lesion extending over the RPE,only focal irregularities in the anteriorly displaced RPE surface were observed.In contrast,mapping of occult CNV showed a more irregular displacement of the RPE layer.The RPE map standard deviation indicating surface irregularity differed statistically significantly between the groups,with coefficients of variance of 5.9% for controls,6.1% for classic and 8.8% for occult CNV(P< 0.001).Regarding repeatability,RPE level maps showed 1.2% coefficient of variance and an intra-class correlation coefficient of 0.87 for triplicate measurements in CNV patients.Conclusions:Topographic mapping of CNV lesions offers a fast,reproducible method for obtaining three-dimensional morphometric information on the RPE level and to quantify changes.
