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P. Fonseca, T. Miranda, B. Rui, R. Silva, J. Cunha–Vaz; Identification of Alterations of the Outer Blood–Retinal Barrier Integrity in Different Stages of Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2107.
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© ARVO (1962-2015); The Authors (2016-present)
Identification of alterations of the integrity of the outer blood–retinal barrier (BRB) in a cross sectional study of eyes with different stages of age–related macular degeneration (AMD).
A series of 34 eyes from 20 patients presenting different stages of AMD. Ten eyes with soft drusen, five eyes with geographical atrophy, eight eyes with occult choroidal neovascularization (CNV), six eyes with classic CNV and five eyes with identified chorioretinal anastomosis were examined by Retinal Leakage Analysis* (modified SLO – Heidelberg Engineering, Dossenheim, Germany), fluorescein angiography (HRA 2 – Heidelberg Engineering, Dossenheim, Germany), Optical Coherence Tomography (OCT – Zeiss, California, USA), and multi–focal ERG (Roland, Wiesbaden, Germany).
Retinal leakage and topographic lesion localization using the Retinal Leakage Analyzer identify well alterations in the integrity of the BRB at the level of the retinal pigment epithelium. The integrity of the outer BRB was maintained in 8 of 10 eyes with soft drusen. The two eyes that showed localized alterations of the BRB had large soft drusen and there was direct correlation between the location of the drusen and the alterations of the BRB. These eyes showed abnormal ERG responses. The eyes with geographical atrophy showed well defined alterations of the BRB. All forms of "wet" AMD demonstrated alterations of the BRB except in two cases of occult CNV, with retinal pigment epithelial detachments, where the BRB remained intact.
Alterations of the outer BRB may be detected over soft drusen and are a constant finding in well established geographical atrophy. In the presence of CNV, alterations of the BRB indicate retinal involvement and appear to indicate penetration of the CNV into the retina.
* Bernardes R., Dias, J., Cunha–Vaz, J.: Mapping the Human Blood–Retinal Barrier Function. IEEE. TBE, 2005, 52(1):106–116.
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