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C.N. Keilhauer, W.F. Schrader, B.H. Weber; Autofluorescence Imaging of the Ocular Fundus: Towards a Subclassification of Age-related Maculopathy (ARM) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1757.
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Purpose: Age-related maculopathy (ARM) represents a common disease of multifactorial etiology. Besides environmental influences genetic factors are thought to exert effects on age of onset and severity of disease. Formation and accumulation of lipofuscin-like material within the retinal pigment epithelium (RPE) is suspected to be a key event in the pathogenesis of ARM. Here, we characterize and define patterns of lipofuscin-like depositions in a large cohort of ARM patients in an effort to refine phenotype classifications. Methods: To record the pattern of retinal autofluorescence (AF), 377 patients with ARM or mild forms of non-exsudative age-related macular degeneration (AMD) were included in the study and were analysed with a scanning laser ophthalmoscope (Heidelberg Retina Angiograph, Heidelberg Engineering, Germany: excitation 488nm, emission > 500nm). Funduscopic changes ranged from severe pigment epithelial alterations, geographic atrophies to confluent soft drusen without leakage in angiography in at least one eye. Results: The maculopathies observed in our patient cohort were classified with regard to macular and background autofluorescence patterns and macular pigment density into 4 distinct groups. Group I summarizes macular lesions with increased AF, mostly due to tears of Bruch's membrane (50 patients), group II reflects different AF patterns of macular drusen further subdivided into different background AF patterns (regular/granular/reticular) (175 patients), group III (geographic atrophies, 80 patients) is subdivided with regard to background AF pattern and pattern of geographic atrophies, group IV combines a heterogeneous group of exsudative maculopathies with "healthy" fellow eyes in regard to AF pattern and shape of macular pigment (30). Conclusion: Topography and distinct patterns of lipofuscin-dependent autofluorescence may directly or indirectly be influenced by genetic factors. Hence, the suggested grouping of ARM/AMD phenotypes may ultimately facilitate the identification of genes conferring susceptibility to this multifactorial disease.
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