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S Schmitz-Valckenberg, JJ Jorzik, W Einbock, S Witte, F Schutt, S Dithmar, S Wolf, FG HolzFAM-Study Group; Patterns of Abnormal Autofluorescence in Advanced Atrophic ARMD: Classification and Implications for Progression . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2518.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To introduce a new classification for abnormal autofluorescence (AF) patterns in the junctional zone of geographic atrophy (GA) associated with ARMD and to correlate rates of spread of the atrophic areas. Methods:Digital autofluorescence (AF) images were recorded in 406 eyes from 239 patients with GA using a confocal SLO (exc. 488 nm, em. above 500 nm; Heidelberg Retina Angiograph) as part of the prospective, multicenter FAM-Study (Fundus Autofluorescence in Age-related Macular Degeneration). Baseline images were assessed for abnormal patterns of AF in the junctional zone. Serial images of 44 eyes over 1 to 4,5 years were analyzed for spread of atrophy using an automated computerized image analysis method for delineation and quantitation of GA. Results:Image quality was sufficient in 210 eyes (52%) to allow a meaningful analysis. Distinct patterns of abnormal AF were classified into focal (7%), band (20%), diffuse (63%), and patchy homogeneous (1%) while some eyes showed no elevated AF (9%). The diffuse pattern was subclassified into reticular (7%), fine granular (30%), branching (53%) and fine granular with punctate peripheral spots (10%). Mean relative progression rates per year differed between types of abnormal AF-patterns ranging from 15,2% (focal) to 424% (patchy homogeneous). Conclusion:Distinct phenotypic pattern of abnormal AF in the junctional zone of GA can be determined using cSLO-AF-imaging. The results indicate that these have an impact on progression rates of atrophy over time and, thus, of visual loss. Since RPE-lipofuscin contains the dominant fluorophores responsible for fundus AF detected with the cSLO-method applied herein, the observations implicate that excessive lipofuscin accumulation plays an important role in the pathogenesis of RPE-cell death in GA due to ARMD. We speculate that different AF-patterns reflect heterogeneity at the cellular and molecular level. Clinical AF-recording allows identification of novel prognostic determinants and may be helpful in monitoring future therapeutic interventions to slow down progression of GA.
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