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Arno Goebel, Sophia Grundei, Monika Fleckenstein, Frank Holz, Steffen Schmitz-Valckenberg; Imaging of Focal Hyperpigmentary Changes in Intermediate Age-related Macular Degeneration - A Longitudinal Analysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4165.
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Focal hyperpigmentations represent a high-risk factor for progression from intermediate to advanced age-related macular degeneration (AMD). In this study alterations of hyperpigmentary changes in intermediate AMD were determined over time by means of multimodal imaging.
One-year follow-up (t1) data of 37 patients (mean age 74) was recorded and evaluated. Of those, eyes with intermediate AMD (AREDS-classification) showing focally increased brownish pigment were selected for analysis. Imaging including color fundus photography (CFP), fundus autofluorescene (FAF) and spectral-domain optical coherence tomography (SD-OCT) was performed at baseline examination (t0) and one year later (t1). After semi-automated alignment of different imaging modalities and examination dates, each increased pigment was topographically correlated with the focal FAF- and SD-OCT-signal.
Hyperpigmentary changes at baseline were funduscopically visible in 21 of 47 eyes at t0 and t1. In total, 69 loci of increased pigment were evaluated. FAF signal at t0 was increased, normal, decreased or not evaluable in 44, 13, 0 and 12 hyperpigmentations respectively. FAF signal altered over time in 5 cases. Coregistrated SD-OCT images showed hyperreflective foci above band 4 in 35 and only at band 4 level in 5 cases. Precisely aligned SD-OCT follow-up scans were available in 37 hyperpigmentations. Of those, a shift of the hyperreflective signal in inner retinal layers was documented in 10 cases during the review period.
Visible hyperpigmentary changes on fundus photograph exhibit complex and dynamic alterations in different imaging modalities. The variation of location of the hyperreflective signal in SD-OCT over time may represent a migration of RPE cells and/or melanin-loaden macrophages towards inner retinal layers. The prognostic implications of these microstructural changes require further investigations with extend review periods.
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