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Tetsuya Yamagishi, Hideki Koizumi, Taizo Yamazaki, Nobuhiro Terao, Kotomi Nakayama, Shigeru Kinoshita; Fundus Autofluorescence of Exudative Age-Related Macular Degeneration with Intraretinal Cystoid Lesion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5847.
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Eyes with exudative age-related macular degeneration (AMD) often demonstrate an intraretinal cystoid lesion at the macula on optical coherence tomography (OCT) images. This lesion is either cystoid macular edema (CME) as active exudation, or cystoid macular degeneration (CMD) as fibroatrophic scar. However, fluorescein angiography (FA) is required for a definitive diagnosis. The purpose of this study was to investigate fundus autofluorescence (FAF) findings in eyes with exudative AMD and an intraretinal cystoid lesion.
This study included 37 eyes of 36 patients (9 eyes of 9 females and 28 eyes of 27 males; mean age: 77.3 years) with exudative AMD which were shown via an OCT image to have cystoid lesion traversing the macula. FAF (excitation: 488 nm, barrier: 500 nm) photography and FA were performed with a confocal scanning ophthalmoscope (Heidelberg Retina Angiograph 2; Heidelberg Engineering, Dossenheim, Germany). The 37 eyes were divided into the following 2 groups according to the FA findings: 1) the CME group (eyes with active leakage of fluorescein dye at the cystoid lesion, and 2) the CMD group (eyes showing staining without active leakage). The differences in FAF findings between these 2 groups were retrospectively evaluated.
Of the total 37 eyes, the CME group and the CMD group included 26 eyes and 11 eyes, respectively. In the CME group, 23 eyes (88.5%) presented well-distinguished hyperautofluorescence corresponding to the cystoid lesion. In contrast, only 1 eye (9.1%) in the CMD group showed hyperautofluorescence at the cystoid lesion. These hyperautofluorescence findings were observed more frequently in the CME group than in the CMD group (P < 0.0001).
FAF with the 488nm excitation reportedly displays analogous hyperautofluorescence at the cystoid lesion of CME. In this present study, the difference of the FAF findings between the CME and CMD groups may reflect the viability or damage of retinal pigment epithelial (RPE) cells below the cystoid lesion. In the CMD-group eyes, we assume that not only the sensory retina but also the RPE cell layer had been severely damaged by the long-term exudative change to date. FAF photography may become the adjunctive diagnostic tool used for distinguishing CMD from CME in the clinical setting.
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