Abstract
Purpose:
To evaluate the characteristics of fundus auto-fluorescence ( FAF) patterns in patients with exudative AMD treated with intravitreal ranibizumab.
Methods:
Retrospective analysis of 33 patients (40 eyes) diagnosed with exudative AMD was carried out at baseline with ranibizumab intravitreal injections and 1 month after the third injection. All patients had fundus fluorescein angiography and FAF imaging using Heidelberg Spectralis. Patients were divided into 3 groups, classic wet AMD, occult AMD, and mixed wet AMD. The characteristics of the FAF were then described using previous recognised patterns.
Results:
Of the 40 eyes evaluated 19 patients were classified as classic wet AMD, 14 as occult and 6 mixed AMD. FAF results for different patterns of exudative AMD were compared before treatment and after 3 intravitreal injections. The 3 classifications were analysed.<br /> Classic: At baseline of the 19 with classic wet AMD, 18 demonstrated decreased FAF at the centre of the lesion but also increased signal toward the lesion edge.1 patient with classic showed near normal FAF. After 3 injections, 73.68% demonstrated less hypofluorescence with increased hyperfluorescence at the lesion. 26.32 % remained unchanged.<br /> Occult: At baseline of the 16 patients with occult AMD, 75% demonstrated a mottled FAF. 18.75% patients had a FAF pattern the same as the classic of decreased FAF at the centre of the lesion with increased signal at the edges and 1 FAF appeared near normal. Following the third injection of ranibizumab 62.5% eyes demonstrated less hypofluorescence and 37.5% were unchanged.<br /> Mixed:100% of the mixed type exhibited characteristics of both occult and classic AMD. After 3 injections some change in the pattern was observed of either increased FAF or decreased FAF.
Conclusions:
It has been suggested that the noninvasive imaging technique of FAF could be used as a prognostic predictive marker in AMD. FAF is a result of RPE cell metabolism and dysfunction which leads to large amounts of lipofuscin accummulating in the RPE cells.FAF can be used to visualize the extent of damage and stage of disease progression. Others have described different patterns of FAF in early non exudative AMD but our findings show that patients with classic wet AMD, occult AMD, and mixed AMD can exhibit different FAF patterns before and after intravitreal injections. FAF could therefore be used to monitor disease development,severity and prognosis of AMD.