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G. Barteselli, F. Viola, E. Villani, L. Dell'Arti, D. Vezzola, V. Canton, R. Sala, F. Magnani, M. Cappellini, R. Ratiglia; Fundus Autofluorescence Patterns in Deferoxamine Maculopathy: Morphological Evaluation and Natural Course. Invest. Ophthalmol. Vis. Sci. 2010;51(13):323.
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© ARVO (1962-2015); The Authors (2016-present)
To describe and classify patterns of abnormal fundus autofluorescence (FAF; excitation 488nm, emission > 500nm) and their natural progression in eyes with deferoxamine maculopathy.
14 consecutive thalassemic patients with deferoxamine maculopathy (27 eyes) were included. FAF images were performed with a confocal scanning laser ophthalmoscope (HRA2 Spectralis, Heidelberg Engineering). The patterns of fundus alterations detected by FAF were evaluated and their progression was analyzed.
All patients showed alterations in FAF, classified into four phenotypic patterns including minimal change (12 eyes), focal (5 eyes), patchy (6 eyes) and speckled (4 eyes). Areas of abnormal increased or decreased FAF signals could correspond or not to visible alterations in indirect ophthalmoscopy. In 18 of 27 eyes, the alterations in FAF progressed beyond the vascular arcades, in the other cases were confined to the macula. During follow up (mean 11 months, range 3-26 months) patchy pattern showed a marked progression of abnormalities in 2 out of 3 patients, who developed retinal pigment epitelium atrophy. The only patient with patchy pattern who could discontinue the treatment, partial regression occurred. Speckled pattern showed slight changes in FAF, while minimal change and focal patterns didn’t show any change. Visual acuity was significantly reduced in eyes with patchy pattern, showing a progressive decrease during the follow up if the treatment was not discontinued. No significant decrease of vision occurred in other patterns during the follow up.
FAF is a non-invasive and valid imaging method exam for early detection of retinal pigment epithelium abnormalities in deferoxamine maculopathy and can be used to monitor the status of the macula in patients at risk for this toxicity. Patterns of FAF may indicate different stages of maculopathy and could be useful as a guide for discontinuing or switching the treatment.
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