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Katie Topping, Kimberly Cockerham, Andrea Kossler; Fundus Flavoprotein Autofluorescence in Compressive Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5880.
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© ARVO (1962-2015); The Authors (2016-present)
We introduce the utility of fundus flavoprotein autofluorescence (FPF) in the setting of compressive optic neuropathy (CON) due to various orbital processes. This technology is a noninvasive tool that quantifies mitochondrial dysnfunction suggestive of cellular damage.
Three cases from an ongoing prospective, observational clinical study of FPF are presented. Patients studied include adults 18 years or older and each case suffered from CON that resolved spontaneously or with intervention. Each subject had comprehensive examination, Humphrey visual field (HVF), optical coherence tomography (OCT), and FPF before and after improvement of visual function. Outcome measures include visual acuity, HVF, OCT, and FPF with higher scores suggesting mitochondrial dysfunction.
Three patients with CON due to carotid-cavernous fistula (CCF), unilateral intraconal marginal zone lymphoma (MZL), and bilateral intraconal mass due to Erdheim-Chester disease (ECD) had testing before and after CON resolution. All patients showed improvements in their post-resolution FPF score, correlating with improvements on exam, HVF, and OCT. The patient with CCF improved from 424 to 260 in the clearly affected eye after fistula closure. The fellow eye improved from 322 to 253 suggesting asymmetric, bilateral involvement. The patient with MZL improved from 506 to 351 after systemic chemotherapy where the fellow eye was stable at 376. The patient with ECD improved from 519 to 293 after treatment with vemurafenib while the less-involved eye improved from 449 to 291.
FPF has been shown in other retinal and optic nerve diseases to correlate with mitochondrial stress. Optic nerve dysfunction due to orbital disease causes mitochondrial stress which is quantified by FPF. FPF parallels other parameters including visual acuity, visual field, and OCT in our series demonstrated by significant elevation of FPF scores that improved in all of the described patients after resolution of CON. This technology shows promise in monitoring for CON in orbital disease by objectively quantifying mitochondrial dysfunction. We continue to investigate the role of FPF technology in other orbital diseases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Pre-treatment FPF of the right (A) and left (B) optic discs showing increased fluorescence compared to post-reatment FPF of the right (C) and left (D) optic discs showing normalization of FPF score (age-matched control = 332).
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