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Peter Charbel Issa, Laurenz Pauleikhoff, Tjebo Heeren, Konstantinos Balaskas, Catherine A Egan; Fundus autofluorescence in macular telangiectasia type 2. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5001.
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© ARVO (1962-2015); The Authors (2016-present)
Macular telangiectasia type 2 (MacTel type 2) is a binocular disease with characteristic vascular and degenerative changes of the macula, and a disease epicentre temporal to the foveal centre. Multiple imaging modalities aiding the diagnosis of MacTel type 2 have been studied. The role of fundus autofluorescence (AF) imaging has not yet been investigated in detail. The aim of this study was to analyze AF characteristics in a large cohort of patients with MacTel type 2
Fundus AF images of 757 eyes (395 patients) from the Moorfields Reading Centre database of the MacTel Natural History Observation and Registry Study were analyzed. Graded features included 1) presence of macular AF changes, 2) increased, mixed or decreased AF signal of the nasal and temporal half graded individually, 3) temporal-nasal asymmetry of AF changes, and 4) visibility of vascular changes such as blunted vessels or ectatic capillaries. In a subset of 200 eyes, fundus AF was analysed in combination with other imaging modalities in order to identify and describe alterations associated with macular AF changes.
The vast majority of eyes (742/757; 98%) showed macular AF changes. The most common change was an increase in AF (86% nasally, 61% temporally). In 95% of all cases (717/757), macular AF changes were more pronounced temporal compared to nasal to the foveal centre. Image quality allowed assessment of the vascular changes including macular capillaries in 697 eyes and revealed vascular changes in 79% (548). The most common cause of increased AF were macular pigment-related phenomena: the characteristic loss of macular pigment results in a loss of the normal foveal AF-masking and thus an apparently increased AF signal. Similar loss-of masking effects were found in areas of photoreceptor atrophy (loss of masking due to lack of photopigment), or lack of retinal tissue in areas of hyporeflective spaces. Decreased macular AF was frequently caused by pigment plaques or neovascular membranes, and was only rarely due to an isolated atrophy of the retinal pigment epithelium. Eyes that did not show any changes on AF images did not show any obvious changes on optical coherence tomography either.
The study demonstrated that almost all registry study patient with MacTel type 2 showed characteristic findings on fundus AF imaging, underlining the importance of AF imaging as a diagnostic criterion and for determining disease state in family members.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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