Confocal scanning laser ophthalmoscope in the retromode imaging modality in exudative age-related macular degeneration.

PURPOSE: To evaluate the ability of confocal scanning laser ophthalmoscope (cSLO) in the retromode imaging modality in detecting retinal changes secondary to exudative age-related macular degeneration (AMD). METHODS: Seventeen eyes of 13 consecutive patients affected by CNV secondary to AMD were evaluated with optical coherence tomography (OCT) to detect neuroretinal detachment (NRD), pigment epithelial detachment (PED), cystoid macular edema (CME), and epiretinal membranes (ERM). All eyes were examined with a cSLO equipped with infrared retromode (RM) imaging modality. Infrared and fundus autofluorescence images were also obtained (IR and FAF). The intermethod agreement between OCT and cSLO was evaluated considering single cSLO imaging modality separately (IR, FAF, and RM), and all imaging modalities together. RESULTS: Eight eyes (47 %) had NRD at OCT; intermethod agreement was poor for any single cSLO imaging modality considered separately (k: 0.14, 0.01, and 0.29 for cSLO IR, FAF, and RM, respectively). Four eyes had PED at OCT (24 %); intermethod agreement was mild for cSLO RM, poor for IR and FAF (k: 0.51, 0.16, and 0.00, respectively). CME was present in eight eyes (47 %); intermethod agreement was excellent for cSLO RM, poor for IR and FAF (k: 0.88, 0.38, and 0.26, respectively). ERM was present in three eyes (18 %); intermethod agreement was mild for cSLO IR, poor for FAF, and excellent for RM (k: 0.59, 0.00, and 0.76, respectively). CONCLUSIONS: cSLO RM imaging is a useful and reproducible technique in detecting retinal features associated with CNV, particularly CME.

Short wavelength fundus autofluorescence versus near-infrared fundus autofluorescence, with microperimetric correspondence, in patients with geographic atrophy due to age-related macular degeneration.

AIM: To compare standard short-wavelength fundus autofluorescence (SW-FAF) and near infrared-wavelength fundus autofluorescence (NIR-FAF) in detecting geographic atrophy (GA) secondary to age-related macular degeneration, and its retinal sensitivity impairment. METHODS: Twenty-five consecutive patients (36 eyes) affected by GA were studied by means of fundus autofluorescence imaging, using both SW-FAF (excitation: 488 nm, emission >500 nm) and NIR-FAF (excitation: 787 nm, emission >800 nm). All patients underwent microperimetry to assess fixation characteristics and retinal sensitivity. RESULTS: In the extrafoveal region, the total hypoautofluorescent (hypo-FAF) area was significantly wider with NIR-FAF than with SW-FAF (8.03±6.68 mm(2) vs 7.37±6.34 mm(2) respectively; p=0.005). In the foveal area, the total hypo-FAF area was smaller with NIR-FAF than with SW-FAF (0.19±0.03 mm(2) versus 0.42±0.12 mm(2) respectively; p=0.008). Foveal sparing was larger at NIR-FAF compared with SW-FAF (p=0.021). In nine cases (25%) the site of fixation was hypoautofluorescent on SW-FAF, but normal on NIR-FAF with preserved retinal sensitivity. CONCLUSIONS: Standard SW-FAF may overestimate GA in the foveal area, correctly detected by NIR-FAF. In the extrafoveal area, SW-FAF may underestimate GA. Standard SW-FAF should be integrated with NIR FAF when detecting and following GA to avoid inconsistent results and misinterpretation, from both a morphological and functional perspective. Microperimetry helps to quantify retinal sensitivity in GA.

Retinal function in patients with serpiginous choroiditis: a microperimetry study.

PURPOSE: To investigate fixation pattern and retinal sensitivity in patients with serpiginous choroiditis (SC). METHODS: Twenty-eight eyes (14 patients) with SC were evaluated. Best-corrected visual acuity, color fundus photography, fundus autofluorescence, and fluorescein and indocyanine green angiography were performed. Microperimetry was used to assess fixation pattern and retinal sensitivity. RESULTS: Of 28 eyes, 16 (57%) had central, one (4%) poor central, and 11 (39%) eccentric fixation; and 18 (64%) had stable, four (14%) relatively unstable, and six (21%) unstable fixation. In patients with posterior pole symmetrically involved in both eyes, the better eye had stable and central fixation in all cases. Atrophic lesions were characterized by a dense scotoma in all cases, with a relative scotoma at their margins in ten eyes (38%). In two cases of active disease, a dense scotoma correlated to an active lesion could be detected. A relative scotoma was documented in areas not involved by the disease at the posterior pole in eight eyes (28%), and in the peripapillary area in 11 eyes (39%). CONCLUSIONS: Quantification of retinal sensitivity and fixation pattern by microperimetry offers new data about the impact of visual impairment in patients with SC. A reduction of retinal sensitivity in an apparently healthy area suggests a wider functional involvement of the retina, undetectable by morphologic evaluation alone.