Skip to main content

Advertisement

SpringerLink
Log in

Foveal RPE autofluorescence as a prognostic factor for anti-VEGF therapy in exudative AMD

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Autofluorescence (AF) of the retinal pigment epithelium (RPE) are thought to reflect metabolic activity of the RPE cells, which in turn is largely driven by photoreceptor outer segment renewal. In exudative AMD, choroidal new vessels (CNV) may be confined to Bruch’s membrane, or transgress the RPE, with consequence loss of photoreceptor cells. It has been suggested that they may be distinguished with autofluorescence imaging. The aim of our study was to analyze the prognostic value of RPE autofluorescence in relationship to the therapeutic outcome of anti-VEGF (vascular endothelial growth factor) therapy in exudative AMD.

Patients and methods

AF images (Heidelberg Retina Angiograph) were obtained from 95 eyes (95 patients, mean age 77.64 years, 39 male and 56 female) with exudative macular lesions and associated drusen before therapy with intravitreal Bevacizumab (Avastin®). Increased, normal, or decreased AF of a central area with diameters of 500 and 1,000 μm around the foveola were distinguished, and compared with the outcome of central vision. As a measure of data reproducibility (inter- and intraobserver variability), the kappa statistics (K > 0.6 “good”, K > 0.8 “excellent”) and exact agreement in % were calculated.

Results

Analysis of AF showed a significant difference in outcome of visual acuity in eyes with changes in AF of the central 500 und 1000 μm (Mann-Whitney test, p500 μm < 0.001, p1000 μm = 0.02). Comparison of eyes with increased AF to the other eyes also resulted a significant difference in visual acuity at follow-up (p incr < 0.001); those with decreased AF had no significant difference to the eyes with normal or increased AF (p decr = 0.1733).

Conclusions

The RPE-AF of exudative AMD lesions varies greatly. The AF differences probably represent different kinds of metabolism disorders in the RPE. Furthermore, they apparently have a great influence on the chances of anti- vascular endothelial growth factor (VEGF) therapy success; in particular the development of visual acuity is less favorable in eyes with initially increased central AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bindewald A, Bird AC, Dandekar SS, Dolar-Szczasny J, Dreyhaupt J, Fitzke FW, Einbock W, Holz FG, Jorzik JJ, Keilhauer C, Lois N, Mlynski J, Pauleikhoff D, Staurenghi G, Wolf S (2005) Classification of fundus autofluorescence patterns in early age-related macular disease. Invest Ophthalmol Vis Sci 46(9):3309–3314

    Article  PubMed  Google Scholar 

  2. Bindewald A, Schmitz-Valckenberg S, Jorzik JJ, Dolar-Szczasny J, Sieber H, Keilhauer C, Weinberger AW, Dithmar S, Pauleikhoff D, Mansmann U, Wolf S, Holz FG (2005) Classification of abnormal fundus autofluorescence patterns in the junctional zone of geographic atrophy in patients with age related macular degeneration. Br J Ophthalmol 89(7):874–878

    Article  PubMed  CAS  Google Scholar 

  3. Dandekar SS, Jenkins SA, Peto T, Scholl HP, Sehmi KS, Fitzke FW, Bird AC, Webster AR (2005) Autofluorescence imaging of choroidal neovascularization due to age-related macular degeneration. Arch Ophthalmol 123(11):1507–1513

    Article  PubMed  Google Scholar 

  4. Delori FC, Dorey CK, Staurenghi G, Arend O, Goger DG, Weiter JJ (1995) In vivo fluorescence of the ocular fundus exhibits retinal pigment epithelium lipofuscin characteristics. Invest Ophthalmol Vis Sci 36(3):718–729

    PubMed  CAS  Google Scholar 

  5. Delori FC, Staurenghi G, Arend O, Dorey CK, Goger DG, Weiter JJ (1995) In vivo measurement of lipofuscin in Stargardt’s disease–Fundus flavimaculatus. Invest Ophthalmol Vis Sci 36(11):2327–2331

    PubMed  CAS  Google Scholar 

  6. Einbock W, Moessner A, Schnurrbusch UE, Holz FG, Wolf S (2005) Changes in fundus autofluorescence in patients with age-related maculopathy. Correlation to visual function: a prospective study. Graefes Arch Clin Exp Ophthalmol 243(4):300–305

    Article  PubMed  Google Scholar 

  7. Eldred GE, Lasky MR (1993) Retinal age pigments generated by self-assembling lysosomotropic detergents. Nature 361(6414):724–726

    Article  PubMed  CAS  Google Scholar 

  8. Framme C, Bunse A, Sofroni R, Thalhammer T, Walter A, Sachs HG, Gabel VP (2006) Fundus autofluorescence before and after photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration. Ophthalmic Surg Lasers Imaging 37(5):406–414

    PubMed  Google Scholar 

  9. Holz FG (2001) Autofluorescence imaging of the macula. Ophthalmologe 98(1):10–18

    Article  PubMed  CAS  Google Scholar 

  10. Holz FG, Bellman C, Staudt S, Schutt F, Volcker HE (2001) Fundus autofluorescence and development of geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 42(5):1051–1056

    PubMed  CAS  Google Scholar 

  11. Holz FG, Bellmann C, Margaritidis M, Schutt F, Otto TP, Volcker HE (1999) Patterns of increased in vivo fundus autofluorescence in the junctional zone of geographic atrophy of the retinal pigment epithelium associated with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 237(2):145–152

    Article  PubMed  CAS  Google Scholar 

  12. Holz FG, Bindewald-Wittich A, Fleckenstein M, Dreyhaupt J, Scholl HP, Schmitz-Valckenberg S (2007) Progression of geographic atrophy and impact of fundus autofluorescence patterns in age-related macular degeneration. Am J Ophthalmol 143(3):463–472

    Article  PubMed  Google Scholar 

  13. Schmitz-Valckenberg S, Bindewald-Wittich A, Dolar-Szczasny J, Dreyhaupt J, Wolf S, Scholl HP, Holz FG (2006) Correlation between the area of increased autofluorescence surrounding geographic atrophy and disease progression in patients with AMD. Invest Ophthalmol Vis Sci 47(6):2648–2654

    Article  PubMed  Google Scholar 

  14. Schmitz-Valckenberg S, Holz FG, Bird AC, Spaide RF (2008) FUNDUS AUTOFLUORESCENCE IMAGING: Review and Perspectives. Retina 28(3):385–409

    PubMed  Google Scholar 

  15. Scholl HP, Bellmann C, Dandekar SS, Bird AC, Fitzke FW (2004) Photopic and scotopic fine matrix mapping of retinal areas of increased fundus autofluorescence in patients with age-related maculopathy. Invest Ophthalmol Vis Sci 45(2):574–583

    Article  PubMed  Google Scholar 

  16. Smith RT, Chan JK, Busuoic M, Sivagnanavel V, Bird AC, Chong NV (2006) Autofluorescence characteristics of early, atrophic, and high-risk fellow eyes in age-related macular degeneration. Invest Ophthalmol Vis Sci 47(12):5495–5504

    Article  PubMed  Google Scholar 

  17. Spital G, Radermacher M, Muller C, Brumm G, Lommatzsch A, Pauleikhoff D (1998) Autofluorescence characteristics of lipofuscin components in different forms of late senile macular degeneration. Klin Monatsbl Augenheilkd 213(1):23–31

    Article  PubMed  CAS  Google Scholar 

  18. von Ruckmann A, Fitzke FW, Bird AC (1995) Distribution of fundus autofluorescence with a scanning laser ophthalmoscope. Br J Ophthalmol 79(5):407–412

    Article  Google Scholar 

  19. von Ruckmann A, Fitzke FW, Bird AC (1997) Fundus autofluorescence in age-related macular disease imaged with a laser scanning ophthalmoscope. Invest Ophthalmol Vis Sci 38(2):478–486

    Google Scholar 

  20. von Ruckmann A, Fitzke FW, Bird AC (1997) In vivo fundus autofluorescence in macular dystrophies. Arch Ophthalmol 115(5):609–615

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Germany

    Britta Heimes, Albrecht Lommatzsch, Meike Zeimer, Matthias Gutfleisch, Georg Spital & Daniel Pauleikhoff

  2. Moorfields Eye Hospital, London, UK

    Alan C. Bird

Authors
  1. Britta Heimes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Albrecht Lommatzsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meike Zeimer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias Gutfleisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georg Spital
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alan C. Bird
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Pauleikhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Britta Heimes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heimes, B., Lommatzsch, A., Zeimer, M. et al. Foveal RPE autofluorescence as a prognostic factor for anti-VEGF therapy in exudative AMD. Graefes Arch Clin Exp Ophthalmol 246, 1229–1234 (2008). https://doi.org/10.1007/s00417-008-0854-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-008-0854-z

Keywords

Search

Navigation