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Imaging of focal hyperpigmentary changes in intermediate age-related macular degeneration: a longitudinal analysis

Session Details

Session Title: AMD III

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 11:32

Venue: Hall G1 (Level 2)

First Author: A.Gobel GERMANY

Co Author(s):    S. Grundei   M. Fleckenstein   F. Holz   S. Schmitz-Valckenberg     

Abstract Details

Purpose:

Focal hyperpigmentations represent a high-risk factor for progression from intermediate to advanced age-related macular degeneration (AMD). In this study alterations of hyperpigmentary changes in intermediate AMD were determined over time by means of multimodal imaging.

Setting:

Cohort Study / Bonn, Germany

Methods:

One-year follow-up (t1) data of 77 patients (mean age 74) were recorded and evaluated. Of those, eyes with intermediate AMD (AREDS-classification) showing focally increased brownish pigmentations were selected for analysis. Imaging including color fundus photography (CFP), fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) was performed at baseline examination (t0) and one year later (t1). After semi-automated alignment of different imaging modalities and examination dates, each hyperpigmentation was topographically correlated with the focal FAF- and SD-OCT-signal.

Results:

Hyperpigmentary changes at baseline were funduscopically visible in 38 of 92 eyes with intermediate AMD at t0 and t1. In total, 122 loci were evaluated. The FAF signal at t0 was increased, normal, decreased or not evaluable in 82, 19, 0 and 21 lesions, respectively. The FAF signal was altered over time in 6 cases. Co-registrated SD-OCT images showed hyperreflective foci above band 4 in 75 and only at band 4 level in 11 cases. Follow-up SD-OCT B-scans were available in 72 hyperpigmentations. Of those, a shift of the hyperreflective signal towards more inner retinal layers was documented in 22 cases during the review period.

Conclusions:

Visible hyperpigmentary changes on fundus photograph exhibit complex and dynamic alterations in different imaging modalities. The variation of location of the hyperreflective signal in SD-OCT over time may represent a migration of RPE cells and/or melanin-loaden macrophages towards inner retinal layers. The prognostic implications of these microstructural changes require further investigations with extended review periods.

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