Abstract:
Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence. We describe SADs according to their putative pathophysiological origin and also according to their clinical pattern, i.e., number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium phagocytic capacity, with direct or indirect retinal pigment epithelium injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the retinal pigment epithelium and the photoreceptor outer segments. Clinically, however, they could be classified into eight subclasses of SADs, as observed on fundus autofluorescence as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or nonpatterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely available short-wavelength fundus autofluorescence could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
摘要:
视网膜下自发荧光沉积物(SAD)可能在后极中发现,与各种各样的条件有关。这些疾病通常在短波长眼底自发荧光(FAF)上出现典型的自发荧光病变。我们根据其推定的病理生理起源来描述SAD,而且根据他们的临床模式,即数字,形状,通常的位置。在与吞噬作用和蛋白质运输的内在损害相关的疾病中,确定了SAD的五个主要推定病理生理学起源。视网膜色素上皮(RPE)吞噬能力过剩,直接或间接RPE损伤,和/或与在RPE和感光体外段之间机械分离的长期浆液性视网膜脱离相关的病症。然而,临床上,它们可以分为8个SAD子类,在FAF上观察到如下:单个卵黄样黄斑病变,多个圆形或卵黄样病变,多发性乳头状周围病变,斑点病变,豹斑病变,黄斑模式病变,模式病变位于与病因疾病相同的区域,或非模式化病变。因此,如果可能需要多模态成像来诊断SAD的原因,提出的基于非侵入性的分类,广泛可用的短波长FAF可以指导临床医生在考虑使用更具侵入性的工具之前做出诊断决策树.