Interpretations of Fundus Autofluorescence from Studies of the Bisretinoids of the Retina
Interpretations of Fundus Autofluorescence from Studies of the Bisretinoids of the Retina
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DOI：
10.1167/iovs.10-5852
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发表时间：
2010-09-01
影响因子：
4.4
通讯作者：
Yamamoto, Kazunori
中科院分区：
文献类型：
--
作者：
Sparrow, Janet R.;Yoon, Kee Dong;Yamamoto, Kazunori
对单基因和多因素视网膜变性的监测，包括老年性黄斑变性(AMD)和某些形式的视网膜色素变性(RP)，通常包括眼底自发荧光成像，这是一种主要依赖于视网膜色素上皮(RPE)细胞中双维A酸脂褐素产生的荧光的方式。1-3这些双维A酸类化合物最初形成于感光细胞，继而沉积在RPE中。在眼底自发荧光图像中，地理性萎缩(GA)，甚至更小的孤立萎缩斑块，都可以被识别为荧光严重减弱的区域。4、5增强的自体荧光信号经常被注意到，但较少被理解，包括在GA4边缘和在某些RP患者出现的强烈自体荧光的副凹内环内观察到的高强度自体荧光。5在这篇文章中，我们探讨了可能导致眼底自体荧光强度的因素，并提供了证据，证明RPE细胞中的脂褐素含量不是控制眼底自体荧光强度的唯一因素。RPE脂褐素的光氧化也可导致荧光发射增强。此外，我们认为，在RPE和光感受器细胞功能障碍和萎缩的情况下，维生素A醛的处理受损可以导致光感受器细胞中双维A类荧光团的过度产生，从而使这些细胞成为眼底自体荧光的异常但主要的来源。这些问题的相关性与AMD和单基因视网膜病变的眼底自发荧光进行了讨论。
Monitoring of monogenic and multifactorial forms of reti-nal degeneration, including age-related macular degeneration (AMD) and some forms of retinitis pigmentosa (RP), often includes fundus autofluorescence imaging, a modality that primarily relies on the fluorescence generated from the bisretinoids of lipofuscin in retinal pigment epithelial (RPE) cells. 1–3 These bisretinoids form initially in photoreceptor cells and are deposited secondarily in the RPE. In fundus autofluorescence images, geographic atrophy (GA), and even smaller isolated patches of atrophy, can be recognized as areas of profoundly reduced fluorescence. 4, 5 Often noticed but less understood are elevated autofluorescence signals, including the high-intensity autofluorescence observed at the margin of GA4 and within the parafoveal rings of intense autofluorescence that occur in some patients with RP. 5 In this article, we visit factors that can contribute to fundus hyperautofluorescence and we provide evidence that the amount of lipofuscin in RPE cells is not the only factor governing fundus autofluorescence intensity. Photooxidation of RPE lipofuscin can also result in heightened fluorescence emission. In addition, we propose that impaired handling of vitamin A aldehyde in the setting of RPE and photoreceptor cell dysfunction and atrophy can result in excessive production of bisretinoid fluorophores in photoreceptor cells, such that these cells become an anomalous yet major source of fundus autofluorescence. The relevance of these issues to fundus autofluorescence in AMD and monogenic retinal disorders is discussed.