Atlas of fundus angiography

193 Pages·2006·34.327 MB·English, German

by  Heinrich Heimann, Ulrich Kellner, Michael H. Foerster, Heinrich Heimann, Ulrich Kellner, Michael H. Foerster

I
II
Atlas of
Fundus Angiography
Heinrich Heimann, MD
Consultant Ophthalmic Surgeon
St. Paul’s Eye Unit
Royal Liverpool University Hospital
Liverpool, United Kingdom
Ulrich Kellner, MD
Professor of Ophthalmology
AugenZentrum Siegburg
Siegburg, Germany
RetinaScience
Bonn, Germany
Michael H Foerster, MD
Professor of Ophthalmology
Department of Ophthalmology
Charité Campus Benjamin Franklin
Berlin, Germany
With contributions by
Nikolaos E Bechrakis, Jan Breckwoldt, Faik Gelisken,
Heinrich Heimann, Horst Helbig, Werner Inhoffen,
Claudia Jandeck, Ulrich Kellner, Lothar Krause,
Klaus-Martin Kreusel, Andreas Schueler, Joachim Wachtlin
Translated by Leslie Udvarhelyi
638 illustrations
Thieme
Stuttgart · New York
III
LibraryofCongressCataloging-in-PublicationDataisavailablefrom Importantnote:Medicineisanever-changingscienceundergoing
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Thisbookeditionpublishedandcopyrighted2003byGeorgThieme propertreatmentanddrugtherapy.Insofarasthisbookmentions
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referencesareinaccordancewiththestateofknowledgeatthe
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IV
Dedication
This publication is dedicated to the memory of Professor Klaus Heimann (1935–1999),
Director of the Department of Vitreoretinal Diseases
at the University of Cologne, Germany (1975–1999)
V
VI
Preface
Morethan40yearsago,theinitialreportsonfluorescein dystrophiesandacquiredretinaldegeneration.Thenon-
angiography of the ocular fundus were rejected by the invasivenessofthismethodmeansthatithasclearadvan-
major ophthalmology journals. In 1968, some 8years tagesoverfluoresceinangiography,butfurtherevidence-
after these pioneering works, Achim Wessing published basedanalysisofitsvalueforclinicaldecision-makingis
the first German textbook on the subject. Since then, stillrequiredinlargerstudies.
fluorescein angiography has become an established and Followingthesuccessofaone-daycourseonfluorescein
standard examination technique in modern ophthal- angiography held annually in Berlin before the German
mology. The Stereoscopic Atlas of Macular Diseases by OphthalmologicalSocietyConference,weaskedthecourse
DonaldGassbecamethestandardtextbookforinterpret- lecturers, from various departments in Germany and
ingfluorescein-angiographicimages. Switzerland,toconverttheirthoroughlecturesandexcel-
Duetotheprocedure’slowriskprofileandatendencyfor lentimagesintoconcisechaptersforthistextbook.Every
angiographytobemisusedasamethodofdocumenting efforthasbeenmadetobridgethegapbetweentheinter-
the course of diseases, fluorescein angiography has to pretationofangiogramsanddecision-makinginaclinical
someextentbeenoverusedinrecentyears.Thelandmark setting,andtoseparateevidence-basedindicationsforan-
EarlyTreatmentforDiabeticRetinopathyStudy,providing giographyfromthoseofmoreacademicinterest.Thetypi-
adefinitionof“clinicallysignificantmacularedema,”had calangiographicfindingsinthemostprevalentdiseases
alreadypointedoutthatangiographyisonlyofvalueifa arethereforeshownherealongwithessentialinformation
carefulclinicalexaminationhasalreadyraisedadiagnos- regardingthepathogenesis,thecausesoftheangiographic
ticortherapeuticquestion.Theavailabilityofnewtreat- phenomena,andimplicationsfortreatment.Theaimofthe
ments for choroidal neovascularization (CNV) has more bookistoprovideacompactguideforthebeginneraswell
thandoubledthenumberofangiographiescarriedoutin asforthemoreadvancedclinician.
tertiarycentersinrecentyears.Thisinturnhasledtoin- Themajorityoftheimagesweretakenbyhighlyskilledand
creasing interest in the method of fluorescein angiogra- specialized photographers, particularly Gesa Bröskamp
phy,ascurrenttreatmentstrategiesanddecision-making andKarinEhrenberg(Berlin),HugoNiederberger(St.Gal-
arelargelybasedontheuseofthistechniqueasa“gold len), Ernst Kleinknecht, Susanne Schweyer, and Anette
standard” for the classification of CNVs in accordance Keck(Tübingen)andSilkeWeinitz(Siegburg).Theauto-
withtheMacularPhotocoagulationStudy. fluorescenceimageswereprovidedbyAgnesB.Rennerand
Apartfromtheadventofdigitalphotography,thetechni- Hilmar Tillack (Berlin) and Silke Weinitz (Siegburg). We
caldetailsoffluoresceinangiographyarestilllargelythe wouldalsoliketoexpressourgratitudetoallofthestaffin
sameasthetechniquesdescribedintheveryfirstpublica- theparticipatingdepartmentswhowereinvolvedinthe
tions.Althoughstereoscopictechniquesarenecessaryto treatmentofthepatients.Particularthanksarealsodueto
differentiate the occult components of CNVs, this tech- Antje-Karen Richter, Mona Chatterjee, and Elke Plach at
niquehasnotbeenmetwithwidespreadacceptanceout- ThiemeMedicalPublishers,whohelpedusputtogether
side tertiary centers. Indocyanine angiography initially thefirsteditionofthisbook.
promised to become a new breakthrough technique for FollowingthesuccessofthefirstGermaneditionofthe
thediagnosisandtreatmentofchoroiddiseasesinpartic- atlas,itwassoondecidedtotranslateitintoEnglish.Allof
ular. However, following initial enthusiasm for the thechapterswererevisedbytheindividualauthorsand
method,itsusebecamelimitedtoafewevidence-based editors, and new information was included—e.g., new
indications.Opticalcoherencetomographyisanoninva- treatmentstrategiesforage-relatedmaculardiseaseand
siveexaminationmethodthathasclearadvantagesover theuseofinfraredreflectanceimagingandfundusauto-
fluoresceinangiographywithregardtotheinterpretation fluorescenceinmaculardisease—aswellasalargenum-
ofdiseasesatthevitreoretinalinterfaceandforqualita- berofnewimages.Allofthereferencelistswerealsoup-
tive and semiquantitative follow-up examinations of dated. We would like to thank Leslie Udvarhelyi for the
macular edema. However, it is not capable of replacing carefultranslationoftheGermantextandAnnieHollins
fluorescein angiography for treatment decision-making andCliffBergmanatThiemeMedicalPublishersfortheir
inthethreemostprevalentmaculardiseasesencountered supportinthepreparationofthisEnglishedition.
in everyday practice—age-related macular degeneration, Lastbutnotleast,wewouldliketothankallofthecon-
diabetic macular edema, and retinal venous occlusions. tributing authors for the dedication and care they have
Theanalysisofautofluorescencephenomenainthefun- putintopreparingtheirchapters.
dus promises to become one of the next examination
methodsthatwillcomeintouseinroutineclinicalprac- HeinrichHeimann
tice, particularly in nonexudative age-related macular UlrichKellner
degenerationandforearlydetectionofhereditaryretinal MichaelFoerster
VII
Contributors
NikolaosEBechrakis,MD ClaudiaJandeck,MD
ProfessorofOphthalmology AssociateProfessorofOphthalmology
DepartmentofOphthalmology ArtemisZentrenDillenburg/Frankfurt
CharitéCampusBenjaminFranklin Dillenburg,Germany
Berlin,Germany
UlrichKellner,MD
JanBreckwoldt,MD ProfessorofOphthalmology
DepartmentofAnesthesiology AugenZentrumSiegburg
CharitéCampusBenjaminFranklin Siegburg,Germany
Berlin,Germany RetinaScience
Bonn,Germany
MichaelHFoerster,MD
ProfessorofOphthalmology LotharKrause,MD
DepartmentofOphthalmology DepartmentofOphthalmology
CharitéCampusBenjaminFranklin CharitéCampusBenjaminFranklin
Berlin,Germany Berlin,Germany
FaikGelisken,MD Klaus-MartinKreusel,MD
DepartmentofOphthalmologyI AssociateProfessorofOphthalmology
UniversityofTuebingen EyeCenter
Tuebingen,Germany DRK-KlinikenWestend
Berlin,Germany
HeinrichHeimann,MD
ConsultantOphthalmicSurgeon AndreasSchueler,MD
St.Paul’sEyeUnit EyeClinicUniversitaetsallee
RoyalLiverpoolUniversityHospital Bremen,Germany
Liverpool,UnitedKingdom
JoachimWachtlin,MD
HorstHelbig,MD AssociateProfessorofOphthalmology
ProfessorofOphthalmology CharitéCampusBenjaminFranklin
UniversitaetsspitalZurich Berlin,Germany
Zurich,Switzerland
WernerInhoffen,DSc
DepartmentofOphthalmologyI
UniversityofTuebingen
Tuebingen,Germany
VIII
Contents
1 Examination Methods ........... 3 3.12 AngiographyafterLaserTreatment
forChoroidalNeovascularization .......... 54
1.1 FluoresceinAngiography.................. 3
FaikGelisken
HeinrichHeimann
3.13 AngiographyafterPhotodynamicTherapy
1.2 IndocyanineGreenAngiography........... 10
forChoroidalNeovascularization .......... 56
FaikGelisken
JoachimWachtlin
1.3 FundusAutofluorescence ................. 14
3.14 AngiographyafterIntravitrealDrug
UlrichKellner
AdministrationforChoroidalNeovasculari-
1.4 StereoAngiography....................... 18 zation .................................... 60
WernerInhoffen UlrichKellnerandJoachimWachtlin
1.5 ComparisonofRetinalImagingMethods ... 20
UlrichKellner
4 Hereditary and Toxic Retinal
2 Adverse Effects of Fluorescein
Disorders............................. 64
and Indocyanine Green
4.1 RetinitisPigmentosa ...................... 64
Angiography........................ 24
UlrichKellner
JanBreckwoldtandUlrichKellner
4.2 ChoroideremiaandGyrateAtrophy ........ 66
UlrichKellner
3 Age-Related Macular
4.3 X-LinkedCongenitalRetinoschisis ......... 68
Degeneration and Choroidal UlrichKellner
Neovascularization of Other 4.4 StargardtDisease ......................... 70
Etiologies ............................ 26 UlrichKellner
4.5 BestDisease(VitelliformMacular
3.1 ClassificationofAge-RelatedMacular
Dystrophy) ............................... 72
Disease................................... 26
UlrichKellner
JoachimWachtlin
4.6 AdultVitelliformMacularDystrophy
3.2 Age-RelatedMaculopathy ................. 28
andPatternDystrophies................... 74
UlrichKellner
UlrichKellner
3.3 GeographicAtrophy....................... 32
4.7 HydroxychloroquineandChloroquine
UlrichKellner
Retinopathy .............................. 76
3.4 ClassicChoroidalNeovascularization....... 34 UlrichKellner
JoachimWachtlin
3.5 OccultChoroidalNeovascularization ....... 36
FaikGelisken 5 Tumors ............................... 78
3.6 IndocyanineGreenAngiographyinOccult
ChoroidalNeovascularization.............. 40 5.1 ChoroidalNevi............................ 78
FaikGelisken NikolaosEBechrakis
3.7 LocalizationofChoroidalNeovasculari- 5.2 ChoroidalMelanoma ...................... 80
zation .................................... 44 NikolaosEBechrakisandLotharKrause
JoachimWachtlin 5.3 ChoroidalHemangioma ................... 84
3.8 PigmentEpithelialTear ................... 46 Klaus-MartinKreuselandLotharKrause
FaikGelisken 5.4 RetinalCapillaryAngioma ................. 86
3.9 RetinalAngiomatousProliferation ......... 48 Klaus-MartinKreusel
FaikGelisken 5.5 Astrocytoma.............................. 88
3.10 PolypoidalChoroidalVasculopathy ........ 50 Klaus-MartinKreusel
FaikGelisken 5.6 ChoroidalMetastasis ...................... 90
3.11 ChoroidalNeovascularization:Other Klaus-MartinKreuselandLotharKrause
Etiologies ................................ 52 5.7 VasoproliferativeTumors.................. 92
JoachimWachtlin Klaus-MartinKreusel
IX