Understanding Fluorescein Angiography docx

Manfred Spitznas Understanding Fluorescein Angiography Fluoreszeinangiografie verstehen Entendiendo Angiograf´ıa con Fluoresce´ına Manfred Spitznas Understanding Fluorescein Angiograph y Fluor eszeinangiografie v erstehen Entendiendo Angiograf´ıa con Fluoresce´ına Traducci´on: Hugo Quiroz-Mercado With 58 Figures in 180 Parts Prof. Dr. Manf red Spitznas Universitäts-Augenklinik Sigmund-Freud-Straße 25 D-53105 Bonn Germany ISBN 3-540-30060-0 Springer-Verlag Berlin Heidelberg New York Library of Congress Control Number: 2005938292 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. 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Editor:MarionPhilipp,Heidelberg Desk Editor: Martina Himberger, Heidelberg Production Editor: Joachim W. Schmidt, Munich Cover design: eStudio Calamar, Spain Typesetting: FotoSatz Pfeifer GmbH, D-82166 Graefelfing Printedonacid-freepaper–24/3151–543210 Contents Basic facts 3 Normalcentralretinalcapillaries 4 Normalperipheralretinalcapillaries 6 Pluggedperipheralretinalcapillaries 8 Optical phenomena 11 Transparencyofneurosensoryretina 12 Normal Transparent structures 14 Decreased Post mortem 16 Blood 18 Melanin 26 Transparencyofretinalpigmentepithelium 28 Normal Melanin granules 30 Decreased Macula 32 Hypertrophy of RPE 34 Choroidal folds 36 Choroidal nevi 38 Increased Drusen 40 Scars, degenerative processes 44 TransparencyofBruch’smembrane 46 Normal Elastic layer 48 Increased Angioid streaks 52 Mechanical phenomena 55 Attachmentofretinalpigmentepithelium 56 V Normal Hemidesmosomes 58 Disturbed Pigment epithelial detachment 60 Dynamic phenomena 63 Morphologicandphysiologicbasis 64 Capillarypores,zonulaeoccludentes 66 Permeabilityofretinalvessels 68 Normal Zonulae occludentes 70 Pathologic 72 Open zonulae occludentes 74 Endothelial cell loss 78 Pores 80 Permeabilityofchoroidalvessels 84 Normal Pores 86 Zonulae occludentes 90 Pathologic 92 Permeabilityofretinalpigmentepithelium 94 Normal Zonulae occludentes 94 Chorioretinal diffusion 96 Retinochorioidal diffusion 98 Pathologic Diffusion in scars 102 Fluid movement in scars 104 Laser scars 106 Central serous chorioretinopathy 108 Age-related macular degeneration 120 Figure References 126 VI Contents Inhalt Grundlegende Fakten 3 NormalezentraleNetzhautkapillaren 4 NormaleperiphereNetzhautkapillaren 6 VerstopfteperiphereNetzhautkapillaren 8 Optische Phänomene 10 Transparenz der Neuroretina 12 Normal Transparente Strukturen 14 Vermi nd er t Postmortal 16 Blut 18 Melanin 26 TransparenzdesretinalenPigmentepithels 28 Normal Melaningranula 30 Ver mi nder t Makula 32 RPE-Hypertrophie 34 Aderhautfalten 36 Aderhautnaevi 38 Ver mehr t Drüsen 40 Narben, degenerative Prozesse 44 TransparenzderBruch-Membran 46 Normal Elastische Schicht 48 Ver mehr t Gefäßähnliche Streifen 52 Mechanische Phänomene 55 AnheftungdesretinalenPigmentepithels 56 VII Normal Hämidesmosomen 58 Gestört Pigmentepithelabhebung 60 Dynamische Phänomene 63 MorphologischeundphysiologischeGrundlagen 64 Kapillarporen,Zonulaeoccludentes 66 PermeabilitätderNetzhautgefäße 68 Normal Zonulae occludentes 70 Pathologisch 72 Geöffnete Zonulae occludentes 74 Endothelzellverlust 78 Poren 80 PermeabilitätderAderhautgefäße 84 Normal Poren 86 Zonulae occludentes 90 Pathologisch 92 PermeabilitätdesretinalenPigmentepithels 94 Normal Zonulae occludentes 94 Chorioretinale Diffusion 96 Retinochorioidale Diffusion 98 Pathologisch Diffusion bei Narben 102 Flüssigkeitsbewegung bei Narben 104 Lasernarben 106 Chorioretinopathia centralis serosa 108 Altersbedingte Makuladegeneration 120 Bildnachweis 126 VIII Inhalt Contenido Conceptos b´asicos 3 Capilarescentralesdelaretinanormales 4 Capilares perif´ericosdelaretinanormales 6 Capilares perif´ericos de la retina ocluidos 8 Fen´om enos ´opticos 11 Transparenciadelaretinaneurosensorial 12 Normal Estructuras transparentes 14 Disminuida Post mortem 16 Sangre 18 Melanina 26 Transparenciadelepiteliopigmentadodelaretina 28 Normal Gr´anulos de melanina 30 Disminuida M´acula 32 Hipertrofia del EPR 34 Pliegues coroideos 36 Nevos coroideos 38 Aumentada Drusas 40 Cicatrices, procesos degenerativos 44 TransparenciadelamembranadeBruch 46 Normal Capa el´astica 48 Aumentada Estrias angioides 52 Fen´omenos mec´anicos 55 Adherenciadelepiteliopigmentadodelaretina 56 IX Normal Hemidesmosomas 58 Alterada Despegamiento del epitelio pigmentado 60 Fen´omenos din´amicos 63 Bases morfol´ogicas y fisiol´ogicas 64 Porosdecapilares,zonulae occludentes 66 Permeabilidaddevasosretinianos 68 Normal Zonulae occludentes 70 Patol´ogica 72 Zonulae occludentes abiertas 74 P´erdida de c´elulas endoteliales 78 Poros 80 Permeabilidaddevasoscoroideos 84 Normal Poros 86 Zonulae occludentes 90 Patol´ogica 92 Permeabilidaddelepiteliopigmentadodelaretina 94 Normal Zonula occludentes 94 Difusi´on coriorretiniana 96 Difusi´on retinocoroidea 98 Patol´ogica Difusi´on en cicatrices 102 Movimiento de fluidos en cicatrices 104 Cicatrices de l´aser 106 Coriorretinopat´ıa serosa central 108 Degeneraci´on macular relacionada a la edad 120 Referencias de las figuras 126 X Contenido ›› Fluorescein angiography is an indispensable tool in modern oph- thalmology. It is based on the behavior of intravenously adminis- tered sodium fluorescein in the tissues of the ocular fundus. The phenomena observed provide the ophthalmologist with valuable diagnostic information. This book describes the morphological characteristics and struc- tural changes underlying these phenomena. ›› Die Fluoreszeinangiographie ist ein unverzichtbares Werkzeug der modernen Augenheilkunde. Sie basiert auf dem Verhalten intrave- nös applizierten Natriumfluoreszeins in den Geweben des Augen- hintergrunds. Die dabei beobachteten Phänomene liefern dem Augenarzt wertvolle diagnostische Hinweise. Das vorliegende Buch beschreibt die morphologischen Merkmale und strukturellen Veränderungen, die diesen Phänomenen zu- grunde liegen. ›› La angiograf´ıa con fluoresce´ına es una herramienta indispensable en la oftalmolog´ıa moderna. Esta se basa en el comportamiento de la fluoresce´ına s ´odica administrada intravenosamente en tejidos del fondo ocular. Los fen ´omenos observados proveen al oftalm ´ologo de una informaci ´on diagn ´ostica de gran valor. Este libro describe las caracter´ısticas morfol ´ogicas y cambios estructurales que soportan estos fen ´omenos. 1 [...]...3 Basic facts Grundlegende Fakten Conceptos b´ sicos a 4 Basic Facts › Fluorescein angiography is a remarkable in vivo technique, because it is able to resolve the minute capillaries in the neighborhood of the foveal avascular zone which measure only 3.5 µm in diameter (top) This... (enfermedad de Eales) El resultado de estas tres instancias es hipoxia perif´rica seguida de neovascularizaci´ n (infee o rior) Fig 3 ¸ Plugged Peripheral Retinal Capillaries 9 10 › The phenomena of fluorescein angiography are divided into optical mechanical dynamic › Die Phänomene der Fluoreszeinangiographie werden eingeteilt in optisch mechanisch dynamisch › Los fenomenos de la angiograf´a con fluoresce´na... con tinta Fig 6 ¸ Decreased / Post Mortem 17 18 Optical Phenomena / Transparency of Neurosensory Retina › In the living eye, edema that obscures the normal background fluorescence of the choroid in the fluorescein angiogram can occur under a variety of pathological conditions as illustrated with this case edema in advanced diabetic retinopathy › Im lebenden Auge kann ein Ödem, das die darunter liegende... it is located more superficially, the retinal vessels are obscured, too Pigment can also be present on, or within, the wall of retinal vessels (right), making them focally non-transparent so that the fluorescein- stained blood column is no longer visible › Auch Ansammlungen von Pigment, wie bei diesem Melanozytom (links), können zu einem Transparenzverlust führen Wenn das Pigment tief in der Netzhaut . Manfred Spitznas Understanding Fluorescein Angiography Fluoreszeinangiografie verstehen Entendiendo Angiograf´ıa con Fluoresce´ına Manfred Spitznas Understanding Fluorescein Angiograph. figuras 126 X Contenido ›› Fluorescein angiography is an indispensable tool in modern oph- thalmology. It is based on the behavior of intravenously adminis- tered sodium fluorescein in the tissues. que soportan estos fen ´omenos. 1 Basic facts Grundlegende Fakten Conceptos b´asicos 3 ›› Fluorescein angiography is a remarkable in vivo technique, because it is able to resolve the minute capillaries