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Delayed macular choriocapillary circulation in age-related macular degeneration

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Abstract

Purpose. To investigate the macular choriocapillary circulation (MCC) in eyes with age-related macular degeneration (ARMD) and to correlate these findings with the associated clinical and angiographic drusen characteristics. Methods. Scanning laser ophthalmoscope fluorescein videoangiography was performed on 34 eyes with age-related macular degeneration and eight age-matched normal volunteers. Drusen characteristics were assessed using the Wisconsin age-related maculopathy grading scale. Results. A delayed macular choriocapillary circulation (DMCC) was defined as a macular choriocapillary filling time greater than 3 standard deviations from the normal mean (greater than 5 seconds). Nine (26%) of the 34 eyes with ARMD were found to have a DMCC. After age adjustment, eyes with DMCC were more likely to have geographic atrophy of the retinal pigment epithelium (p = 0.003) or choroidal neovascularization (p = 0.07) than were eyes with a normal MCC. Regional differences in choriocapillary filling times were present in the eyes with a DMCC, including nasal-to-temporal, central-to-peripheral, and inferior-to-superior gradients of progressively less choriocapillary filling delay. The DMCC correlated with the location, number, size, confluence, and fluorescein staining characteristics of the associated drusen. Conclusion. DMCC occurs in some eyes with ARMD. This finding may not only assist in defining eyes at risk for progressive disease but may also help to elucidate the pathogenesis of age-related macular degeneration.

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References

  1. Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, et al. The Framingham Eye Study. I. Outline and major prevalence findings. Am J Epidemiol 1977; 106: 17–32.

    Google Scholar 

  2. Gibson JM, Rosenthal AR, Lavery J. A study of the prevalence of eye disease in the elderly in an English community. Trans Ophthalmol Soc UK 1985; 104:196–203.

    Google Scholar 

  3. Martinez GS, Campbell AJ, Reinken J, Allan BC. Prevalence of ocular disease in a population study of subjects 65 years old and older. Am J Ophthalmol 1982; 94: 181–9.

    Google Scholar 

  4. Ghafour IM, Allan D, Foulds WS. Common causes of blindness and visual handicap in the west of Scotland. Br J Ophthalmol 1983; 67: 209–13.

    Google Scholar 

  5. Bird AC. Pathophysiology of AMD. In: Hampton GR, Nelsen PT (eds) Age-related macular degeneration: principles and practice. Raven Press, New York, pp 63–83, 1992.

    Google Scholar 

  6. Gass JDM. Drusen and disciform macular detachment and degeneration. Arch Ophthalmol 1973; 90: 206–17.

    Google Scholar 

  7. Schoeppner G, Chuang EL, Bird AC. The risk of fellow eye visual loss with unilateral retinal pigment epithelial tears. Am J Ophthalmol 1989; 108: 683–5.

    Google Scholar 

  8. Green WR, Key SN III. Senile macular degeneration: a histopathologic study. Trans Am Ophthalmol Soc 1977; 75: 180–254.

    Google Scholar 

  9. Sarks SH. Ageing and degeneration in the macular region: a clinico-pathologic study. Br J Ophthalmol 1967; 60: 324–41.

    Google Scholar 

  10. Pauleikhoff D, Chen JC, Chisholm IH, Bird AC. Choroidal perfusion abnormality with age-related Bruch's membrane change. Am J Ophthalmol 1990; 109:211–7.

    Google Scholar 

  11. Richard G. Choroidal circulation. Georg Thieme Verlag, New York, 1992.

  12. Polkinghorne PJ, Capon MRC, Berninger T, Lyness AL, Sehmi K, Bird AC. Sorsby's fundus dystrophy: a clinical study. Ophthalmology 1989; 96: 1763–8.

    Google Scholar 

  13. Capon MRC, Marshall J, Krafft JI, Alexander RA, Hiscott PS, Bird AC. Sorsby's fundus dystrophy: a light and electron microscopic study. Ophthalmology 1989; 96: 1769–77.

    Google Scholar 

  14. Novotny HR, Alvis DL. A method of photographing fluorescence in circulating blood in the human retina. Circulation 1961; 24: 82–6.

    Google Scholar 

  15. Richard G. Videoangiography: a new technique for the quantification of the retinal circulation. In: Lambrou GN, Greve EL (eds) Ocular blood flow in glaucoma. Kugler & Ghedini Publications, Amsterdam, pp 267–83, 1989

    Google Scholar 

  16. Klein R, Davis MD, Magli YL, Segal P, Klein BEK, Hubbard L. The Wisconsin age-related maculopathy grading system. Ophthalmology 1991; 98: 1128–34.

    Google Scholar 

  17. Zhao J, Lopez PF, Frambach DA, Lee PP. Retinal and choroidal circulation disturbances in glaucomatous eyes. Ophthalmology 1993; 113 Sept Suppl: 113.

    Google Scholar 

  18. Archer D, Krill AE, Newell FW. Fluorescein studies of normal choroidal circulation. Am J Ophthalmol 1970; 69: 543–54.

    Google Scholar 

  19. Hayreh SS. Physiological anatomy of the choroidal vascular bed. Int Ophthalmol 1983; 6: 85–93.

    Google Scholar 

  20. De Laey JJ. Fluorescein angiography of the choroid in health and disease. Int Ophthalmol 1983; 6: 125–38.

    Google Scholar 

  21. Dollery CT, Henkind P, Kohner EM, Paterson JW. Effect of raised intraocular pressure on the retinal and choroidal circulation. Invest Ophthalmol 1968; 7: 191–8.

    Google Scholar 

  22. Gaudric A, Coscas G, Bird AC. Choroidal ischemia. Am J Ophthalmol 1982; 94: 489–98.

    Google Scholar 

  23. Van Buskirk EM, Lessell S, Friedman E. Pigmentary epitheliopathy and erythema nodosum. Arch Ophthalmol 1971; 85: 369–72.

    Google Scholar 

  24. Foulds WS, Lee WR, Taylor WOG. Clinical and pathological aspects of choroidal ischaemia. Trans Ophthalmol Soc UK 1971;91: 323–41.

    Google Scholar 

  25. Korte GE, Reppucci V, Henkind P. RPE destruction causes choriocapillary atrophy. Invest Ophthalmol Vis Sci 1984; 25: 1135–45.

    Google Scholar 

  26. La Vail MM, Battelle BA. Influence of eye pigmentation and light deprivation on inherited retinal dystrophy in the rat. Exp Eye Res 1975; 21: 167–92.

    Google Scholar 

  27. Herron WL Jr, Riegel BW, Brennan E, Rubin ML. Retinal dystrophy in the pigment rat. Invest Ophthalmol 1974; 13: 87–94.

    Google Scholar 

  28. Bird AC, Marshall J. Retinal pigment epithelial detachments in the elderly. Trans Ophthalmol Soc UK 1986; 105: 674–82.

    Google Scholar 

  29. Chuang EL, Bird AC. The pathogenesis of tears of the retinal pigment epithelium. Am J Ophthalmol 1988; 105: 285–90.

    Google Scholar 

  30. Pauleikhoff D, Harper CA, Marshall J, Bird AC. Aging changes in Bruch's membrane: a histochemical and morphologic study. Ophthalmology 1990; 97: 171–8.

    Google Scholar 

  31. Pauleikhoff D, Barondes MJ, Minassian D, Chisholm IH, Bird AC. Drusen as risk factors in age-related macular disease. Am J Ophthalmol 1990; 109: 38–43.

    Google Scholar 

  32. Piguet B, Palmvang IB, Chisholm IH, Minassian D, Bird AC. Evolution of age-related macular degeneration with choroidal perfusion abnormality. Am J Ophthalmol 1992; 113: 657–63.

    Google Scholar 

  33. Chen JC, Fitzke FW, Pauleikhoff D, Bird AC. Functional loss in age-related Bruch's membrane change with choroidal perfusion defect. Invest Ophthalmol Vis Sci 1992; 33: 334–40.

    Google Scholar 

  34. Yannuzzi LA, Slakter JS, Sorenson JA, Guyer DR, Orlock DA. Digital indocyanine green Videoangiography and choroidal neovascularization. Retina 1992; 12: 191–223.

    Google Scholar 

  35. Lopez PF, Lambert HM, Grossniklaus HE, Sternberg P Jr. Well-defined subfoveal choroidal neovascular membranes in age-related macular degeneration. Ophthalmology 1993; 100: 415–22.

    Google Scholar 

  36. Hageman GS, Kirchoff-Rempe MA, Lewis GP, Fisher SK, Anderson DH. Sequestration of basic fibroblast growth factor in the primate retinal interphotoreceptor matrix. Proc Natl Acad Sci USA 1991; 88: 6706–10.

    Google Scholar 

  37. Grossniklaus HE, Martinez JA, Brown VB, Lambert HM, Sternberg P Jr, Capone A Jr, et al. Immunohistochemical and histochemical properties of surgically excised subretinal neovascular membranes in age-related macular degeneration. Am J Ophthalmol 1992; 114:464–72.

    Google Scholar 

  38. Yao N, Reynaud X, Dorey CK. Neovascularization correlates with area of a vascular retina in the rat model of ROP. Invest Ophthalmol Vis Sci 1993; 34 Suppl: 838.

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Authors and Affiliations

  1. Doheny Eye Institute and the Department of Ophthalmology, University of Southern California School of Medicine, 1450 San Pablo Street, 90033, Los Angeles, CA, USA

    Jialiang Zhao, Donald A. Frambach, Paul P. Lee, Martha Lee & Pedro F. Lopez

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  1. Jialiang Zhao
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  2. Donald A. Frambach
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  3. Paul P. Lee
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  4. Martha Lee
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  5. Pedro F. Lopez
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Zhao, J., Frambach, D.A., Lee, P.P. et al. Delayed macular choriocapillary circulation in age-related macular degeneration. Int Ophthalmol 19, 1–12 (1995). https://doi.org/10.1007/BF00156412

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  • DOI: https://doi.org/10.1007/BF00156412

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