Nahinfrarot-Autofluoreszenz: klinische Anwendung und diagnostische Relevanz

Zusammenfassung

Die Nahinfrarot-Autofluoreszenz (NIA) ist ein nicht-invasives Verfahren zur Untersuchung des retinalen Pigmentepithels (RPE) basierend auf der Darstellung des antioxidativen Schutzfaktors Melanin in den RPE-Zellen. Die NIA verbessert die Früherkennung chorioretinaler Erkrankungen, da bei vielen dieser Erkrankungen mit der NIA Strukturveränderungen des RPE nachweisbar sind, bevor sich in anderen Untersuchungen Krankheitszeichen erkennen lassen.

Abstract

Near-infrared autofluorescence (NIA) is a non-invasive retinal imaging technique for examination of the retinal pigment epithelium (RPE) based on the autofluorescence of melanin. Melanin has several functions within the RPE cells, in one of them it serves as a protective antioxidative factor within the RPE cells and is involved in the phagocytosis of photoreceptor outer segments. Disorders that affect the photoreceptor-RPE complex result in alterations of RPE cells which are detectable by alterations of NIA. Therefore, NIA allows to detect early alterations in inherited and acquired chorioretinal disorders, frequently prior to ophthalmoscopical visualisation and often prior to alterations in lipofuscin associated fundus autofluorescence (FAF) or optical coherence tomography (OCT). Although NIA and FAF relate to disorders affecting the RPE, findings between both imaging methods differ and the area involved has been demonstrated to be larger in NIA compared to FAF in several disorders (e.g., age-related macular degeneration, retinitis pigmentosa, ABCA4-gene associated Stargardt disease and cone-rod dystrophy, light damage), indicating that NIA detects earlier alterations compared to FAF. In addition, due to the absence of blue-light filtering which limits foveal visualisation in FAF, foveal alterations can be much better detected using NIA. A reduced subfoveal NIA intensity is the earliest sign of autosomal dominant BEST1-associated disease, when FAF and OCT are still normal. In other disorders, a normal subfoveal NIA intensity is associated with good visual acuity. This review summarizes the present knowledge on NIA and demonstrates biomarkers for various chorioretinal disorders.

Kernaussagen

• Die Nahinfrarot-Autofluoreszenz (NIA) ist eine nichtinvasive Untersuchungstechnik, welche auf den fluorophoren Eigenschaften des Melanins in den RPE-Zellen basiert und dadurch Veränderungen des Melanin-Gehalts im retinalen Pigmentepithel (RPE) darstellen kann.

• Die NIA ist eine für den Patienten wenig belastende retinale Bildgebung und kann daher auch bei Kindern oder stark blendungsempfindlichen Personen gut durchgeführt werden.

• Die NIA ermöglicht es, Veränderungen im RPE bei allen Erkrankungen mit Beteiligung des Photorezeptor-RPE-Komplexes darzustellen.

• Eine normale NIA ist gekennzeichnet durch eine subfoveal hohe Intensität, die zum Rand der Makula abnimmt und dann nach peripher gleichmäßig bleibt.

• Die NIA kann, wegen der fehlenden Blockade durch makuläres Pigment, Läsionen in der Fovea besser darstellen als die FAF.

• Sowohl bei erworbenen als auch hereditären chorioretinalen Erkrankungen zeigen sich korrespondierend zu Veränderungen der NIA meistens auch Veränderungen in der FAF und der OCT. Die Veränderungen in diesen drei Techniken basieren auf unterschiedlichen pathophysiologischen Mechanismen. Sie zeigen daher unterschiedliche und teils deutlich divergente Phänomene.

• Eine normale subfoveale NIA-Intensität korreliert in der Regel mit einem guten Visus.

• Eine reduzierte NIA-Intensität ist bei vielen Erkrankungen das früheste oder eines der frühesten Krankheitszeichen. Insofern ist die betroffene Region in der NIA in der Regel größer als in der FAF und auch der OCT.

• Beim Morbus Best ist eine zentral reduzierte NIA-Intensität das früheste und möglicherweise lebenslang einzige Zeichen einer Manifestation.

Schlüsselwörter

nichtinvasive retinale Bildgebung - Nahinfrarot-Autofluoreszenz - retinales Pigmentepithel - Photorezeptoren - retinale Erkrankungen

Key words

non-invasive retinal imaging - near-infrared fundus autofluorescence - retinal pigment epithelium - photoreceptors - retinal disorders

Publication History

Article published online:
24 May 2022

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