gms | German Medical Science

23rd Annual Meeting of the German Retina Society

German Retina Society

24.09. - 25.09.2010, Freiburg

High-risk Fundus Autofluorescence Phenotype in Aeographic Atrophy – Spectral domain OCT characteristics

Meeting Abstract

  • Monika Fleckenstein - University Eye Clinic Bonn
  • S. Schmitz-Valckenberg - University Eye Clinic Bonn
  • S. Kosanetzky - University Eye Clinic Bonn
  • C. Martens - University Eye Clinic Bonn
  • C. K. Brinkmann - University Eye Clinic Bonn
  • F. G. Holz - University Eye Clinic Bonn

German Retina Society. 23rd Annual Conference of the German Retina Society. Freiburg i. Br., 24.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10rg06

doi: 10.3205/10rg06, urn:nbn:de:0183-10rg065

This is the translated version of the article.
The original version can be found at:

Published: September 21, 2010

© 2010 Fleckenstein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Patterns of abnormal fundus autofluorescence (FAF) in the perilesional zone of geographic atrophy (GA) in AMD serve as predictors for individual disease progression. The "diffuse-trickling" phenotype thereby shows the highest progression rate (Holz et al. AJO 143:463-72, 2007). In this study, morphological alterations of thei high-risk phenotype are analysed by spectral domain (SD)-OCT.

Methods: Thirty-six eyes of twenty patients (mean age 64.6±9.3 years) with the “diffuse-trickling” phenotype were examined by simultaneous SD-OCT and confocal scanninglaser ophthalmoscopy (Spectralis, Heidelberg Engineering). Progression rate of atrophy lesions was measure by semi-automated image processing. Morphological alterations in the perilesional zone, at the GA border, and eithin the atrophic lesion were quantitatively analysed.

Results: Eye with the “diffuse-trickling” phenotype, exhibited a ‘splitting’ of SD-OCT band 4 (retinal pigment epithelium [RPE]/Bruchs membrane [BM]), that was most obvious directly at the border but also in distance to the atrophic lesion. Within the atrophy, in extension of the inner part of band 4, there was a fine discontinues band, that faded with the distance to the border and with time, respectively. A splitting of band 4 was detected in a minority of eyes with other GA phenotypes, but, when seen this was less widespread and less pronounced.

Discussion: The characteristic finding in the “diffuse-trickling” phenotype – the splitting of OCT band 4 – may be due to excessive, widespread accumulation of sub-pigmentepithelial material. Possible morphological correlate are “basal laminar deposits” (BLamD) which could previously not be visualized in vivo. Their vertical extent may correlate with the degree of RPE- and photoreceptor degeneration and they may persist within the atrophic lesion. Excessive BLamD accumulation may induce aggressive GA progression with time and may therefore explain phenotypic characteristics of the “diffuse-trickling” phenotype.