Manfred Spitznas
Understanding Fluorescein Angiography Fluoreszeinangiografie verstehen
Entendiendo Angiograf´ıa con Fluoresce´ına
Manfred Spitznas
Understanding Fluorescein Angiography
Fluoreszeinangiografie verstehen
Entendiendo Angiograf´ıa con Fluoresce´ına
Traducci´on: Hugo Quiroz-Mercado
With 58 Figures in 180 Parts
Prof. Dr. Manfred 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
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Contents
Basic facts . . . . 3
Normal central retinal capillaries . . . . 4
Normal peripheral retinal capillaries . . . . 6
Plugged peripheral retinal capillaries . . . . 8
Optical phenomena . . . 11
Transparency of neurosensory retina . . . 12
Normal Transparent structures . . . 14
Decreased Post mortem . . . 16
Blood . . . 18
Melanin . . . 26
Transparency of retinal pigment epithelium . . . 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
Transparency of Bruch’s membrane . . . 46
Normal Elastic layer . . . 48
Increased Angioid streaks . . . 52
Mechanical phenomena . . . 55
Attachment of retinal pigment epithelium . . . 56 V
Normal
Hemidesmosomes . . . 58
Disturbed Pigment epithelial detachment . . . 60
Dynamic phenomena . . . 63
Morphologic and physiologic basis . . . 64
Capillary pores, zonulae occludentes . . . 66
Permeability of retinal vessels . . . 68
Normal Zonulae occludentes . . . 70
Pathologic . . . 72
Open zonulae occludentes . . . 74
Endothelial cell loss . . . 78
Pores . . . 80
Permeability of choroidal vessels . . . 84
Normal Pores . . . 86
Zonulae occludentes . . . 90
Pathologic . . . 92
Permeability of retinal pigment epithelium . . . 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
Normale zentrale Netzhautkapillaren . . . . 4
Normale periphere Netzhautkapillaren . . . . 6
Verstopfte periphere Netzhautkapillaren . . . . 8
Optische Phänomene . . . 10
Transparenz der Neuroretina . . . 12
Normal Transparente Strukturen . . . 14
Vermindert Postmortal . . . 16
Blut . . . 18
Melanin . . . 26
Transparenz des retinalen Pigmentepithels . . . 28
Normal Melaningranula . . . 30
Vermindert Makula . . . 32
RPE-Hypertrophie . . . 34
Aderhautfalten . . . 36
Aderhautnaevi . . . 38
Vermehrt Drüsen . . . 40
Narben, degenerative Prozesse . . . 44
Transparenz der Bruch-Membran . . . 46
Normal Elastische Schicht . . . 48
Vermehrt Gefäßähnliche Streifen . . . 52
Mechanische Phänomene . . . 55
Anheftung des retinalen Pigmentepithels . . . 56 VII
Normal
Hämidesmosomen . . . 58
Gestört Pigmentepithelabhebung . . . 60
Dynamische Phänomene . . . 63
Morphologische und physiologische Grundlagen . . . 64
Kapillarporen, Zonulae occludentes . . . 66
Permeabilität der Netzhautgefäße . . . 68
Normal Zonulae occludentes . . . 70
Pathologisch . . . 72
Geöffnete Zonulae occludentes . . . 74
Endothelzellverlust . . . 78
Poren . . . 80
Permeabilität der Aderhautgefäße . . . 84
Normal Poren . . . 86
Zonulae occludentes . . . 90
Pathologisch . . . 92
Permeabilität des retinalen Pigmentepithels . . . 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
Capilares centrales de la retina normales . . . . 4
Capilares perif´ericos de la retina normales . . . . 6
Capilares perif´ericos de la retina ocluidos . . . . 8
Fen´omenos ´opticos . . . 11
Transparencia de la retina neurosensorial . . . 12
Normal Estructuras transparentes . . . 14
Disminuida Post mortem . . . 16
Sangre . . . 18
Melanina . . . 26
Transparencia del epitelio pigmentado de la retina . . . 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
Transparencia de la membrana de Bruch . . . 46
Normal Capa el´astica . . . 48
Aumentada Estrias angioides . . . 52
Fen´omenos mec´anicos . . . 55
Adherencia del epitelio pigmentado de la retina . . . 56 IX
Normal
Hemidesmosomas . . . 58
Alterada Despegamiento del epitelio pigmentado . . . 60
Fen´omenos din´amicos . . . 63
Bases morfol´ogicas y fisiol´ogicas . . . 64
Poros de capilares, zonulae occludentes . . . 66
Permeabilidad de vasos retinianos . . . 68
Normal Zonulae occludentes . . . 70
Patol´ogica . . . 72
Zonulae occludentes abiertas . . . 74
P´erdida de c´elulas endoteliales . . . 78
Poros . . . 80
Permeabilidad de vasos coroideos . . . 84
Normal Poros . . . 86
Zonulae occludentes . . . 90
Patol´ogica . . . 92
Permeabilidad del epitelio pigmentado de la retina . . . 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.
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