{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:31:00Z","timestamp":1702513860752},"reference-count":38,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Monbl Augenheilkd"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Hintergrund Bei der geografischen Atrophie (GA) im Rahmen einer altersabh\u00e4ngigen Makuladegeneration (AMD) entwickelt sich ein Verlust an Photorezeptoren (PR), retinalem Pigmentepithel (RPE) und Choriokapillaris (CC). F\u00fcr therapeutische Ans\u00e4tze ist es entscheidend, welche morphologische Struktur bei einem individuellen Patienten prim\u00e4r gesch\u00e4digt ist und dann sekund\u00e4re Sch\u00e4digungsprozesse initiiert. Wurde bisher das RPE mit seiner Lipofuszinakkumulation als prim\u00e4r gesch\u00e4digte und zum Untergang \u201everdammte\u201c Struktur bei der Entwicklung einer GA angesehen, so zeigte sich in histologischen Studien, dass bei einigen Patienten prim\u00e4r die Photorezeptoren untergehen mit sekund\u00e4rem Verlust an RPE und CC oder aber auch prim\u00e4r eine CC-Regression vorliegen kann. Ziel der vorliegenden Studie war es, mittels multimodaler Bildgebung das Ausma\u00df der Sch\u00e4digung auf der Ebene der PR, des RPE und der CC zu bestimmen, individuelle ph\u00e4notypische Variationen der GA zu charakterisieren\n\t\t\t\t\tund die korrespondierenden funktionellen Ver\u00e4nderungen zu untersuchen.<\/jats:p><jats:p>\n          Patienten und Methode Bei 20 Augen von 20 Patienten (mittleres Alter 78 Jahre; 14 weiblich, 6 m\u00e4nnlich) mit der klinischen Diagnose einer GA wurden Fundusautofluoreszenzaufnahmen (FAF-Aufnahmen) zur Beurteilung des RPE-Schadens, SD-OCT-En-face-Aufnahmen auf der Ebene der PR zur Charakterisierung des PR-Schadens und eine OCT-Angiografie (OCT-A) AngioVue, Optovue, 50\u2009\u00b5m CC-Segmentierung mit Lokalisation unterhalb des RPE zur Beurteilung einer Regression der Choriokapillaris vorgenommen. Die entsprechenden Fl\u00e4chen des ver\u00e4nderten Areals wurden in den entsprechenden Schichten vermessen. Bei allen Patienten wurde zudem der Visus bestimmt und eine automatische standardisierte 10\u00b0-Mikroperimetrie (MAIA-Mikroperimeter, CENTERVUE; 4-2-Strategie, 68 Untersuchungspunkte) durchgef\u00fchrt. Die Ergebnisse dieser Untersuchungen wurden evaluiert und miteinander korreliert.<\/jats:p><jats:p>\n          Ergebnisse Alle Augen zeigten eine unterschiedliche Ausdehnung der jeweils atrophen Areale im Bereich der PR, des RPE und der CC. Bei einer Differenzierung der Gesamtgruppe in Bezug auf das jeweils gr\u00f6\u00dfte atrophe Areal war bei 13 Augen (65%) das gr\u00f6\u00dfte atrophe Areal auf Ebene des RPE zu beobachten. Bei 3 Augen (15%) war das gr\u00f6\u00dfte atrophe Areal in der PR-Schicht und bei 4 Augen (20%) auf Ebene der CC zu finden. W\u00e4hrend die Visusminderung allein vom Vorhandensein einer fovealen Restinsel abhing, wiesen die mikroperimetrischen Ergebnisse eine Korrelation zwischen dem Ausma\u00df des nachweisbaren funktionellen Defizits und dem jeweils gr\u00f6\u00dften atrophen Areal auf.<\/jats:p><jats:p>\n          Schlussfolgerungen Die multimodale Bildgebung mittels FAF, En-face-OCT, OCT-A und die Korrelation mit der Mikroperimetrie als funktioneller Parameter erm\u00f6glichen klinisch eine ph\u00e4notypische Differenzierung der GA sowie eine pr\u00e4zisere Charakterisierung der funktionellen Auswirkungen. Sie best\u00e4tigt klinisch die histologisch aufgezeigten Unterschiede der am \u201eintensivsten\u201c gesch\u00e4digten Struktur (PR, RPE oder CC) bei der klinischen Diagnose GA. Die in dieser Pilotstudie aufgezeigten Unterschiede m\u00fcssen allerdings in Reading-Center-basierten gr\u00f6\u00dferen Kohorten best\u00e4tigt werden. Sie h\u00e4tten allerdings zentrale Auswirkungen f\u00fcr die Ansatzpunkte, Patientenselektion und klinische Outcome Measures f\u00fcr zuk\u00fcnftige Behandlungsstudien bei der GA.<\/jats:p>","DOI":"10.1055\/a-1002-0006","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T00:23:32Z","timestamp":1574814212000},"page":"166-172","source":"Crossref","is-referenced-by-count":2,"title":["Gibt es unterschiedliche Ph\u00e4notypen bei der geografischen Atrophie der AMD? \u2013 Pilotstudie zur Differenzierung mittels multimodaler Bildgebung"],"prefix":"10.1055","volume":"238","author":[{"given":"Ioannis","family":"Papapostolou","sequence":"additional","affiliation":[{"name":"Retinologie, Augenzentrum am St.\u00a0Franziskus-Hospital M\u00fcnster, M\u00fcnster"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albrecht Peter","family":"Lommatzsch","sequence":"additional","affiliation":[{"name":"Retinologie, Augenzentrum am St.\u00a0Franziskus-Hospital M\u00fcnster, M\u00fcnster"},{"name":"Retinologie, Achim Wessing Institute of Ophthalmological Diagnostic (AWIO), Essen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Louise","family":"Farecki","sequence":"additional","affiliation":[{"name":"Retinologie, Augenzentrum am St.\u00a0Franziskus-Hospital M\u00fcnster, M\u00fcnster"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Ziegler","sequence":"additional","affiliation":[{"name":"Retinologie, Augenzentrum am St.\u00a0Franziskus-Hospital M\u00fcnster, M\u00fcnster"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Gutfleisch","sequence":"additional","affiliation":[{"name":"Retinologie, Augenzentrum am St.\u00a0Franziskus-Hospital M\u00fcnster, M\u00fcnster"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Pauleikhoff","sequence":"additional","affiliation":[{"name":"Retinologie, Augenzentrum am St.\u00a0Franziskus-Hospital M\u00fcnster, M\u00fcnster"},{"name":"Retinologie, Universit\u00e4tsaugenklinik Essen der Universit\u00e4t Essen-Duisburg, Essen"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,11,26]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"4982","DOI":"10.1167\/iovs.09-3639","article-title":"Relationship between RPE and choriocapillaris in age-related macular degeneration","volume":"50","author":"D S McLeod","year":"2009","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"4372","DOI":"10.1167\/iovs.12-11525","article-title":"Multimodal assessment of microscopic morphology and retinal function in patients with geographic atrophy","volume":"54","author":"A Panorgias","year":"2013","journal-title":"Invest Ophthalmol Vis 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