Monitoring macular pigment changes in macular holes using fluorescence lifetime imaging ophthalmoscopy

Lydia Sauer; Sven Peters; Johanna Schmidt; Dietrich Schweitzer; Matthias Klemm; Lisa Ramm; Regine Augsten; Martin Hammer

doi:10.1111/aos.13269

Monitoring macular pigment changes in macular holes using fluorescence lifetime imaging ophthalmoscopy

Acta Ophthalmol. 2017 Aug;95(5):481-492. doi: 10.1111/aos.13269. Epub 2016 Oct 24.

Authors

Lydia Sauer¹, Sven Peters¹, Johanna Schmidt¹, Dietrich Schweitzer¹, Matthias Klemm², Lisa Ramm³, Regine Augsten¹, Martin Hammer^{1

4}

Affiliations

¹ Department of Ophthalmology, University Hospital Jena, Jena, Germany.
² Institute of Biomedical Engineering and Informatics, Technical University Ilmenau, Ilmenau, Germany.
³ Department of Ophthalmology, University Hospital Carl-Gustav Carus, TU Dresden, Germany.
⁴ Center for Medical Optics and Photonics, University of Jena, Jena, Germany.

PMID: 27775222
DOI: 10.1111/aos.13269

Abstract

Purpose: To investigate the impact of macular pigment (MP) on fundus autofluorescence (FAF) lifetimes in vivo by characterizing full-thickness idiopathic macular holes (MH) and macular pseudo-holes (MPH).

Methods: A total of 37 patients with MH and 52 with MPH were included. Using the fluorescence lifetime imaging ophthalmoscope (FLIO), based on a Heidelberg Engineering Spectralis system, a 30° retinal field was investigated. FAF decays were detected in a short (498-560 nm; ch1) and long (560-720 nm; ch2) wavelength channel. τ_m , the mean fluorescence lifetime, was calculated from a three-exponential approximation of the FAF decays. Macular coherence tomography scans were recorded, and macular pigment's optical density (MPOD) was measured (one-wavelength reflectometry). Two MH subgroups were analysed according to the presence or absence of an operculum above the MH. A total of 17 healthy fellow eyes were included. A longitudinal FAF decay examination was conducted in nine patients, which were followed up after surgery and showed a closed MH.

Results: In MH without opercula, significant τ_m differences (p < 0.001) were found between the hole area (MHa) and surrounding areas (MHb) (ch1: MHa 238 ± 64 ps, MHb 181 ± 78 ps; ch2: MHa 275 ± 49 ps, MHb 223 ± 48 ps), as well as between MHa and healthy eyes or closed MH. Shorter τ_m , adjacent to the hole, can be assigned to areas with equivalently higher MPOD. Opercula containing MP also show short τ_m . In MPH, the intactness of the Hele fibre layer is associated with shortest τ_m .

Conclusions: Shortest τ_m originates from MP-containing retinal layers, especially from the Henle fibre layer. Fluorescence lifetime imaging ophthalmoscope (FLIO) provides information on the MP distribution, the pathogenesis and topology of MH. Macular pigment (MP) fluorescence may provide a biomarker for monitoring pathological changes in retinal diseases.

Keywords: FLIO; fluorescence lifetime imaging; macular holes; macular pigment.

MeSH terms

Aged
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Macula Lutea / pathology*
Male
Monitoring, Physiologic / methods*
Ophthalmoscopy / methods*
Prospective Studies
Reproducibility of Results
Retinal Perforations / diagnosis*
Retinal Pigment Epithelium / pathology*
Tomography, Optical Coherence / methods
Visual Acuity