Subretinal autofluorescent deposits: A review and proposal for clinical classification.

Survey of ophthalmology(2023)

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Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence (FAF). We tdescribe SADs according to their putative pathophysiological origin, but also according to their clinical pattern, i.e. number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium (RPE) phagocytic capacity, with direct or indirect RPE injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the RPE and the photoreceptor outer segments. However, clinically, they could be classified into eight subclasses of SADs, as observed on FAF as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or non-patterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely-available short-wavelength FAF could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
subretinal autofluorescent deposits,clinical classification
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