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Multimodal imaging in deferoxamine retinopathy.

Francesco Viola1, Giulio Barteselli, Laura DellʼArti

  • 1Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, Cà Granda Foundation-Ospedale Maggiore Policlinico, Milan, Italy.

Retina (Philadelphia, Pa.)
|January 1, 2014
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Summary

Deferoxamine (DFO) retinopathy can cause various pattern dystrophy-like changes in the macula. Multimodal imaging reveals these changes are more widespread than initially apparent, often leading to retinal pigment epithelium atrophy.

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Area of Science:

  • Ophthalmology
  • Retinal Imaging
  • Pharmacology

Background:

  • Deferoxamine (DFO) is a crucial iron-chelating agent used in treating conditions like beta-thalassemia.
  • Long-term DFO therapy can lead to ocular toxicity, specifically DFO retinopathy, affecting the macula.
  • Understanding the clinical presentation and progression of DFO retinopathy is vital for patient management.

Purpose of the Study:

  • To characterize the macular lesions in patients with deferoxamine (DFO) retinopathy.
  • To monitor the clinical progression of these lesions using multimodal imaging techniques.

Main Methods:

  • Retrospective analysis of 20 patients with beta-thalassemia and DFO retinopathy (40 eyes) after at least 10 years of DFO treatment.
  • Utilized multimodal imaging: fundus photography, confocal laser scanning ophthalmoscopy (CLSO) with near-infrared reflectance (NIR) and fundus autofluorescence (FAF), and spectral domain optical coherence tomography (SD-OCT).

Main Results:

  • Fifty percent of patients exhibited pattern dystrophy-like changes (e.g., butterfly-shaped, fundus flavimaculatus-like, fundus pulverulentus-like, vitelliform-like).
  • The other fifty percent showed minimal macular changes and were significantly younger.
  • CLSO and SD-OCT revealed more diverse and widespread abnormalities than ophthalmoscopy, involving outer retina or Bruch membrane-RPE complex.
  • Follow-up showed progressive RPE atrophy in areas with pattern dystrophy-like changes.

Conclusions:

  • DFO retinopathy presents with diverse pattern dystrophy-like or minimal changes affecting the RPE-Bruch membrane-photoreceptor complex.
  • Multimodal imaging highlights the extensive nature of fundus changes, often underestimated by ophthalmoscopy.
  • Histologic findings are consistent with multimodal imaging, implicating retinoids, fluorophores, and RPE abnormalities, ultimately leading to RPE atrophy.