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Monika Fleckenstein, Steffen Schmitz-Valckenberg, Christine Martens, Sebastian Kosanetzky, Paulina Haas, Rolf Fimmers, Frank G. Holz, FAM Study Group; Geographic Atrophy associated with the "Diffuse-Trickling" Fundus Autofluorescence Pattern. Invest. Ophthalmol. Vis. Sci. 2012;53(14):851.
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To further characterize patients with geographic atrophy (GA) exhibiting the "diffuse-trickling" (DT) pattern on fundus autofluorescence (FAF) imaging (Fleckenstein et al. Invest Ophthalmol Vis Sci. 2011;52(6):3761-6). Discriminating features from other patterns include a multi-lobular appearance and rapid enlargement of atrophic areas.
In the context of the Fundus Autofluorescence in Age-related Macular Degeneration (FAM) Study (NCT00393692) patients with DT-GA in at least one eye were examined including simultaneous confocal scanning-laser-ophthalmoscopy and spectral-domain optical coherence tomography (SD-OCT) imaging (Spectralis HRA+OCT, Heidelberg Engineering). Subfoveal choroidal thickness (SCT) measurements were performed in SD-OCT images and the cardiovascular profile was recorded. Data on age, gender distribution, smoking history, and systemic diseases, respectively, were compared to FAM study patients (n=288, mean age at first examination 75.4 ± 8.1 years, 60.1% female) with other abnormal FAF patterns ("non diffuse-trickling"-NDT).
Patients with DT-GA (n=61, 63.9% female) had a mean age of 68.3 ± 11.7 years at first examination. Mean SCT in a subset of patients with available data (n=42) was 137.7 ± 55.3µm. Medical history assessment revealed that in the age group <65, 66.7% of female patients had a history of stage 2 hypertension and 54.2% of patients had been hospitalized due to severe cardiovascular diseases. Comparison with NDT-GA patients revealed a significantly younger age (p<0.001), a disproportional decline in the male study population from 55.2% in the age group <65 to 18.8% in the age group ≥65, and a significantly higher myocardial infarction rate in the age group <65 (p=0.011) in DT-GA patients.
The findings indicate an association of the DT-GA subtype with systemic cardiovascular diseases. Together with the ocular morphological characteristics including a reduced choroidal thickness, a vascular insufficiency may play a pathogenetic role. Identification of the DT-GA phenotype in natural history and interventional studies using appropriate imaging modalities may be prudent to further explore discriminating etiologic factors.
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