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L. M. Smithen, J. S. Duker, E. Reichel, A. H. Rogers, C. R. Baumal, J. M. Seddon; Speckled Hyperpigmentation as a Positive Prognostic Indicator in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):236.
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To report the appearance of speckled hyperpigmentation at the onset of neovascular age-related macular degeneration (ARMD) as a positive prognostic indicator.
Patients with a particular appearance of speckled hyperpigmentation at the conversion from dry to wet ARMD were identified. Patients who received prior laser or photodynamic therapy and those with diabetic retinopathy or a history of central serous chorioretinopathy were excluded. A comparative group of patients without speckled hyperpigmentation was selected at random from known neovascular ARMD patients. Visual acuity (VA) and central foveal thickness (CFT) as measured on optical coherence tomography (OCT) were noted at the onset of neovascular ARMD and at follow-up.
Group A consisted of 10 eyes of 10 patients with a particular appearance of speckled hyperpigmentation (7 women, 3 men; average age 79.6 years; mean follow-up of 476.9 days). The mean number of intravitreal ranibizumab injections was 4.1; average injection interval of 116.3 days. Average VA at conversion was logMar 0.36 with a CFT of 277.7µ. Average VA at the most recent visit was logMar 0.30 with a mean CFT of 203.7µ. Eight patients had no fluid at their most recent visit. Group B consisted of 10 eyes of 10 patients without speckled hyperpigmentation at conversion (7 women, 3 men; average age 84.3 years; mean follow-up 457.4 days). A mean of 5.1 injections were administered at an average interval of 89.7 days. Average VA at conversion was logMar 0.80 with a CFT of 315.7µ. The average VA at most recent exam was logMar 1.16 with a CFT of 227.4µ. Three patients had no fluid at the most recent visit. There was a statistically significant difference in presenting VA (p<0.01), final VA (p<0.01), and change in visual acuity (p<0.01) demonstrating that the speckled hyperpigmentation patients had a better presenting VA, better final VA, and had better preservation of vision. There was a small but not statistically significant difference in presenting and final CFT.
Speckled hyperpigmentation at the onset of neovascular ARMD may portend a good visual prognosis.
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