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H.S. Reddy, J.I. Loewenstein, A. Lane, L. Shen; Peripapillary Choroidal Neovascularization . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3077.
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Purpose: To investigate the natural history and treatment of peripapillary choroidal neovascularization (PCNV) and to examine whether PCNV is a distinct entity from age–related macular degeneration (AMD). Methods: Chart review and retrospective case–control comparison were done. Cases were patients over 50 with peripapillary membranes of idiopathic etiology (not associated with trauma, angioid streaks, POHS etc). Controls were patients older than age 50 with foveal CNV due to AMD. Part I: For the 68 PCNV eyes (60 patients), visual acuity, presence of blood/fluid/lipid, membrane features (size, occult/classic, proximity to fovea) were recorded at initial visit. Treatment and visual acuity at the final visit were recorded. Predictors and outcomes of treatment were analyzed using logistic and Cox regression techniques. Part II: The fellow eyes of 50 unilateral PCNV patients were compared to the fellow eyes of 62 control patients. The following data were obtained from fundus photographs/FA's: #drusen, drusen type and size, focal hyperpigmentation, geographic atrophy, RPE detachment, and foveal CNV. Smoking history, hypertension, and hyperlipidemia were also recorded. Results:Part I: Fluid, blood, or lipid was present in 97% of PCNV cases and extended into the fovea in 38% of eyes. The mean initial membrane size was 4.1 MPS disc areas. 75% of eyes had occult membranes while 25% had classic CNV. 35 cases (52%) of eyes received treatment,and laser was the primary modality(29 cases) followed by PDT(4 cases) and surgery (2 cases). The only significant predictor of treatment was membrane proximity to the fovea(p=0.03). Membranes less than 6 disc areas were somewhat more likely to be treated (p=0.08). Age–adjusted Cox regression models showed that treated eyes were no different from untreated eyes in progression to visual loss. Proximity to fovea was a risk factor for blindness (p=0.04) and membrane size approached significance as a risk factor for >2 line visual loss (p=0.10). Part II: The fellow eyes of controls were more likely to have drusen (68%) than those of cases (46%, p=0.02). There was no difference between cases and controls in drusen type, geographic atrophy, RPE detachment, foveal CNV, or prevalence of hypertension, hyperlipidemia, and smoking history. Conclusions: Idiopathic PCNV is typically occult and does not drastically affect visual acuity until near the fovea(< 750 u). Therefore most peripapillary lesions should be conservatively managed. This study shows that PCNV shares ocular and systemic risk factors with wet AMD suggesting that they may be in the same spectrum of disease.
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