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C.N. Keilhauer, W.F. Schrader, A. Bindewald, F.G. Holz, FAM–Study Group; Peripapillary Atrophy in Age–related Macular Degeneration (AMD) . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3078.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare the prevalence and characteristics of peripapillary atrophy (PPA) in various AMD phenotypes and normal controls. Methods: Digital fundus autofluorescence (FAF) images were recorded with a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph, Heidelberg Engineering, Germany; exc 488nm, em >500nm). 149 patients with geographic atrophy (GA), 123 patients with RPE mottling, 117 patients with drusen, and 108 age–matched normal subjects were examined. Additionally, 132 younger normal subjects below 55 years of age were analyzed. Myopic eyes were excluded. FAF variations associated with PPA were classified into four patterns: conus–shaped with unremarkable margins, peripapillary border with homogeneously increased FAF, speckled FAF variations in the junctional zone, and lace–like peripapillary FAF pattern.. Results: While 142 (95%) patients with GA had PPA, this was seen in 74 (69 %) of the age–matched control group (p<0.001), in 111 (90%) patients with RPE mottling ( p<0.001) and in 91 (78%) patients in the drusen group. PPA was more commonly associated with GA and RPE mottling compared to eyes with drusen only (p<0.01). The PPA subtype with homogeneously increased FAF was present in 15% of the GA patients, in 10% of RPE mottling group, in 26% of the drusen group, and in 29% of the age–matched controls. PPA in the young control group was noted in 71 (54%) eyes, and thus significantly less frequent compared to 69% of the older controls (p<0.02). Homogeneously increased FAF was seen in 38% of all young controls. Conclusion: The results indicate a high prevalence of PPA in various AMD phenotypes. Compared to older controls, younger normal subjects exhibit PPA less frequently, while a homogeneously increased FAF pattern is more common in the latter group. Excessive lipofuscin accumulation in the RPE as indicated by elevated FAF signals may precede development of GA. In contrast to GA and RPE mottling, both frequency and type of PPA in the drusen subgroup resembles normal age–related controls. PPA appears to represent a feature of both normal aging and RPE degeneration in association with age–related macular disease. The underlying molecular mechanisms for the similar pathology at two remote retinal sites, i.e. macular and peripapillary area, remain to be elucidated.
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