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W.M. Haddad, G. Coscas, F. Coscas, M. Papp, G. Mimoun, E. Souied, G. Soubrane; The Second Eye in Exudative Age-Related Macular Degeneration With Choroido-Retinal Anastomosis: Natural History and Follow-Up . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4991.
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Purpose : To analyze the second eye of patients with exudative age-related macular degeneration (AMD) and choroido-retinal anastomosis (CRA) and/or retinal angiomatous proliferation (RAP); to identify any potential correlations between the disease phenotype in the first eye and the clinical features in the second eye; to assess the risk factors for the development of any choroidal or retinal neovascularization in such eyes. Methods : Ophthalmoscopy and fluorescein angiography (FA) as well as indocyanine green angiography (ICG-A) using a Scanning Laser Ophthalmoscope were performed at baseline in the second eye of patients with AMD and CRA and/or RAP in one eye. These examinations were repeated each 3-month period during follow-up. The following findings were recorded at each examination: presence, number and type of drusen and of retinal pigment epithelium (RPE) abnormalities, presence of a CRA, presence of a RAP, presence and development of choroidal neovascularization (CNV), presence of a RPE detachment (PED), presence and extent of geographic atrophy (GA). Results : Up to December 1st, 2002, baseline findings were available for a consecutive series of 44 patients. In 12 out of 44 second eyes (27%), a disciform scar was already present. Overall, angiographic findings suggesting a CRA were identified in 12 out of 15 second eyes (80%) that developed exudative AMD during a mean follow-up period of 16.15 months (range 6 - 57 months). In 3 second eyes (7%) with a recent onset of visual symptoms, a vascularized PED was identified at baseline on FA and ICG-A, with a CRA detected in 2 out of 3 eyes. In another 9 asymptomatic second eyes (20%) with a visual acuity ranging between 20/40 and 20/20, exudative changes also were identified at baseline with a CRA suspected in 8 out of 9 eyes. In all remaining 20 second eyes without any exudative sign at baseline, at least 5 serous drusen associated with areas of pigmentary changes were identified in the central 3000µ macular area. Advanced AMD developed in 5 of these 20 eyes (25%) during follow-up including geographic atrophy in 2 eyes, PED with CRA in 2 eyes and a massive subretinal and vitreous hemorrhage in 1 eye. The study is still ongoing. Conclusions : These findings suggest that careful angiographic examination is particularly required at baseline for the second eye of patients with exudative AMD and CRA in one eye considering the high incidence (20%) of exudative changes without any visual symptom at this stage. Moreover, during follow-up, CRA seems to be in most cases (80%) a bilateral feature in patients with exudative AMD.
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