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Deborah Witkin, John Sanderson, Daniela Ferrara, Elias Reichel; Disease Activity in Disciform Scars due to Age-Related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2013;54(15):4094. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
End-stage AMD often develops into a disciform scar, considered clinically stable. Data suggest, however, that disease activity may persist regardless of scar formation. The goal of this study is to analyze incidence of disease progression indicated by hemorrhage, lipid exudate, atrophy, and fibrosis in disciform scars over time.
Medical records from patients diagnosed with AMD from 2009 to 2012 were reviewed. Patients with macular disciform scars with ≥10 months follow-up were included. Exclusion criteria were: history of other macular pathology or retinal disease, poor image quality, or inability to evaluate the entire lesion. Color fundus photos were analyzed by two independent observers for progression. A progression event was defined as increase in area of atrophy, increase in area of fibrosis, lipid exudate in a new location, or hemorrhage in a new location compared to baseline photos.
1148 charts were reviewed and 128 eyes of 115 patients met the study criteria and were analyzed. Patients were seen on average every 5.85±7.85 months and were followed for an average of 3.8±1.7 years. Seventy-seven eyes (60%) had at least one event. Mean time from baseline to first event was 1.8±1.2 years, and eyes with multiple events were more likely to have the first event occur earlier (P = .0035, mean 1.4±0.9 years). 19 eyes (15%) had more than one type of event (lipid exudate, fibrosis, or hemorrhage). Only eyes with hemorrhage had more than three events. Mean time to 1st hemorrhage was 1.8±1.4 years and then occurred approximately yearly for subsequent events. Eyes were also evaluated for presence of 360° of atrophy around the scar. Eyes with 360° atrophy were 46.0% less likely to have increased fibrosis, new exudate, or new hemorrhage than eyes without atrophy (relative risk = 0.540, p=.002, 13 of 77 eyes with progression vs. 22 of 51 eyes without progression showed 360° atrophy) .
Disease activity occurs in eyes with disciform scars. Hemorrhage is the most common sign of activity and has a tendency to recur. After presentation of the first hemorrhage, they are likely to recur approximately yearly. Patients who show increased area of atrophy over time are unlikely to show increased fibrosis, hemorrhage, or lipid exudation. Presence of 360°atrophy around the scar may have a protective effect against development of hemorrhage, lipid exudate, or fibrosis.
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