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Anne Sikorav, Oudy Semoun, Sandrine A Zweifel, Eric H Souied; Incidence and quantification of geographic atrophy associated with neovascular age related macular degeneration at initial presentation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4940.
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© ARVO (1962-2015); The Authors (2016-present)
To identify and quantify geographic atrophy (GA) associated with neovascular age related macular degeneration (AMD) at initial presentation using a novel fundus autofluorescence (FAF) semi-automated software and to correlate the results with demographical and clinical datas
Retrospective data analysis of all patients who first attended the retina department of a single academic medical center between August 2012 and August 2013 with new diagnosis of neovascular AMD. Best corrected visual acuity, fundus photographs, infrared, fundus autofluorescence (FAF) imaging, and Spectral domain optical coherence tomography (Spectralis HRA+OCT, Heidelberg Engineering, Germany) were performed, associated with fluorescein and indocyanine green angiographies. Identification of GA, when present, was independently performed by 3 readers. Quantification of atrophy areas was done on FAF frames using Region Finder, a semi automated software embedded in Spectralis device.
207 eyes of 174 patients (mean age: 79.6 ± 9.0 years) were included. 92 eyes (44.4%) had type I choroidal neovascularization (CNV); 43 (20.8%) had type II, and 24 (11.6%) had mixed pattern CNV lesions. Polypoidal choroidal vasculopathy was diagnosed in 16 (7.7%) and chorioretinal anastomosis in 32 (15.5%) of cases. Analyze of FAF frames showed that GA was associated with neovascular AMD in 48 eyes (23.2 %). Mean size of GA was 1.18 mm2 +/−1.6 mm2 (range 0.02- 4.93) and foveal involvement was found in 17 eyes (35.4%). Quantification of GA was not possible or difficult in several cases : presence of macular hemorrhage (15.9%), unsatisfactory quality of FAF frames (5.3%), FAF imaging not performed (8.7%). In theses cases, combined imaging, with infra red, OCT, and angiography, identified the presence of atrophy in 23 (11.1%). In total, taking into account datas both from Region Finder and multimodal imaging, our results suggest that GA is present in 34.3% of eyes newly diagnosed with exudative AMD. Subset analysis of frequency for each CNV type associated with GA found a higher incidence of type II (50%).
GA is associated with neovascular AMD in 1/3 of cases at initial presentation, which is higher than previously reported in the literature. Combined imaging, including Region Finder Analyzer software is an effective tool to identify and quantify atrophic retinal areas at diagnosis.
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