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JJ Jorzik, S Schmitz-Valckenberg, J Chen, K Unnebrink, FG HolzFAM-Study Group; Reticular Pseudodrusen and Peripapillary Atrophy associated with Geographic Atrophy in advanced ARMD . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2517.
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Purpose: In the prospective, multicenter FAM (Fundus Autofluorescence in Age-related Macular Degeneration)-Study various patterns of abnormal fundus autofluorescence (AF) in the junctional zone of geographic atrophy (GA) have previously been identified with an impact on the rate of progression. In addition we noted two seperate features to be frequently associated with advanced atrophic ARMD: reticular pseudodrusen (RPD) and peripapillary atrophy (PPA). Both changes are readily identified on AF images. Here we sought to compare the prevalence of these features in eyes with and without GA. Method: 406 eyes of 239 patients with GA have so far been recruited in one arm of the FAM-Study. AF images were obtained using a confocal scanning laser ophthalmoscope (exc. 488 nm, em. above 500 nm; HRA, Heidelberg, Germany). Areas of atrophy are associated with a well defined zone of markedly decreased AF. RPD were identified both on AF images and reflection images (825 nm) in accordance with previous definitions (Arnold et al. 1995). Image quality was sufficient in 299 eyes. Prevalence of these features was compared to 193 eyes, including normal eyes, eyes with other early and late manifestations of ARMD as well as eyes with other retinal diseases (myopia ≷2 dpt excluded). Digital images were evaluated by two independent readers. Results: PPA was observed in 195 of 299 (65.2%) eyes with GA in contrast to 28 of 101 eyes (27.7%) of non-ARMD control eyes (p<0.01). PPA showed variable extend ranging from small atrophic spots to confluent PPA. RPD were present in 38 of 256 (14.8%) eyes with GA, while none of the control eyes without ARMD manifestations showed this feature (p<0.01). Only 9.7 % of eyes with neovascular ARMD had RPD. Conclusion: The findings indicate that RPD and PPA are commonly associated with advanced atrophic ARMD. PPA tends to enlarge over time to become confluent with macular atrophic areas as an end-stage. The causative link between a similar disease process at both sites is unknown. Origin and morphological substrate of RPD is unclear. Fibrous replacement of the choroidal stroma concurrent with regression of choriocapillaris vessels have been proposed. The previously shown association of the deveolpment of GA with delayed choroidal perfusion may indicate a causative link between these phenomena. Extended longitudinal natural history studies in ARMD eyes recording these features may help to better understand their pathogenetic role and possible prognostic significance.
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