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Reticular Pseudodrusen and Peripapillary Atrophy associated with Geographic Atrophy in advanced ARMD

1Jorzik J., 1Schmitz-Valckenberg S., 1Sieber H., 1Chen J., 2Unnebrink K., 3Wolf S., 1Holz F. G.,
1Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)
2Ruprecht-Karls-Universität Heidelberg, Koordinierungszentrum für Klinische Studien (Heidelberg)
3Klinik und Poliklinik für Augenheilkunde, Universität Leipzig (Leipzig)

Purpose: In the prospective, multicenter FAM (Fundus Autofluorescence in Age-related Macular Degeneration)-Study we noted two features which are readily identified in fundus autofluroescence (AF) images, i.e. reticular pseudodrusen (RPD) and peripapillary atrophy (PPA), to be associated with geographic atrophy (GA).
Method: AF- images have been obtained from 462 eyes/277 patients with GA using confocal SLO (exc. 488 nm, em. above 500 nm; HRA, Heidelberg, Germany). Prevalence of PPA and RPD were compared with 193 eyes, including normal eyes, eyes with other early and late manifestations of ARMD, as well as eyes with other retinal diseases. Digital images were evaluated by two independent readers.
Results: PPA was observed in 218 of 327 (66.7%) 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 with a correlation of atrophy in both locations. RPD were present in 52 of 285 (18.2%) eyes with GA, while none of the control eyes without ARMD and only 9.7 % of eyes with neovascular ARMD showed this feature (p<0.05).
Conclusions: These findings indicate that RPD and PPA are commonly associated with advanced atrophic ARMD. We spceulate that RPD represent a predisposing factor for the development of GA. Fibrous replacement of the choroidal stroma concurrent with regression of choriocapillaris vessels have been proposed to be the morphological substrate of RPD. The causative link between macular and peripapillary atrophy remains unclear, while the association question some previous AMD-pathogenesis-hypotheses of GA with regard to the predeliction of the macular area. Expanded longitudinal natural history studies appreciating these features with AF-imaging help to evaluate their possible role as prognostic determinants.
Supported by the DFG AMD-Research Priority Program SPP 1088; HO 1926/1-1