Development of atrophy of the retinal pigment epithelium around disciform scars
Open accessAbstract
BACKGROUND/AIMS: Eyes with burnt out disciform scars secondary to age related macular degeneration (AMD) are regarded as visually stable. The aim of this study is to report the subsequent development of atrophy of the retinal pigment epithelium (RPE) around the scars and discuss the possible basis. METHODS: 20 eyes from 18 patients were observed to develop atrophy around choroidal neovascularisation (CNV). A method of measuring expansion of the atrophy over time is described using the Topcon Imagenet 2000 system. An additional 10 clinicopathological examples were reviewed. RESULTS: Clinically CNV became surrounded initially by a ring of pallor that progressed to an expanding band of atrophy of the RPE. It developed most rapidly in the first 3 years after CNV became quiescent but then continued to expand slowly to more than three times the size of the scar. Histopathological specimens showed large choroidal vessels entering the scars directly and a reduced number of small choroidal vessels beneath and around the scar CONCLUSIONS: Disciform scars may become surrounded by an expanding band of atrophy of the RPE, postulated to result from remodelling of the choroidal circulation. The ongoing enlargement of the resulting scotoma may need to be considered when planning management and assessing treatment outcomes.
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In more than half of the Sarks et al. eyes, atrophy measurements began only after 2 years.
“Further the measurements of atrophy in more than half of these commenced only after two years”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [31]
The Rate of expansion section reports that 9 of 20 eyes had a follow-up review within two years of atrophy onset, leaving 11 without a review in that interval. But it describes those visits as follow-up after atrophy began to be measured, not as the start of measurement. The claim therefore confuses follow-up timing with when measurements commenced. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe Sarks et al. study had limitations: it was retrospective and included only 20 eyes treated with various modalities.
“but the study was limited by its retrospective nature with only a small number of eyes (n=20) that had undergone treatment with laser photocoagulation, radiotherapy, intravitreal triamcinolone injections, or combinations of these.31”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [31]
Sarks and colleagues reported expanding macular atrophy linked to fibrotic scars arising from nAMD.
“Sarks et al. had described the expanding macular atrophy associated with fibrotic scars developing from nAMD.”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [31]
Sarks et al. proposed that this atrophy expanded more rapidly in earlier follow-up periods.
“They suggested that the expansion of such atrophy was faster during the earlier periods of follow up”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [31]
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- Authors
- Sarks, J.
- Affiliations
- Neuroscience Research Australia (AU)
- Corresponding author
- Sarks, J
- Venue
- British Journal of Ophthalmology
- Publisher
- BMJ
- Published
- 2006-04-01
- Volume
- 90
- Issue
- 4
- Pages
- 442-446
- ISSN
- 0007-1161 (ISSN-L)
- PMC
- PMC1857011
- OpenAlex
- W2031202579
- Cited by
- 36
- References
- 25
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 1 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 2
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Ophthalmology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- retinal pigment epithelium atrophy, disciform scar, age-related macular degeneration, choroidal neovascularization, choroidal vasculature
- MeSH terms
- Aged, Aged, 80 and over, Atrophy, Cicatrix, Female, Fluorescein Angiography, Follow-Up Studies, Humans, Macular Degeneration, Male, Middle Aged, Pigment Epithelium of Eye, Disease Progression, Choroidal Neovascularization
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