![]() 8 In the clinic, these changes had been observed in fellow eyes of patients with unilateral acute central serous chorioretinopathy (CSC). First, pachychoroid pigment epitheliopathy (PPE) is a condition characterized by fundus autofluorescence (FAF) and OCT-detected RPE changes that occurred in the regions of choroidal thickening. 6, 7 The following four disease groups are resided in this spectrum. Pachychoroid disease is a spectrum of disorders that represent attenuation of the choriocapillaris, thickened choroid with dilated choroidal veins and functionally disturbed RPE homeostasis. Therefore, these two diseases should be differentially diagnosed to be managed based on the underlying causes of each. 5 Although high myopia shares overlapping fundus features with AMD, myopic eyes are less likely to have AMD. 2 Based on the Singapore Indian Eye Study (2013), a population-based, cross-sectional study of Indians aged 40–84 years living in Singapore, there is the differential association between the prevalence of myopia and AMD. 2 The “wet stages” consist of lacquer cracks and myopic choroidal neovascularization (CNV) ( Fig. 6.1E–F). The “dry” stages include tessellated fundus, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, and macular atrophy ( Fig. 6.1A–D). The simplified meta-analysis of pathologic myopia (META-PA) classification represents an evolution process from “dry” pathologic myopia to “wet” pathologic myopia. 4 The incidence of staphyloma is high in older people with pathologic myopia (96.7% in those > 50 years old). ![]() The age and the AXL have been found to be highly correlated with the development and progression of staphylomas. 3 A posterior staphyloma is an outward protrusion of all layers of the posterior eye globe. Therefore, the existence of PPA −BM, that is, γ zone may be a marker of the presence of high myopia. PPA −BM has been considered as a result of mechanical stretching in the peripapillary sclera and border tissues during axial elongation. β-PPA without Bruch’s membrane (BrM), a subtype of β-PPA, is called PPA −BM, that is, parapapillary γ zone. β-parapapillary atrophy (β-PPA) is a parapapillary region of visible large choroidal vessels and sclera caused by lacking of retinal pigment epithelium (RPE). The mechanical expansion in the peri-papillary sclera results in a concentric depigmentation at para-papillary region, the so-called myopic conus ( Fig. 6.1C). A myopic conus is an early change in the posterior fundus of highly myopic eyes. The fundus lesions of pathologic myopia may show several similarities to those of AMD. Pathologic myopia comprises multiple ocular tissue pathologies due to the elongation of the axial length of the eyeball (AXL). ![]() Many conditions may mimic nonneovascular AMD, exemplified by pathologic myopia, pachychoroid spectrum diseases, macular dystrophies, hydroxychloroquine toxicity, and cancer-associated retinopathy. Weiye Li, in Age-Related Macular Degeneration, 2022 Differential diagnosis of dry AMD
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