PMC5088476_01
Patient 1 at presentation. Color fundus (a) and fundus autofluorescence images (b) demonstrate geographic atrophy at the infero-temporal aspect of the right macula and a small atrophic spot at the superior aspect of the left macula (arrowheads). Speckled areas of hyper- and hypo-autofluorescence can also be seen at the nasal aspect of the optic discs bilaterally. Insets provide high magnification views of the macula where regions of atrophy have been demarcated (yellow lines)
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Fig1
Results of MMI on the initial visit are provided in Fig. 1.
Clinical course of Patient 1. Serial spectral-domain optical coherence tomography (SD-OCT) images taken approximately every 2 years demonstrate relative preservation of outer retinal structures in the right eye (left panel) and progressive atrophy in the left eye (right panel). Color fundus and fundus autofluorescence images acquired at the final visit demonstrate a greater area of atrophy in the left eye relative to the right. SD-OCT images of the final visit reveal persistent intraretinal edema from type 1 NV in the right eye
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Fig2
At the most recent follow-up, visual acuity was 20/50 + 2 in the right eye and 20/400 in the left eye (Fig. 2).
PMC5088476_02
Patient 2 at presentation. Color fundus (a) and fundus autofluorescence (b) images demonstrate the absence of geographic atrophy at the baseline visit. Reticular pseudodrusen and mottled retinal pigment epithelial changes are evident bilaterally. Spectral-domain optical coherence tomography images (c) demonstrate subretinal fluid and type 1 neovascularization in the right eye. A vitelliform lesion is present in the left fovea
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Fig3
In the left eye there were drusen, reticular pseudodrusen, and a small subfoveal acquired vitelliform lesion (Fig. 3).
Clinical course of Patient 2. Serial spectral-domain optical coherence tomography (SD-OCT) images taken approximately every 2 years demonstrate resolution of subretinal fluid and preservation of outer retinal structures in the right eye (left panel) and reabsorption of vitelliform material, thinning of the choriocapillaris, retinal pigment epitheium and photoreceptor layer in the left eye (right panel). Color fundus and fundus autofluorescence images acquired at the final visit demonstrate a greater area of atrophy in the left eye relative to the right. SD-OCT images of the final visit reveal persistent type 1 NV in the right eye
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Fig4
The area of GA at final visit was 0.30 mm2 for the right eye and 6.72 mm2 for the left eye (Fig. 4).
PMC5088476_03
Patient 3 at presentation. As noted on color photographs (a) and fundus autofluorescence (b), neither eye had geographic atrophy. Mild non-neovascular AMD changes consisting of drusen and pigment mottling were present in the right eye while a juxtafoveal acquired vitelliform lesion was present in the left eye, in addition to somewhat denser drusen and pigment clumping
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Fig5
At baseline the right eye demonstrated type 1 neovascular AMD and the left eye had an acquired, juxtafoveal vitelliform lesion in addition to drusen and pigment clumping (Fig. 5).
Clinical course of Patient 3. Serial spectral-domain optical coherence tomography (SD-OCT) images taken approximately every 2 years demonstrate gradual progression of central geographic atrophy in the left eye (right panel) and minimal progression of foveal atrophy in the right eye (left panel). The marked difference between the left and right eyes with respect to the area of atrophy (yellow lines) is illustrated in color fundus and fundus autofluorescence images that were acquired at the most recent visit. SD-OCT of the right eye at the final visit reveals persistent type 1 NV
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Fig6
The area of GA at final visit was 0.07 mm2 for the right eye and 5.72 mm2 for the left eye (Fig. 6).
PMC5088476_04
Patient 4 at presentation. Areas of geographic atrophy (yellow lines) are clearly evident on color fundus (a) and fundus autofluorescence images (b) of the left and right eyes. Spectral-domain optical coherence (SD-OCT) images (c) taken of the right eye (top) and left eye (bottom) at the initiation of anti-vascular endothelial therapy for the right eye. The scans show subretinal and intraretinal fluid in the right eye and normal subfoveal findings in the left eye
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Fig7
Intermediate sized, refractile drusen and 4 areas of GA were seen in the left eye (Fig. 7).
Clinical course of Patient 4. Serial spectral-domain optical coherence tomography (SD-OCT) images taken approximately every 2 years demonstrate gradual progression of central geographic atrophy and the development of outer retinal tubulations in the left eye (right panel). In the right eye (left panel), there is broad type 1 NV. Color fundus and fundus autofluorescence images acquired at the final visit demonstrate a greater area of atrophy (yellow lines) in the left eye relative to the right. SD-OCT image of the final visit also reveals persistent type 1 NV in the right eye with intraretinal edema
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Fig8
The area of GA at final visit was 0.61 mm2 for the right eye and 7.84 mm2 for the left eye (Fig. 8).