geographic atrophy

A1: area of geographic atrophy that allows visualization of the choroidal circulation

B1: geographic atrophy has extended to the temporal area after 4 years of follow-up. This new area of atrophy, however, is not as marked as the initial area.

A2 (green AF): diffuse perilesional hyperAF pattern (reticular type)

B2 (green AF): the increase in the area of atrophy after 4 years of follow-up leaves a central island of healthy retina

A3: In the foveal section, a cRORA (complete atrophy of the RPE and retina) is seen nasal to the fovea.

B3: temporal to the fovea, iRORA (incomplete RPE and retinal atrophy) is seen after 4 years of follow-up. As it is an area of incomplete atrophy, it is not seen as intensely as the cRORA area in the retinography (B1).

B4: OCT en face after 4 years of follow-up. Segmenting in choroid, the area of RPE atrophy is perfectly delimited.

Description

78-year-old woman who comes to the consultation for a check-up.

VA in LE is 20/20. An area of extrafoveal geographic atrophy is observed in the fundus, which is confirmed by autofluorescence and OCT (A).

After 4 years of follow-up, the VA in LE is 20/40. The area of geographic atrophy has extended, leaving a central island of healthy retina (B).

Comments

Geographic atrophy is one of the 3 forms of advanced AMD (along with neovascular AMD and outer retinal atrophy – ORA). It is defined by an area of absent RPE of at least 175 microns in diameter visualised in the fundus or on a retinogram. Autofluorescence delineates very well the area of RPE atrophy and the perilesional autofluorescence pattern is a marker of progression ( none and patchy patterns imply slower growth than banded and diffuse patterns). iRORA and cRORA (as well as iORA and cORA) are consensus terms to define the different types of structural alterations that can be seen in cross-sections of OCT. In addition, en face OCT allows very precise delineation of the area of atrophy of the RPE and the outer retina.

Description

Comments

Indication