Extensive macular atrophy with pseudodrusen-like appearance: comprehensive review of the literature
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Published:2024-08-12
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ISSN:0721-832X
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Container-title:Graefe's Archive for Clinical and Experimental Ophthalmology
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language:en
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Short-container-title:Graefes Arch Clin Exp Ophthalmol
Author:
Carlà Matteo MarioORCID, Giannuzzi Federico, Boselli Francesco, Crincoli Emanuele, Rizzo Stanislao
Abstract
Abstract
Purpose
This review focuses on extensive macular atrophy with pseudodrusen-like appearance (EMAP), a recently described maculopathy presenting with pseudodrusen-like lesions and chorioretinal atrophy more pronounced in the vertical axis.
Methods
Narrative review of the literature published until May 2024.
Results
The early onset age of EMAP (50–55 years) and its distinctive natural history, which includes night blindness followed by severe vision loss, differentiate it from atrophic age-related macular degeneration (AMD). A clear pathogenesis has not been determined, but risk factors include female gender and complement system abnormalities (altered levels of C3 and CH50). Moreover, lifelong exposure to pesticides has been suggested as risk factor for direct neuronal degeneration involving rods and cones. In the early phase of the disease, reticular pseudodrusen-like lesions appear in the superior perifovea and tend to coalescence horizontally into a flat, continuous, reflective material localized between the retinal pigmented epithelium and Bruch’s membrane. Over time, EMAP causes profound RPE and outer retinal atrophy in the macular area, with a recent classification reporting a 3-stages evolution pattern. Blue autofluorescence showed rapidly evolving atrophy with either hyperautofluorescent or isoautofluorescent borders. Significant similarities between the diffuse-trickling phenotype of geographic atrophy and EMAP have been reported. Macular neovascularization is a possible complication.
Conclusion
EMAP is specific form of early-onset atrophic macular degeneration with rapid evolution and no treatment. Further studies are needed to assess the best management.
Funder
Università Cattolica del Sacro Cuore
Publisher
Springer Science and Business Media LLC
Reference49 articles.
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