D Pawlak1, E Souied, G Mimoun, M Papp-Pawlak, G Coscas, G Soubrane. 1. Clinique Ophtalmologique Universitaire de Créteil, Hôpital Intercommunal et Henri Mondor (Assistance Publique des Hôpitaux de Paris), Université Paris XII, Créteil, France. dompawlak@aol.com
Abstract
OBJECTIVE: Fundus flavimaculatus is an aspect of Stargardt disease, which is characterized by juvenile onset, rapidly progressive deterioration, and poor visual outcome due to atrophic areas or flecks. Recently, a late-onset form has been described, on the borderline with AMD. However, choroidal neovascular complications are not frequent and rarely described in Stargardt's disease. CASE REPORT: Late discovery of FFM in a patient over 50 years old. During her follow-up, she presented a decrease in visual acuity due to juxtafoveal choroidal neovascularization. In spite of laser treatment, a retrofoveal recurrence appeared, which was treated with perifoveal laser. DISCUSSION: Confusion between AMD and a late-onset Stargardt may occur because of their many clinical similarities. The population and the fundus results can be similar to AMD and an examiner may be confused. In the literature, choroidal neovascular complications appear in patients over 50 years of age who may suffer from AMD. In fundus flavimaculatus, pigmentary epithelium alterations are due to progressive lipoproteic scrap storage that predisposes to Bruch's membrane rupture and choroidal neovascularization. This physiopathology resembles the that of AMD. CONCLUSION: Choroidal neovascular complications are possible in late-onset Stargardt disease. Their appearance together may be greater than previously believed.
OBJECTIVE:Fundus flavimaculatus is an aspect of Stargardt disease, which is characterized by juvenile onset, rapidly progressive deterioration, and poor visual outcome due to atrophic areas or flecks. Recently, a late-onset form has been described, on the borderline with AMD. However, choroidal neovascular complications are not frequent and rarely described in Stargardt's disease. CASE REPORT: Late discovery of FFM in a patient over 50 years old. During her follow-up, she presented a decrease in visual acuity due to juxtafoveal choroidal neovascularization. In spite of laser treatment, a retrofoveal recurrence appeared, which was treated with perifoveal laser. DISCUSSION: Confusion between AMD and a late-onset Stargardt may occur because of their many clinical similarities. The population and the fundus results can be similar to AMD and an examiner may be confused. In the literature, choroidal neovascular complications appear in patients over 50 years of age who may suffer from AMD. In fundus flavimaculatus, pigmentary epithelium alterations are due to progressive lipoproteic scrap storage that predisposes to Bruch's membrane rupture and choroidal neovascularization. This physiopathology resembles the that of AMD. CONCLUSION:Choroidal neovascular complications are possible in late-onset Stargardt disease. Their appearance together may be greater than previously believed.