Symptomatic choroidal neovascularization in blacks
A. Capone Jr, R. T. Wallace and T. A. Meredith
Department of Ophthalmology, Emory University, Atlanta, GA.
OBJECTIVE: To acquire descriptive clinical information regarding choroidal
neovascularization (CNV) in black Americans. DESIGN: Retrospective review
of 1308 fluorescein angiograms obtained during a 4-year interval. Color
photographs and clinical records of all black patients with
angiographically apparent CNV were subsequently reviewed. SETTING: Retina
service of an inner-city county hospital in Atlanta, Ga, serving a
predominantly black population. RESULTS: Thirty blacks with CNV (36 of 59
eyes) were identified, 26 (87%) of whom were female. Active, exudative
neovascularization was present in at least one eye of 21 patients (70%).
Patients were assigned to one of four diagnostic groups for analysis. Group
1 was made up of 13 patients (43%) with age-related macular degeneration
with CNV. Women outnumbered men 5.5:1. Choroidal neovascularization was
peripapillary in seven (54%) of these 13 patients. Group 2 was made up of
six patients (20%) with idiopathic CNV, which was peripapillary in all
eyes. Group 3 consisted of three women (10%) with idiopathic polypoidal
choroidal vasculopathy. Group 4 was composed of eight patients (27%) with
secondary CNV. The CNV was peripapillary in three (33%) of nine eyes, and
women outnumbered men 7:1. CONCLUSIONS: The spectrum of neovascular
maculopathy in blacks in the current study differed from that typically
seen in whites, both clinically and demographically. Clinically, CNV was
most commonly juxtapapillary (13 [68%] of 19 patients) and unilateral (12
[92%] of 13 patients) among the age-related macular degeneration and
idiopathic groups, while six (20%) of 30 patients (all older than 50 years)
had CNV in the absence of drusen or other known predisposing conditions.
Disciform-stage CNV in both groups was associated with a greater degree of
pigment proliferation than that typically noted in whites. Demographically,
female predominance (87% overall) was dramatic compared with prior studies.
