Fear Research Articles

Pityriasis lichenoides et varioliformis acuta - dilemmas in diagnosis and choice of therapy: A case report

Introduction. Pityriasis lichenoides et varioliformis acuta is a rare inflammatory skin disease of unknown etiology and its diagnosis is sometimes established by eliminating diseases that are considered in the differential diagnosis. Given the lack of randomized clinical trials, recommendations for therapy remain based on case reports and case series. Case Report. We present a 63-year-old female patient with generalized skin lesions including, papules, papulonecrotic lesions, and atrophic scars accompanied by a subjective feeling of itching that occurred 2 months before admission. The histopathological findings showed a mixed perivascular inflammatory cellular infiltrate and capillary blood vessels with thickened walls in the superficial part of the dermis as signs of vasculitis. The infiltrate was dominated by lymphocytes, neutrophils were admixed, but there were no signs of cellular atypia, which supported the clinical diagnosis of pityriasis lichenoides et varioliformis acuta. Therapy with systemic corticosteroids and doxycycline was applied, which led to the resolution of lesions. Conclusion. The authors would like to bring to the readers? attention a rare skin disease, pityriasis lichenoides et varioliformis acuta, point to papulonecrotic tuberculids in differential diagnosis due to similar clinical presentation, remind them of the dilemmas that may arise in case of the described lymphocytic vasculitis based on the findings of histopathological analysis, and highlight the effectiveness of doxycycline and prednisone in the therapy.

Plasma Radiofrequency Ablation for Scar Treatment.

Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial problems with a negative effect on the quality of life. Many conventional approaches have been proposed for the treatment of scars, including surgical techniques, dermabrasion, chemical peels, topical silicone gel, 5-fluorouracile and dermal fillers injection or autologous fat transfer for atrophic scars, and corticosteroids injection for hypertrophic and keloid scars; however, they have sporadic effects. Ablative lasers, such as carbon dioxide laser or Erbium Yag laser, are associated with many collateral effects limiting their application. Non-ablative laser treatments have been shown to be safer and to have fewer side effects, but they have a reduction of clinical efficacy compared to ablative lasers and a minimal improvement of scars. The demand for minimal invasive and safe technology for the treatment of a scars has stimulated the search for more effective novel therapy with fewer collateral effects. Plasma radiofrequency ablation is a new technique consisting of the generation of plasma energy through the production of ionized energy, which thermally heats tissue in a uniform and controlled manner, through a plasma radiofrequency device, inducing a sublimation of the tissue. The aim of this study is to evaluate the effectiveness of P-RF ablation in the treatment of scars performed with D.A.S. Medical device (Technolux, Italia), which is a tool working with the long-wave plasma radiofrequency principle.

Evaluation of psychological well-being and social impact of atrophic acne scarring: A multinational, mixed-methods study

BackgroundMost people with acne are at risk of developing acne scars, but the impact of these scars on patients' quality of life is poorly researched.ObjectiveTo assess the perspective of patients with acne scars and the impact of these scars on their emotional well-being and social functioning.MethodsA 60-minute interview of 30 adults with acne scars informed and contextualized the development of a cross-sectional survey of 723 adults with atrophic acne scars.ResultsThe main themes identified in the qualitative interviews included acceptability to self and others, social functioning, and emotional well-being. In the cross-sectional survey, 31.6%, 49.6%, and 18.8% of the participants had mild, moderate, and severe/very severe acne scarring. The survey revealed that 25.7% of the participants felt less attractive, 27.5% were embarrassed or self-conscious because of their scars, 8.3% reported being verbally and/or physically abused because of their scars on a regular basis, and 15.9% felt that they were unfairly dismissed from work. In addition, 37.5% of the participants believed that their scars affected people's perceptions about them, and 19.7% of the participants were very bothered about hiding their scars daily. Moreover, 35.5% of the participants avoided public appearances, and 43.2% felt that their scars had negatively impacted their relationships.LimitationsThe temporal evaluation of the impact was not estimated.ConclusionEven mild atrophic acne scarring can evoke substantial emotional, social, and functional concerns.

A combined approach of subcision with either cross-linked hyaluronic acid or threads in the treatment of atrophic acne scars.

Acne scars are one of the most common cosmetic concerns causing psychosocial distress. To evaluate the efficacy of subcision versus its combination with either cross-linked hyaluronic acid (HA) or poly-l-lactic acid (PLLA) threads in the treatment of atrophic post-acne scars. Forty patients of both genders with atrophic acne scars were subjected to subcision 1month apart for 3sessions. After the last session of subcision, the patients were reclassified randomly into 2equal groups each received either HA or threads in one side of the face leaving the other side that underwent subcision before as a control. Clinical assessment was carried out by the physicians and patients. Photographs and skin biopsies were obtained. Follow-up was 6months. A significant clinical improvement was achieved in 67.3% of patients after subcision alone compared to 94.1%, 82.4% of subcision combined with HA or threads, respectively. Patients' satisfaction was higher in the combined groups compared to subcision alone (p<0.0001). Side effects were tolerable and transient. Subcision combined with HA or threads could offer a higher significant clinical improvement of acne scars than subcision alone.

Transforming growth factor beta-1 and vascular endothelial growth factor in the recovery and formation of skin scars

Relevance. Scars are multi-tissue structures that significantly reduce the quality of life of the young, able-bodied population. The most socially significant variants are represented by hypertrophic and keloid postoperative scars and scars after burns, atrophic scars after acne vulgaris and striae. Growth factors, which are also used for their treatment, play a significant role in their formation and progression. The aim of this work is to summarize data on the participation of growth factors (transforming growth factor beta-1 and vascular endothelial growth factor) in the formation of a hypertrophic or atrophic scar. Materials and Methods. The study of literary sources of scientometric scientific bases was carried out. Results and Discussion . The study showed that the duration of the scarring phases preceding it is of great importance in scar formation, their prolongation leads to chronic inflammation and the attachment of an autoimmune component, an increase in the number of myofibroblasts due to inhibition of apoptosis and an increase in the synthesis of intercellular substance and immature forms of collagen, as well as thinning of the epidermis over scar. Growth factors such as growth factor beta-1 and vascular endothelial growth factor are capable of shifting the balance of these two main pathways or towards proliferative processes, contributing to an increase in the number of blood vessels in the hemomicrocirculatory bed, the number of mast cells and total cellularity, as well as, in some cases, the synthesis of keloid - that is, the formation of a hypertrophic or keloid scar. On the contrary, the prevalence of inflammatory processes leads to a decrease in cellularity, a decrease in blood vessels and intercellular substance, as well as damage to elastin and collagen fibers, forming the phenotype of an atrophic scar or striae. Conclusion. Growth factors play a key role in scar formation, contributing to an increase in the number of blood vessels in the hemomicrocirculatory bed, the number of mast cells and total cellularity, as well as, in some cases, the synthesis of keloid - that is, the formation of a hypertrophic or keloid scar.

OPPORTUNITIES OF PLATELET RICH PLASMA APPLICATION IN THE TREATMENT OF SKIN SCARS

The number of patients with hypertrophic skin scars is increasing every year. Scar tissue is formed as a result of healing of a wound defect. Therefore, in order to develop optimal methods for the treatment of scarring skin changes, it is necessary to understand the pathogenesis of the wound process. The purpose of this work was to analyze the literature data on the effectiveness of the use of plateletrich plasma (PRP) in the treatment of scarring that appeared in patients with acne. PRP contains epidermis growth factor, vascular endothelial growth factor, which help accelerate the healing of skin wounds. Conclusion: PRP can be successfully used in the treatment of atrophic scars on the skin after acne. Therefore, this method can be used both in monotherapy and in combination with surgical methods of treatment.

OPPORTUNITIES OF PLATELET RICH PLASMA APPLICATION IN THETREATMENT OF SKIN SCARS

The number of patients with hypertrophic skin scars is increasing every year. Scar tissue is formed as a result of healing of a wound defect. Therefore, in order to develop optimal methods for the treatment of scarring skin changes, it is necessary to understand the pathogenesis of the wound process. The purpose of this work was to analyze the literature data on the effectiveness of the use of plateletrich plasma (PRP) in the treatment of scarring that appeared in patients with acne. PRP contains epidermis growth factor, vascular endothelial growth factor, which help accelerate the healing of skin wounds. Conclusion: PRP can be successfully used in the treatment of atrophic scars on the skin after acne. Therefore, this method can be used both in monotherapy and in combination with surgical methods of treatment.

New outreach of ultrasound in aesthetic medicine: a systematic review

Background. Aesthetic medicine and plastic surgery accrue with new methods for aging correction by year. Research is aimed at reducing the acute complications risk of aesthetic surgeries and finding effective routes of their diagnosis and treatment. Vascular and non-vascular contouring complications imaging, thread implantation, atrophic postacne scars, postpartum striae, posttraumatic and postoperative scars remain the topical issues. Objectives. A review of current imaging techniques in aesthetic medicine to outline promising avenues in the diagnostics of atrophia cicatrix using high-resolution ultrasound methods. Methods . Bibliography was mined and analysed in the PubMed, eLibrary, Web of Science, Cyberleninka and Cochrane Library databases for the period of 2017–2021. Content analysis was used with the keyword queries: facial ultrasound [ультразвуковая диагностика кожи], ultrasound in dermatology [диагностика в косметологии], contouring complications [осложнения контурной пластики], complications in cosmetology, complications of hardware rejuvenation [осложнения аппаратного омоложения], atrophic scar diagnostics [диагностика рубцовых атрофий]. Results . Among 351 studied, 57 sources were included in the review. An analysis of past-decade national and foreign literature revealed prevalence of surface linear array 12 and 14 MHz transducers in ultrasonic (US) cosmetology. High-frequency transducers in dermatology and aesthetic medicine have actively developed in recent years. Evidence is published on vascular and non-vascular facial contouring complications diagnosis, aesthetic thread implantation, aging dynamics, psoriasis and onychomycosis control. Scar imaging studies are sparse and not uncovering the full US potential to control their various-stage treatment. Conclusion . A dynamic advancement of high-resolution US in aesthetic medicine paves the promising ways of research into the US capacities for various-origin atrophic scar diagnosis, informative diagnostic criteria elaboration and the development of prognostic and treatment efficacy control techniques.

Study of the effectiveness of fractional laser ablation in patients with atrophic postacne scars using the quantitative scar index

Introduction. Atrophic scars are common in acne patients. Regardless of their number and size, they are persistent defects and reduce patients' quality of life. With a variety of treatment options, effective scar correction remains a challenge. Laser technology continues to evolve and is considered promising for the treatment of scars.The aim of the study was to investigate the effectiveness of the fractional laser ablation method in patients with atrophic postacne scars using the quantitative postacne scar index.Materials and methods. The study involved 60 patients with ARP of II-IV severity, 35 women and 25 men. The patients underwent fractional ablation of scars with an Erbium laser (2940 nm). To assess the scars before and after treatment, we used the post-acne scar severity index according to the quantitative assessment scale according to G.J. Goodman et al. Goodman et al. (2006). The international scales Patient's Satisfaction Score, Physician's Satisfaction Score, and Definitive Graduated Score were used to assess physician and patient satisfaction with the results of the procedures.Results. The quantitative index of postacne scars before treatment ranged from 4.0 to 16.0 points and averaged 10.9±3.56 points; median was 12.0 points (8.0±13.0 points). After fractional laser ablation procedures, improvement of quantitative indexes scores (p&lt;0.05), positive dynamics of the doctor's and patients' evaluation of procedure results were noted; no gender differences were noted.Discussion. Quantitative indices of scar expression reflect the severity of the affected skin areas in patients with postacne. This study confirms the effectiveness of fractional ablation with the Erbium laser in patients with ARP, which is confirmed by a decrease in quantitative scar severity indices. Dynamic growth of PSS, PhSS, DGS indices testifies to high satisfaction of the physician and the patient with the results of treatment and correlates with regression of clinical manifestations in these patients.Conclusion. Despite the limitations and laboriousness of counting quantitative indices of postacne scars, this approach allowed to establish and objectify the clinical efficacy of treatment of patients with ARP by fractionated ablation.

Rapid progression of chorioretinal atrophy in punctate inner choroiditis: a case report

BackgroundThe chorioretinal inflammatory lesions occurring in punctate inner choroiditis evolve into punched-out atrophic scars. Typically, the progression is gradual. We report a case of highly myopic punctate inner choroiditis with rapid progression of chorioretinal atrophy.Case presentationA 48-year-old Japanese woman with high myopia presented with decreased visual acuity. Best-corrected visual acuity was 20/28 in the right eye and 20/16 in the left eye; axial length was 29.0 mm and 28.7 mm, respectively. Fundoscopy revealed an epiretinal membrane in the left eye. Three years later, the best-corrected visual acuity in the left eye had decreased to 20/33; at this time, the patient underwent vitrectomy with epiretinal membrane and internal limiting membrane peeling in this eye. Six months later, the best-corrected visual acuity in the left eye decreased suddenly to 20/100. Optical coherence tomography showed a nodule-like lesion in the outer retina with disruption of the retinal pigment epithelium and a focally thickened choroid, compatible with PIC. One month later, the choroidal thickness had decreased. The central chorioretinal atrophy expanded rapidly at a rate of 0.45 mm2/year over the next 3 years, and new areas of patchy focal chorioretinal atrophy developed in the perifovea.ConclusionsRapid progression of chorioretinal atrophy was observed in a patient with punctate inner choroiditis. Because punctate inner choroiditis is often associated with degenerative myopia, the retina is fragile and may be susceptible to mechanical damage. This case report alerts clinicians to the need for careful management of patients with punctate inner choroiditis, especially after vitrectomy.

Indurated Mass on the Right Central Back.

A 26-year-old Guatemalan man who was a former carpenter presented with an indurated, nontender, nonpruritic, subcutaneous mass on the right central back with multiple draining sinus tracts on the surface and several depressed circular atrophic scars on the periphery of the mass. He denied any trauma, insect bites, fever, chills, headaches, weight loss, or travel history (he relocated to the United States 3.5 years ago) prior to the skin eruption.

Efficacy and safety comparison between 1927\xa0nm thulium laser and 2940\xa0nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial

Acne scarring is a common disfiguring complication of acne, and fractional lasers are widely applied in improving it. This study is to compare the efficacy and safety of fractional non-ablative 1927 nm thulium laser (FTL) and fractional ablative 2940 nm Er:YAG laser (FEL) in the treatment of acne scarring. Subjects with moderate or severe atrophic facial acne scarring received 3 sessions of FTL on the left side of face and FEL on the right side of face at an average interval of 4–6 weeks. Major assessments included Goodman&Baron quantitative global scarring grading system (GBS), self-rated improvement and satisfaction score. Twenty-seven subjects completed the study; for FTL side, average GBS decreased from 11.15 ± 5.04 at baseline to 7.07 ± 4.87 with an improvement percent of 36.54%; for FEL side, average GBS decreased from 10.81 ± 4.46 to 7.00 ± 4.07 with an improvement percent of 35.27%. Adverse effects include transient pain, erythema, edema, and increase of acne. No significant difference was found between two lasers. Both FTL and FEL improved atrophic acne scarring and were well-tolerated. Increase of acne during laser treatment may have a negative impact on efficacy. Trial registration number was NCT04813419 and date of registration was 19th, March, 2021, retrospectively registered.

Clinical and Histopathological evaluation of different tools for the Subcision of Atrophic Acne Scars

Acne scarring can lead to social and psychological distress. To compare the safety, efficacy, and long-term improvement of subcision using tri-beveled hypodermic (Th) needle versus cannula for the treatment of atrophic post-acne scars. Forty-six patients with atrophic post-acne scars were treated with subcision using (Th) needle on one side of the face and a blunt cannula on the other side of the face for 6sessions one month apart. The primary outcome was based on the clinical improvement and patient satisfaction score. Skin biopsies were taken at baseline and 3months after the final session. Follow-up was 9months. Three months after the final session, a statistically highly significant difference was detected in both sides from the baseline (p<0.001). The overall improvement was 73.9% on the (Th) needle side versus 65.2% on the cannula side (p=0.68). There was no significant difference in acne severity scarring grade between both sides (p=0.86). The mean number of sessions was significantly less in the (Th) needle side (p<0.001). Collagen deposition and reorganization were achieved with both modalities. Patient satisfaction showed no significant difference between both sides. The side effects were mild and significantly higher in the (Th) needle side (p=0.001). Both modalities are effective and economic techniques. However, using a cannula is associated with much fewer side effects, more convenient for the patients and physicians compared to the (Th) needle.

Updated treatment of Atrophic Acne Scars

Updated treatment of Atrophic Acne Scars

Study of quality of life indicators in patients with atrophic postacne scars after laser ablation techniques

Introduction. Atrophic postacne scars are a persistent cosmetic defect, cause psychological discomfort, and significantly reduce patients' quality of life. Laser technologies are effectively used for their treatment. The aim of the study was to investigate the quality of life in patients with atrophic post-cancerous scars before and after the use of laser methods of scar correction. Materials and methods. A randomized comparative clinical trial included 120 patients with atrophic postacne scars divided into two comparable groups of 60 patients each. Patients received laser ablation procedures with an Erbium laser (2940 nm). The Dermatological Quality of Life Index (DQLI) questionnaire was used to assess the quality of life before and after the laser procedures. Results. The DICG of patients before treatment ranged from 8 to 17 points and averaged 12.962.05 points. In women the mean value of DICG was 14.221.34 points and was higher compared to men (11.141.45 points) (p0.05). After fractional laser ablation procedures and the procedures of its combination with the treatment of the scar edge with a solid stain, improvement of the DICG scores was observed; intergroup differences were found in self-esteem, in the choice of clothing, in personal and intimate relationships, and in the assessment of daily routine. Discussion. The pre-treatment DICG scores of patients with postacne scars indicate a strong impact of the disease on quality of life. The DICG in women was higher than in men, which may be associated with a greater degree of women's anxiety about the aesthetic condition of the skin and appearance. After treatment, the degree of impact of the disease on patients' quality of life decreased to moderate in both groups. Conclusion. The combined method of treatment contributes to the reduction of DICG compared to fractional ablation procedures, which indicates greater patient satisfaction with the result of these procedures.

Molecular alterations due to Col5a1 haploinsufficiency in a mouse model of classic Ehlers-Danlos syndrome.

Type V collagen is a regulatory fibrillar collagen essential for type I collagen fibril nucleation and organization and its deficiency leads to structurally abnormal extracellular matrix (ECM). Haploinsufficiency of the Col5a1 gene encoding α(1) chain of type V collagen is the primary cause of classic Ehlers-Danlos syndrome (EDS). The mechanisms by which this initial insult leads to the spectrum of clinical presentation are not fully understood. Using transcriptome analysis of skin and Achilles tendons from Col5a1 haploinsufficient (Col5a1+/-) mice, we recognized molecular alterations associated with the tissue phenotypes. We identified dysregulation of ECM components including thrombospondin-1, lysyl oxidase, and lumican in the skin of Col5a1+/- mice when compared with control. We also identified upregulation of transforming growth factor β1 (Tgf-β) in serum and increased expression of pSmad2 in skin from Col5a1+/- mice, suggesting Tgf-β dysregulation is a contributor to abnormal wound healing and atrophic scarring seen in classic EDS. Together, these findings support altered matrix to cell signaling as a component of the pathogenesis of the tissue phenotype in classic EDS and point out potential downstream signaling pathways that may be targeted for the treatment of this disease.

İstanbul’daki kutanöz layşmanyazis olgularının klinik ve epidemiyolojik özellikleri

Cutaneous leishmaniasis (CL) is a vector-borne disease characterized by skin lesions healing with an atrophic scar. Istanbul is a high-risk province for CL due to internal and international immigrants. The aim of this study is to determine the clinical and epidemiological characteristics of CL cases in Istanbul. In this descriptive study, we evaluated the Cutaneous leishmaniasis cases in Istanbul between June 1st, 2014 and May 31st, 2015. The ethics committee and instutional permissions were received. Frequency analysis were used for data analysis. The study was carried out with 197 CL cases. Percentage of patients under 18 years old was 52%. Seventy-seven percent of cases were Syrian and most of them had no passports. Household average number was six. Percentage of individuals with a CL lesion at household in the last year was 23%. Sixteen percent of cases reported a recent visit to Southeastern Anatolia and 55% of them reported that the lesions appeared after the visit. About half of cases had more than one lesion. Face (43.7%) was the most commonly affected. The lesions of 74 cases (38%) appeared before living in Istanbul. Health Directorates of the districts where Syrian immigrants live in Istanbul should screen Syrian immigrants in terms of CL periodically. Also improving living conditions, drying of stagnant water areas, use of mosquito nets, wearing long-sleeved clothes, diagnosis, and effective treatment of CL are recommended methods for CL control.

Impact of Facial Atrophic Acne Scars on Quality of Life: A Multi-country Population-Based Survey.

BackgroundAcne affects more than 80% of adolescents and young adults, who most often develop acne scars. Supporting data on the effect of acne scars on patient’s health-related quality of life (HRQOL) are limited.ObjectiveThe aim was to determine how the severity of acne scars impacts the HRQOL of afflicted individuals.MethodsIn this population-based cross-sectional study, 723 adults with facial acne scars but without active acne lesions self-completed the Self-assessment of Clinical Acne-Related Scars (SCARS) questionnaire formulated to investigate degree of acne scarring. The Facial Acne Scar Quality of Life (FASQoL), Dermatology Life Quality Index (DLQI), and Dysmorphic Concern Questionnaire (DCQ) were completed to assess the attitude of these patients toward their scars and the impact of scarring on their HRQOL.ResultsThe mean (standard error) DLQI score for facial acne scars was 6.26 (0.22). Acne scars were considered a ‘very large’ or ‘extremely large’ concern by 19.3% of participants with mild scars as compared to 20.1% and 34.0% of participants with moderate and severe/very severe scars, respectively (P = 0.003). Higher FASQoL scores were associated with increased severity of scarring (P = 0.001). In total, 16.9% of participants had clinical features of dysmorphia (i.e., DCQ > 13). DCQ scores were significantly higher among participants with more severe scarring (mean DCQ score of 8.04 [0.28], 8.40 [0.18], and 10.13 [0.08] among participants with mild, moderate, and severe/very severe acne scars, respectively; P = 0.001). Most commonly reported signs of emotional distress were self-consciousness (68.0%) and worry about scars not going away (74.8%).ConclusionsThis study highlights the significant psychosocial impact of atrophic acne scars in the form of embarrassment and self-consciousness. Individuals with mild scars also expressed significant impact on quality of life that increased with aggravation of scar severity. Patient-reported outcomes provide an insight into the physical, functional, and psychological impact of acne scarring from the patient’s perspective.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40257-021-00628-1.

British Association of Dermatologists guidelines for the management of people with cutaneous lupus erythematosus 2021.

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of cutaneous lupus erythematosus (CLE) in the presence or absence of systemic lupus erythematosus (SLE) in adults, young people and children. The document aims to: offer an appraisal of all relevant literature up to December 2020, focusing on any key developments address important, practical clinical questions relating to the primary guideline objective. provide guideline recommendations and if appropriate research recommendations.

Associations and Outcomes of Patients with Submacular Hemorrhage Secondary to Age-related Macular Degeneration in the IVAN Trial

To compare demographics, visual acuity (VA) and retinal morphology between those with, and without baseline submacular hemorrhage (SMH) for patients enrolled in the Inhibit VEGF in Age-related Choroidal Neovascularization trial (IVAN). Secondary analyses of a randomized, controlled trial of image and clinical data. Setting; The IVAN trial collected data in 23 UK hospitals. Study population; IVAN study eyes (with untreated neovascular age-related macular degeneration at randomization) with at least 12 months of follow-up and adequate imaging. Intervention; Study eyes were randomly assigned between monthly ranibizumab, as-needed ranibizumab, monthly bevacizumab, or as-needed bevacizumab. Imaging at baseline was graded independently for the presence, type, position, and extent of SMH. Main outcome measures; The main outcome measures were VA (primary outcome), subretinal fibrosis, atrophic scarring, and retinal thickness outcomes at 12 and 24 months RESULTS: Of 605 IVAN trial participants, 535 were included in this analysis. Patients with SMH at baseline (286 [53%]) were older (P=.010) and affected eyes were more likely to have intraretinal fluid present (P=.038). The VA was significantly worse in those with baseline SMH at month 0 (P < .001; estimate of difference 6 letters; 95% CIs, 4-8 letters), but the difference decreased and was not significant at month 12 or 24. No significant association was found between baseline SMH and subretinal fibrosis, atrophic scarring, or central retinal thickness. The presence of SMH at baseline was associated with age, intraretinal fluid, and decreased baseline VA. By month 12, VA was no longer significantly different in those who presented with SMH at baseline.