Prevalence of patients presenting with neovascular age-related macular degeneration in an urban population

PURPOSE: To determine the number and type of new cases of neovascular age-related macular degeneration (AMD) present in a defined urban population and to establish the proportion that would be recommended for treatment with verteporfin or laser photocoagulation. METHODS: Patients referred to an ophthalmic center in Vienna during a 10-week period because of recent deterioration in vision caused by newly diagnosed neovascular AMD were included. RESULTS: Neovascular AMD was diagnosed in 168 eyes in 153 patients. One hundred one eyes (60.1%) had lesions that were occult with no classic choroidal neovascularization (CNV); of these, 70 were subfoveal, 19 were juxtafoveal, and 12 were extrafoveal. Thirty-five eyes (20.8%) had predominantly classic lesions; of these, 27 were subfoveal, 6 were juxtafoveal, and 2 were extrafoveal. Thirty-two eyes (19.0%) had minimally classic lesions, of which 31 were subfoveal and 1 was extrafoveal. In accordance with consensus guidelines from a panel of experts and with American Academy of Ophthalmology's Preferred Practice Pattern guidelines, 33 lesions (17%) would be considered for treatment with verteporfin therapy. A further 37 subfoveal lesions with occult with no classic CNV and 7 juxtafoveal lesions with occult with no classic CNV might also benefit from verteporfin therapy if there is evidence of presumed recent disease progression. Five lesions (3.0%) could have been treated with laser photocoagulation according to Macular Photocoagulation Study criteria. CONCLUSIONS: These results suggest that verteporfin therapy substantially increases the number of patients with treatable neovascular AMD.     

Laser treatment in 341 patients with exudative agerelated macular degeneration

AIM:To document the prognosis of laser treatment in patients with exudative age-related macular degeneration(AMD).· METHODS:Efficacy of the intervention was evaluated using a before-after method.· RESULTS:A total of 392 eyes of 341 patients with exudative AMD were examined.77.6% had choroideal neovascularisation(CNV).Before the use of indocyanine green(ICG) angiography,occult CNV was detected in only 1.8% of the eyes,but after the use of ICG angiography,this increased to 19.5%(P<0.001).Of the 349 eyes which were followed up,visual acuity had remained stable in 68.2% of the eyes.There was a statistically significant relationship between localisation of lesion and visual acuity changes on pre-and post-laser treatment(P<0.001).Also there was a statistically significant relationship between localisation of lesion and recurrence(P<0.05).The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions.· CONCLUSION:ICG angiography is highly important in the treatment of occult CNV.     

老年性黄斑变性的吲哚青绿和荧光素眼底血管造影

目的 探讨眼底荧光素血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)在老年性黄斑变性(age-related macular degeneration,AMD)患者中的临床应用.方法 对AMD患者375例742只眼的FFA和ICGA检查资料进行分析总结.结果 在所有患者中,萎缩型504只眼(67.9%),渗出型238只眼(32.1%).在同步进行FFA和ICGA检查的渗出型AMD93只眼中,FFA检查发现典型性CNV 14只眼(15.1%),隐匿性CNV 79只眼(84.9%);ICGA检查发现边界清楚的CNV48只眼(51.6%),两者相比差异具有统计学意义(x2=27.97,P＜0.01).ICGA检查发现CNV的供养血管6只眼(6.5%),均位于中心凹旁或中心凹外.在发现边界清楚CNV的48只眼中,中心凹下CNV29只眼(60.4%),中心凹旁CNV 12只眼(25.0%),中心凹外CNV7只眼(14.6%).结论 与FFA相比,ICGA可以更加准确地显示CNV,发现CNV的供养血管,对AMD的临床诊断和治疗具有更重要的指导意义.     

Laser treatment in 341 patients with exudative age-related macular degeneration

AIM: To document the prognosis of laser treatment in patients with exudative age-related macular degeneration (AMD). METHODS: Efficacy of the intervention was evaluated using a before-after method. RESULTS: A total of 392 eyes of 341 patients with exudative AMD were examined. 77.6% had choroideal neovascularisation (CNV). Before the use of indocyanine green (ICG) angiography, occult CNV was detected in only 1.8% of the eyes, but after the use of ICG angiography, this increased to 19.5% (P<0.001). Of the 349 eyes which were followed up, visual acuity had remained stable in 68.2%. There was a statistically significant relationship between the localization of lesion and visual acuity changes on pre- and post-laser treatment (P<0.001). Also there was a statistically significant relationship between the localization of lesion and recurrence (P<0.05). The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions. CONCLUSION: ICG angiography is highly important in the treatment of occult CNV.     

年龄相关性黄斑变性的眼底荧光造影特点(英文)

目的:探讨眼底荧光素血管造影(fundus fluorescein angiog-raphy, FFA)在年龄相关性黄斑变性(age-related macular degeneration, AMD)患者中的特征及临床意义。方法:用日本Nikon NF-505眼底照相机对112例149眼进行FFA检查。结果:在149眼中,萎缩型90眼(60.4%),渗出型59眼(39.6%),依据CNV造影特点和CNV与黄斑中心凹的距离分为中心凹下CNV包括经典型7眼,隐匿型26眼,盘状瘢痕化9眼,旁中心凹CNV包括经典型2眼,隐匿型12眼,中心凹外CNV3眼均为隐匿型。结论:FFA可以发现AMD患者的CNV,并能分辨其性质和部位,有助于指导治疗和评价预后。     

Neovascularization Associated with Large Retinal Pigment Epithelial Detachment in Elderly Korean Patients: Subdivision According to Indocyanine Green Angiographic Features

PURPOSE: In Korean patients, to subdivide the neovascular forms of age-related macular degeneration (AMD) associated with large retinal pigment epithelial detachment (PED), according to the indocyanine green angiographic features. METHODS: Indocyanine green angiograms (ICGA) of 67 elderly patients (72 eyes) who presented with a PED of at least 1 disc diameter were evaluated retrospectively. RESULTS: Polypoidal choroidal vasculopathy (PCV) and typical choroidal neovascularization (CNV)-associated PEDs were identified in 18 eyes (25%) and 19 eyes (26%), respectively. In ten eyes (13.9%), the exact type of neovascularization, whether PCV or CNV, could not be determined. Pure serous PEDs were identified in seven eyes (10%). The remaining 18 eyes (25%) were classified as having retinal angiomatous proliferation (RAP)-associated PED based upon the angiographic findings of vascular connections between the retinal vasculature and the neovascular complex. CONCLUSIONS: Three subset groups of PCV, CNV, and RAP were present with similar frequency in neovascularized AMD with a large PED in these Korean patients. In particular, RAP, previously thought to be rare in Asian patients, was found to be present with considerable frequency.     

Progression of choroidal neovascularization after macular translocation in age-related macular degeneration and degenerative myopia

PURPOSE: To study the progression of choroidal neovascularization (CNV) after macular translocation in age-related macular degeneration (AMD) and degenerative myopia. PATIENTS AND METHODS: The data from 42 consecutive eyes (28 AMD, and 14 degenerative myopia) operated on by limited macular translocation (DeJuan technique), with a follow-up of 6 months or more, were prospectively analyzed. In the AMD group, neovascularization was classic in 54% of eyes and classic and occult in 46% of eyes. Previous laser treatment was applied on extra- or juxtafoveal CNV in 3 eyes. The major outcome measures were visual acuity, fluorescein and indocyanine green angiographies. RESULTS: After translocation, foveal displacement was greater in AMD than in myopic eyes (mean: 1 260 and 812 micro m, respectively). Laser photocoagulation was applied postoperatively onto extra-or juxtafoveal CNV in 26 (93%) AMD eyes and 12 myopic eyes (86%). Mean follow-up was 10 months (range, 6-18 months). Recurrence of CNV occurred in 14 AMD eyes (50%) and 2 myopic eyes (14%) an average of 5.6 months after surgery (range, 1-18 months). Recurrence was more frequent in AMD eyes with preoperative occult CNV (66%) than without (36%). Recurrence reached the new fovea in 69% of cases. Supplementary laser treatment was possible and successful on extra- or juxtafoveal recurrence in 3 eyes. Recurrence was significantly correlated with a poor visual prognosis: eyes without recurrence or with extra- or juxtafoveal recurrence had a final gain in visual acuity of 2.4 lines, eyes with subfoveal recurrence had a loss of 1.3 lines, and eyes with diffuse recurrence had a loss of 4.2 lines. CNV appeared in a new area at a BSS injection site in one eye. Occult CNV seemed to fade relatively within the first postoperative weeks, but were unchanged at the end of follow-up. In one eye, a small polypoidal lesion near the disc noted preoperatively disappeared after surgery. CONCLUSION: Our results suggest that the surgical procedure does not affect the course of classic or occult CNV. The rate of recurrence of CNV after macular translocation seemed similar to that observed after conventional laser treatment for extrafoveal CNV in AMD. Neovascular recurrence is the most frequent postoperative complication and was frequently directed at the new fovea. Despite these complications, macular translocation moves CNV outside of the subfoveolar zone so the eyes can be treated with conventional laser, leading to a favorable outcome at the last follow-up in 57% of cases. Further studies are required to confirm these findings and to define the best criteria for treatment.     

Outcome of choroidal neovascularization in angioid streaks after photodynamic therapy

PURPOSE: To evaluate the visual and anatomic outcomes of photodynamic therapy for choroidal neovascularization (CNV) in patients with angioid streaks. METHODS: The authors retrospectively evaluated 40 consecutive patients (48 eyes) with visual acuity of 20/200 or greater who were treated at 6 referral centers for CNV associated with angioid streaks. Main outcome measures were visual acuity, greatest linear diameter of the lesion, and, in patients with nonsubfoveal CNV, distance from the foveola. RESULTS: Of 34 eyes with subfoveal CNV, 21 were followed up for at least 12 months (range, 5-33 months). Median visual acuity was 20/50 at baseline and 20/120 at the final examination. The 12-month estimate of the percentage of eyes with vision loss of fewer than 3 lines was 68% (95% confidence interval, 50%-85%) by using survival analysis, whereas eyes with no increase in the greatest linear diameter were 45% (95% confidence interval, 27%-62%). Fourteen eyes had extrafoveal (n = 11) or juxtafoveal (n = 3) CNV, 12 of which were followed up for at least 10 months (range, 4-36 months). Visual acuity was 20/40 or greater in all eyes with extrafoveal lesions at baseline and in 5 of 12 eyes at the last examination, when 3 cases of CNV had become subfoveal. At baseline, visual acuity was low in two eyes with juxtafoveal CNV and nearly normal in the third. It remained substantially stable at the end of follow-up (range, 10-36 months), when two lesions were subfoveal. CONCLUSIONS: Most of our patients had good baseline visual function and, thus, were at high risk for losing vision because of the poor prognosis of CNV in angioid streaks. Because most had no or limited vision loss after 1 year, the authors suggest that photodynamic therapy can be used to try to limit or delay visual damage caused by this aggressive disease.     

Utility of indocyanine green angiography guided laser photocoagulation of choroidal neovascularization in age-related macular degeneration

PURPOSE: The efficacy of photocoagulating choroidal neovascularization (CNV) of age-related macular degeneration with indocyanine green angiography(ICG) was evaluated. 1. The utility of ICG-guided laser photocoagulation for juxtafoveal and extrafoveal CNV, 2. The utility of photocoagulating feeder vessels of subfoveal CNV. METHODS: 1. We compared 139 eyes undergoing ICG-guided laser photocoagulation (IA group), with 85 eyes treated with fluorescein angiography (FAG)-guided laser photocoagulation(FA group), of juxtafoveal and extrafoveal CNV. 2. We treated 35 eyes of 35 patients in which feeder vessels detected by ICG served as targets of photocoagulation. RESULTS: 1. The success rate of laser photocoagulation was 81% in the IA group and 82% in the FA group. There was no statically significant difference between the IA and FA groups in terms of distance from the fovea, CNV size, or lesion type. The rates of maintained or improved visual acuity in groups of IA and FA at the final follow-up as compared with those before treatment, were 71% (61/86 eyes) and 65% (36/55 eyes), respectively. 2. The feeder vessels were obliterated in 66%. The percentage of eyes with maintained or improved visual acuity at six months and at final follow-up as compared to visual acuity before treatment was 64% and 58%, respectively. Thirteen(81%) of 16 eyes which had shown extrafoveal feeder vessel ingrowth sites and small CNV of 1-disc area or less showed feeder vessel closure. CONCLUSION: 1. ICG-guided laser photocoagulation of juxtafoveal and extrafoveal CNV should be performed actively in the same way as FAG-guided laser photocoagulation. 2. It is best to attempt to coagulate feeder vessels when they are extrafoveal and when the CNV is small.     

Fluorescein angiographic lesion type frequency in neovascular age-related macular degeneration

OBJECTIVE: To assess the frequency of lesion types using fluorescein angiography (FA) in neovascular age-related macular degeneration (nAMD). DESIGN: Cross-sectional study. PARTICIPANTS: Two hundred cases of nAMD. METHODS: Fluorescein angiograms from 908 patients (university-based, tertiary retinal referral practice [UP] = 478; comprehensive, community-based eye clinic [CC] = 430) were reviewed to identify 200 cases of nAMD (100 from each center). Two graders evaluated the frequency of angiographic subtypes. MAIN OUTCOME MEASURES: Identifying (1) the frequency of subfoveal nAMD lesions that meet the definition of "predominantly classic," "minimally classic," "occult with no classic"; (2) lesion location, size, and subtype; and (3) the intergrader agreement (kappa). RESULTS: There was little difference in the frequency of lesion type between the UP and the CC. Most nAMD lesions were subfoveal (78.5%, 157 of 200), and of these, 20% (32 of 157) were predominantly classic; whereas 73% (114 of 157) were occult with no classic, and 7% (11 of 157) were minimally classic. Of the 200 angiograms, 33 (16.5%) were juxtafoveal, and 10 (5%) were extrafoveal. Twenty of the 43 juxtafoveal and extrafoveal lesions (47%) were predominantly classic. Classic with no occult subfoveal lesions were smaller than minimally classic or occult with no classic (1.7 vs. 3.7 and 2.8 mm; P = 0.001 and 0.01, respectively). Of 114 subfoveal occult with no classic lesions, 54 (47%) had both smaller lesion size <==4 disc areas (DA) and lower visual acuity <20/50, whereas 107 (94%) had a smaller lesion or lower visual acuity. CONCLUSIONS: Most angiographic lesions of patients who undergo FA for nAMD are subfoveal and occult. We estimate that 20% of subfoveal lesions are predominantly classic. Approximately half of the juxtafoveal and extrafoveal lesions are predominantly classic. Nearly 30% of all nAMD lesions have both small occult lesions (size <==4 DA) and a visual acuity less than 20/50. We found minimal difference in lesion type between a UP and a CC.     

Photodynamic therapy using verteporfin for choroidal neovascularization in angioid streaks

PURPOSE: To evaluate the efficacy of photodynamic therapy with verteporfin in the management of choroidal neovascularization (CNV) associated with angioid streaks. DESIGN: Retrospective case series. METHODS: Eleven eyes of nine patients with subfoveal or juxtafoveal CNV due to angioid streaks underwent visual acuity testing, ophthalmic examination, color photography, and fluorescein angiography to evaluate the results of photodynamic therapy with verteporfin. Retreatment of persistent CNV was based on criteria from the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Investigation (TAP) except in one case. Follow-up ranged from 5 to 28 months (mean, 17 months). RESULTS: Nine of 11 eyes had subfoveal lesions while two eyes had juxtafoveal lesions on initial examination. Conversion from a choroidal neovascular membrane (CNVM) to a fibrous disciform lesion following photodynamic therapy was observed in nine eyes. Enlargement of the CNVM was noted in seven of these eyes by fluorescein angiography at final follow-up. Initial best-corrected visual acuity (BCVA) ranged from 20/25 to counting fingers (CF) (mean, 20/400; median, 20/200). Final BCVA ranged from 20/20 to CF (mean, 20/600; median, 20/400). Seven eyes with subfoveal CNVM had an initial BCVA of at least 20/200 while only three eyes maintained this level or better at last follow-up. In one patient with a juxtafoveal CNVM in one eye, vision decreased from 20/25 to 20/400 with enlargement and fibrosis of the CNVM and subfoveal extension. In the fellow eye a juxtafoveal CNVM was initially treated and then retreated earlier than TAP criteria at 6 weeks. Vision improved to 20/20 and has remained stable 5 months after the initial treatment. CONCLUSIONS: Verteporfin for choroidal neovascularization-associated with angioid streaks does not appear to significantly alter the course of this disease with most eyes undergoing enlargement and disciform transformation of the neovascular process. However, aggressive management of these patients with biomicroscopic and fluorescein angiographic examination and timely photodynamic therapy with early retreatment when indicated may be beneficial in certain cases.     

Surgical removal of juxtafoveal and extrafoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: In the treatment of age-related macular degeneration (AMD), the effect on the fovea of photocoagulation of juxtafoveal choroidal neovascularization(CNV) and extrafoveal CNV near the fovea has been of concern, and so usefulness of surgical excision of CNV was evaluated. SUBJECTS AND METHODS: Fifteen eyes with AMD that underwent removal of juxtafoveal CNV and extrafoveal CNV near the fovea and had been followed for over one year were included in this study. Eligibility criteria were preoperative visual acuity of 0.3 or less and evidence of CNV activity by fundus angiography. RESULTS: Visual acuity of 0.4 or more was obtained in 60% of the eyes with best visual acuity and 47% with final visual acuity. The mean best visual acuity was 0.51 in cases with Gass type 2, 0.51 in type 1 + 2 CNV, and 0.21 in type 1 CNV. Good post-operative visual acuity was obtained in type 2 and 1 + 2 cases with type 2 CNV at the foveal side accompanied by preoperative foveal retinal sensitivity of 25 dB or more. There was little improvement of visual acuity in type 1 CNV because the retinal pigmented epithelium defect occurred at the fovea. CONCLUSION: For juxtafoveal CNV and extrafoveal CNV near the fovea in AMD, type 2 and 1 + 2 cases with type 2 CNV at the foveal side are thought to be candidates for surgery. Especially, relatively good postoperative visual acuity was obtained in cases with preoperative foveal retinal sensitivity of 25 dB or above. Active surgical removal is thought to be indicated for these cases.     

Selective occlusion of subfoveal choroidal neovascularization in angioid streaks by using a new technique of ingrowth site treatment

PURPOSE: To evaluate the visual and angiographic effects, as well as optical coherence tomography (OCT) findings, after a new treatment-neovascular ingrowth-site photothrombosis-in patients with subfoveal choroidal neovascularization (CNV) secondary to angioid streaks. DESIGN: Prospective noncomparative small case series. PARTICIPANTS: Five eyes of 5 patients with angioid streaks in whom fluorescein and conventional indocyanine green (ICG) angiography clearly demonstrated distinct CNV vessels supplying the subfoveal neovascular complex. INTERVENTION: All five eyes were submitted to ICG-mediated photothrombosis of the neovascular ingrowth site. This novel, laser/dye-mediated technique uses large-spot, lower-intensity 810-nm light for continuous application of laser energy to ICG concentrated in vascular lesions. MAIN OUTCOME MEASURES: Visual outcome and the results of fluorescein angiography, ICG angiography, and OCT evaluation. RESULTS: Fluorescein and conventional ICG angiography were sufficient to identify the CNV ingrowth site, which was juxtafoveal in 2 and extrafoveal in 3 of the 5 eyes in this series. Obliteration of the entire neovascular lesion was achieved in all patients within the first hour after ICG-mediated photothrombosis of the CNV ingrowth site. At 1 week, the mean change in best-corrected visual acuity from baseline was +3.2 (+/-1.4) lines. Twelve months after treatment, visual acuity improved by 3 or more lines in all patients, and decreased leakage of fluorescein from the CNV, as well as OCT evidence of reduced or resolved retinal edema, was seen at the last follow-up visit. Major complications, such as immediate severe visual loss and retinal vessel occlusion in the early posttreatment period, were not identified in the 5 patients submitted to the procedure. CONCLUSIONS: Photothrombosis of the CNV ingrowth site by using lower-intensity light to direct laser energy continuously after IV ICG infusion is a safe and effective technique for rapid induction of CNV hypoperfusion in selected patients and is associated with considerable improvement in visual acuity and partial restoration of the retinal architecture up to 12 months after treatment.     

Long-term follow-up of management of choroidal neovascularisation secondary to angioid streaks with intravitreal anti-vascular endothelial growth factor

PurposeTo assess the short-term and long-term visual outcomes in patients with choroidal neovascularisation (CNV) secondary to angioid streaks treated with intravitreal anti-vascular endothelial growth factor (VEGF).MethodsRetrospective, single-centre study.ResultsOverall 66 eyes of 52 patients were analysed. Follow-up ranged from 1 to 10 years. BCVA was 62 ETDRS letters at baseline, 68 letters at 1 year, 60 ETDRS letters at 5 years and 58 letters at 7 years. At 2 years patients gained 5.7 ETDRS letters from baseline but this gain was lost at 5 years. At 5 years there was an average loss of ETDRS letters from baseline of 3.3 letters. Sub-group analysis of subfoveal CNV showed worse outcome compared with eyes with extrafoveal and juxtafoveal CNV. In subfoveal CNV, BCVA was 53 ETDRS letters at 1 year (p < 0.0001) and 39 ETDRS at 5 years (p = 0.0005).ConclusionAnti-VEGF therapy is effective at stabilising visual acuity in patients with choroidal neovascularisation secondary to angiod streaks, however there is a gradual decline in visual acuity observed with 5–10 years of follow-up. Furthermore, subfoveal CNV have worse visual outcome compared with extrafoveal and juxtafoveal CNV.     

Verteporfin Therapy for Neovascular Age-Related Macular Degeneration in Indian Eyes

Purpose To determine visual outcome after a 12-month follow-up period of verteporfin therapy for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) in Indian patients. Methods Twenty-five patients (26 eyes) who completed a 12-month follow-up after photodynamic therapy for subfoveal CNV secondary to AMD were included in the study. The follow-up schedule was every month for 2 months and then every 3 months thereafter until 12 months. Improvement in visual acuity was defined as a ≥10-letter gain, and deterioration as a ≥10-letter loss in the Early Treatment Diabetic Retinopathy Study chart at 4 m. Results The mean age of the 25 patients was 62.3 ± 9 years. There were 17 male patients (68%). The mean initial letter acuity was 28. 4 ± 14.1, and the final letter acuity was 25.5 ± 18.4 at 12 months. Initial visual acuity was ≥20/40 in seven eyes, 20/50–20/80 in nine eyes, and 20/100–20/200 in ten eyes; seven eyes had a ≥10-letter gain, and three eyes had a ≥10-letter loss. At the end of 12 months, six eyes had a ≥10-letter gain and ten eyes had a ≥10-letter loss. Conclusion Photodynamic therapy appears to preserve the vision in subfoveal CNV secondary to AMD in the eyes of Indian patients.     

Scanning laser fundus perimetry before laser photocoagulation of well defined choroidal neovascularisation

AIM—To assess the centre of fixation before laser photocoagulation of well defined juxtafoveal or extrafoveal choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD), and to better predict visual function after treatment using scanning laser ophthalmoscope (SLO) fundus perimetry.
METHODS—19 consecutive eyes with juxtafoveal or extrafoveal CNV were examined by fundus perimetry before and after laser treatment with documentation of the fixation point using the SLO. The stability of fixation was defined as standard deviation around the mean fixation point. Overlays of fluorescein angiographic pictures and fundus perimetry were obtained using image analysis software.
RESULTS—Fundus perimetry allowed accurate determination of the centre of fixation. Overlays demonstrated the precise geographic relation of the angiographically detectable foveal margin of the CNV and the centre of fixation. Thereby, prediction of the visual outcome with regard to reading ability was facilitated. Stability of fixation did not change significantly after treatment.
CONCLUSIONS—Fundus perimetry using the SLO was helpful in patients who underwent laser treatment for juxtafoveal or extrafoveal CNV secondary to AMD and may aid the pretreatment counselling of such patients.

     

Retrospective case series of juxtafoveal choroidal neovascularization treated with photodynamic therapy with verteporfin

PURPOSE: To describe visual acuity and angiographic outcomes of juxtafoveal choroidal neovascularization (CNV) treated with photodynamic therapy and verteporfin (PDT). METHODS: Four hundred eighty-four consecutive eyes of 446 patients treated with PDT from January 1, 2001, to June 30, 2002, were identified from billing records. Fluorescein angiograms were reviewed retrospectively to identify juxtafoveal CNV. Eligible patients had CNV in which the central boundary of the lesion was between 1 and 199 microm from the geometric center of the foveal avascular zone (FAZ). Patient charts were reviewed for visual acuity of the treated eye before PDT and at 6- and 12-month follow-up examinations. Presence of subfoveal CNV at 6 and 12 months of follow-up was determined by review of fluorescein angiograms. A lesion was considered subfoveal if it extended underneath the geometric center of the FAZ. RESULTS: Twenty-one eyes had juxtafoveal CNV. Median change in visual acuity both 6 and 12 months after the initial PDT was 0 lines (n = 18 at 6 months, range -14 to + 8 lines; n = 17 at 12 months, range -18 to + 7 lines). Eleven lesions progressed to a subfoveal location by 12 months. Visual acuity in eyes with progressive lesions decreased a median of 4 lines of vision. CONCLUSIONS: Despite a small sample size and limited length of follow-up, this study shows that visual acuity on average can remain stable for at least 12 months after PDT of juxtafoveal lesions. Growth through the foveal center still can occur, however, and this can be associated with substantial visual loss.     

List of Reviewers, 2003

purpose To identify factors affecting visual acuity and its decrease in eyes with subfoveal choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). methods Distance visual acuity was recorded at screening and up to five follow-up visits during the first year of a randomized, double-blind, placebo-controlled trial of oral prinomastat. Subjects had AMD in both eyes and neovascular AMD in at least one eye. Analysis employed a generalized linear mixed model. results Of 158 eligible subjects (age 56-90), 125 (79.1%) received prinomastat. Visual acuity was independently affected by relative acuity of the fellow eye, whether the study eye had been the first or second to develop CNV, age, current smoking, leakage area, and prior photocoagulation. Decrease in visual acuity score, unaffected by prinomastat, was less steep in eyes that had been second to develop CNV. Such eyes had a comparable time since CNV onset to other study eyes. conclusion Fellow eye features independently affect visual acuity and its decrease in eyes with classic neovascular AMD.     

Photodynamic therapy with verteporfin in patients with age-related macular degeneration and juxtafoveal choroidal neovascularization

PURPOSE: To investigate the effects of photodynamic therapy (PDT) on juxtafoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) in a clinical patient material. METHODS: Thirty eyes in 30 consecutive patients with AMD and a juxtafoveal CNV underwent PDT with verteporfin with standard parameters. The patients were followed up for 12 months and retreated every 12 weeks in the event of leakage from CNV. Nineteen patients (63.3%) had a predominantly classic CNV, eight (26.7%) had a 100% occult CNV and three (10%) had a minimally classic lesion. In 27 patients (90%) the lesion was < or = 3 MPS (Macular Photocoagulation Study) disc diameters and < or = 3 MPS disc areas. RESULTS: There was a positive correlation between duration of symptoms and loss of visual acuity at 12 months (p < 0.02). For predominantly classic lesions, there was a positive correlation between duration of symptoms and lesion size (p < 0.005). At 12 months, leakage had stopped after 3.3 +/- 0.9 treatments in 80% of the patients. Visual acuity remained stable in 63.3% of the patients. CONCLUSION: Photodynamic therapy appears to be beneficial in patients with AMD and juxtafoveal CNV.