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.