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Clinical Sciences |

Photodynamic Therapy for Occult Choroidal Neovascularization With PigmentEpithelium Detachment in Age-Related Macular Degeneration FREE

Ruth Axer-Siegel, MD; Rita Ehrlich, MD; Irit Rosenblatt, MD; Michal Kramer, MD; Ethan Priel; Yuval Yassur, MD; Dov Weinberger, MD
[+] Author Affiliations

From the Department of Ophthalmology, Rabin Medical Center, BeilinsonCampus, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University,Tel Aviv, Israel (Drs Axer-Siegel, Ehrlich, Rosenblatt, Kramer, Yassur, andWeinberger); and Mor Institute for Medical Data, Bnei Brak, Israel (Mr Priel).The authors have no relevant financial interest in this article.


Arch Ophthalmol. 2004;122(4):453-459. doi:10.1001/archopht.122.4.453.
Text Size: A A A
Published online

Objective  To study the visual and angiographic outcome of eyes with neovascularage-related macular degeneration associated with pigment epithelium detachment(PED) treated by photodynamic therapy.

Methods  Review of the medical charts and the fluorescein and indocyanine greenangiograms of all consecutive patients with age-related macular degenerationassociated with choroidal neovascularization and serous PED of at least 1disc diameter, who received photodynamic therapy from January 1, 2000, toAugust 31, 2002.

Results  Thirty patients (34 eyes) met the study criteria. Each underwent 1 to8 treatments (mean, 4); duration of follow-up was 12 to 36 months (mean, 19months). Nineteen eyes (56%) lost 3 or more Snellen lines of visual acuity,7 eyes (21%) lost 1 or 2 lines, 6 eyes (18%) maintained their initial acuity,and 2 eyes (6%) gained 1 or 2 lines. Subretinal hemorrhage occurred in 5 eyesand retinal pigment epithelium tears in 4 eyes. In 4 eyes, visual acuity decreasedto counting fingers, hand motions, or light perception.

Conclusions  Although 44% of the 34 eyes with age-related macular degeneration andPED lost fewer than 3 Snellen lines in acuity, severe visual loss to countingfingers or less occurred in 4 eyes, 3 of them with choroidal neovascularizationinside the PED. Further studies and treatment modalities are required to improveprognosis of neovascular age-related macular degeneration with serous PED.

Figures in this Article

Photodynamic therapy (PDT) with verteporfin has been shown to be beneficialfor the treatment of predominantly classic1,2 andoccult with no classic3 subfoveal choroidalneovascularization (CNV) secondary to age-related macular degeneration (AMD).The Macular Photocoagulation Study (MPS)4 recognized2 forms of occult CNV: fibrovascular pigment epithelium detachment (PED) andleakage of undetermined source. Both forms were included as a single groupin the Verteporfin in Photodynamic Therapy study.3 Tothe best of our knowledge, a separate subgroup analysis of the value of PDTin eyes with neovascular AMD with serous PED associated with CNV has not yetbeen published.

We herein report the visual and angiographic outcome of a consecutiveseries of patients with subfoveal occult CNV associated with serous PED ofat least 1 disc diameter, who received PDT in a clinical setting.

The medical charts and the fluorescein (FA) and indocyanine green (ICGA)angiograms of all consecutive patients with AMD associated with CNV and serousPED who received PDT from January 1, 2000, to August 31, 2002, were reviewed.The study was approved by the Legal Department of the Mor Institute for MedicalData, Bnei Brak, Israel, and all the patients signed an informed consent.The PDT was administered according to the protocol of the Treatment of Age-RelatedMacular Degeneration With Photodynamic Therapy study,1,2 withfollow-up every 3 months for at least 12 months (to September 2003). The needfor repeated treatment was determined by the clinician, usually after 3 months.The following data were collected: age and sex; best-corrected Snellen visualacuity (VA) at initial examination and at the end of the follow-up period;number of PDT sessions; and adverse effects of PDT. The FAs and the ICGAswere reviewed by 2 physicians (R.A.-S. and R.E.). The initial diagnosis ofCNV associated with serous PED of at least 1 disc diameter was made by FA,and further analysis was performed with ICGA. The CNV was divided into 3 categoriesby location with respect to the PED, as suggested by Yannuzzi et al5: beneath, CNV located beneaththe PED and entirely within its boundaries (Figure 1); contiguous, CNV that interruptedthe continuity of the margin of the serous PED (Figure 2); and remote, CNV distinctly separatefrom the edge of the serous PED (Figure 3).

Place holder to copy figure label and caption
Figure 1.

A, Fluorescein angiogram showingchoroidal neovascularization (CNV) (arrow) beneath pigment epithelium detachment(PED) (arrowheads). B, Leakage from CNV (arrow) and fluorescein pooling ofthe PED (arrowheads). C, Indocyanine green angiogram (ICGA) demonstratingCNV (arrow) beneath the hypofluorescent PED (arrowheads). D, Late-phase ICGAshowing staining of the CNV (arrow) outlined against the hypofluorescent PED(arrowheads).

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Place holder to copy figure label and caption
Figure 2.

Contiguous choroidal neovascularization(CNV). A, Fluorescein angiogram (FA) showing hyperfluorescent choroidal neovascularization(CNV) (arrow) at the margin of pigment epithelium detachment (PED) (arrowheads).B, Late-phase FA showing leaking CNV (arrow) and fluorescein pooling in thePED. C, Indocyanine green angiogram (ICGA) showing the outline of the CNV(arrow) and the hypofluorescent PED (arrowheads). D, Late-phase ICGA demonstratingslight staining of the CNV and the hypofluorescent PED (arrowheads).

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Place holder to copy figure label and caption
Figure 3.

Remote choroidal neovascularization(CNV). A, Fluorescein angiogram (FA) showing hyperfluorescence located belowthe fovea (arrow) and blocked fluorescence superiorly (arrowheads). B, Late-phaseFA demonstrating leakage from the CNV (arrow) and pooling in the pigment epitheliumdetachment (PED) (arrowheads). C, Indocyanine green angiogram (ICGA) showsa hyperfluorescent spot (arrow) corresponding in location to the CNV shownon the FA. The PED is hypofluorescent (arrowheads). D, Late-phase ICGA showsfocal CNV (arrow) and blocked fluorescence corresponding to the PED (arrowheads).

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Correlations were calculated between the initial and final best-correctedSnellen VA, as well as the change in VA after PDT, and the difference in sizeof the PED, the location of the CNV, and the presence of retinal pigment epithelial(RPE) tear and subretinal hemorrhage.

The χ2 test, Fisher exact test, Pearson correlation,and analysis of variance were performed, as appropriate, with the use of SPSSsoftware (version 10, Professional Statistics Release; SPSS Inc, Chicago,Ill).

The cohort included 30 patients (34 eyes) with neovascular AMD associatedwith PED. There were 18 men and 12 women aged 60 to 90 years (mean, 71.3 years).The number of treatments was 1 to 8 (mean, 4 treatments), and the follow-upperiod ranged from 12 to 36 months (mean, 19 months).

The best-corrected Snellen VA results are presented in Table 1 and Table 2.An improved VA of 1 or 2 Snellen lines was noted in 2 eyes (6%), no changein VA in 6 eyes (18%), a decrease of 1 or 2 lines in 7 eyes (21%), and a decreaseof more than 3 lines in 19 eyes (56%).

Table Graphic Jump LocationTable 1. Visual Acuity (Snellen) Before and After Treatment
Table Graphic Jump LocationTable 2. Distribution of Change in Visual Acuity by Location of ChoroidalNeovascularization*

The serous PED composed more than 50% of the lesion in 31 of 34 eyes.Seventeen eyes had CNV beneath the PED, 9 had remote CNV, and 8 had contiguousCNV. The eyes with CNV beneath the PED had the worst VA outcome, with a 65%rate (11/17) of visual loss of 3 lines or more, compared with 44% (4/9) forthe group with remote CNV and 50% (4/8) for the group with contiguous CNV.The correlation between the location of the CNV and the change in VA did notreach statistical significance (P = .60, χ2 test). Four patients had a final VA of counting fingers, hand motions,or light perception, of whom 3 had CNV beneath the PED and 1 had contiguousCNV. The profound visual loss was due to subretinal hemorrhage in 3 patients(one of whom had an RPE tear as well) and to disciform scar in another patient.

An RPE tear occurred in 4 eyes after 1 or 2 treatments (Table 3). Three of these eyes had CNV beneath the PED, and 1 hadcontiguous CNV. The VA of these eyes ranged from 20/30 to hand motions. Oneadditional patient had an extrafoveal RPE tear before PDT, and his initialVA of 20/80 remained relatively stable at 20/100 after treatment and throughout15 months' follow-up.

Table Graphic Jump LocationTable 3. Visual Acuity of Eyes With Retinal Pigment Epithelial Tear

Of the remaining 29 eyes, the total lesion size increased in 14 eyes(48%), did not change in 11 (38%), and decreased in 4 (14%) (Table 4). No correlation was found between the change in lesionsize and the change in VA (P = .25, χ2 test).

Table Graphic Jump LocationTable 4. Location of Choroidal Neovascularization and Change in LesionSize (n = 29)*

Subretinal hemorrhage occurred in 5 eyes, 3 of them with CNV beneaththe PED, 1 with remote CNV, and 1 with contiguous CNV. Three of these patientshad a final VA of hand motions or light perception, 1 patient had a VA of20/800, and 1 patient had a VA of 20/200. There was a statistically significantcorrelation between the presence of subretinal hemorrhage and profound visualloss (P = .03, Fisher exact test).

Four eyes had retinochoroidal anastomoses on ICGA. The VA decreasedfrom 20/60 to 20/150, from 20/25 to 20/50, and from 20/50 to 20/300 in 1 eyeeach. In the remaining eye, final VA was light perception.

No statistically significant correlation was found between the followingvariables: initial and final VA; initial VA and subretinal hemorrhage; RPEtear and final VA; final VA and location of CNV; and subretinal hemorrhageand location of CNV (analysis of variance).

The findings of the present study indicate that PDT may be of questionablebenefit in eyes with AMD with occult CNV and serous PED. According to thedefinitions proposed by the MPS,4 there areessentially 2 forms of occult CNV: fibrovascular PED and leakage of undeterminedsource (without PED). The MPS guidelines (which were used in the Verteporfinin Photodynamic Therapy study3) distinguishbetween the fibrovascular PED and the typical classic serous detachments ofthe RPE, which may or may not have detectable CNV on FA. Further modificationof the definition of subfoveal neovascular lesions with PED was suggestedby Yannuzzi et al,5 who introduced the term vascularized PED to describe the combination of CNV andserous PED of at least 1 disc diameter. This description differs from theMPS terminology, since it includes ICGA findings, whereas the MPS guidelines(which were used in the verteporfin studies13)include only FA features. On ICGA, the serous component of the PED is hypofluorescent,whereas the vascularized component is hyperfluorescent, while on FA, bothcomponents demonstrate late hyperfluorescence or leakage. Our series includedeyes with CNV associated with serous PED of at least 1 disc diameter, andmost of the eyes (31/34) included serous PED that was larger than 50% of thelesion (eyes ineligible for verteporfin treatment3).In our study, the diagnosis of exudative AMD was made on the basis of clinicalexamination, and the presence of occult CNV with serous PED was determinedby FA. Pigment epithelium detachment larger than 1 disc diameter associatedwith CNV was then analyzed by confocal ICGA. On FA, all pigment epithelialelevations, both serous and vascular, stain, whereas on confocal ICGA, theserous PED remains totally dark and the area of hyperfluorescence localizesthe neovascularization, thereby segregating the serous and vascularized components.Several reports on the clinicopathological correlation of the hyperfluorescenceon ICGA and histopathological proof of CNV support the localization of theCNV at the hyperfluorescent area.68

Vascularized PED (serous PED with CNV) accounts for an estimated 26%to 31% of all newly diagnosed cases of exudative AMD.5,9 Itsnatural course is poor because of disciform scar formation or RPE tears.912 Previousstudies on ICGA-guided laser treatment of vascularized PED yielded disappointingvisual results.1315 Slakteret al13 reported anatomic success in only 43%of eyes with vascularized PED compared with 66% in eyes with occult CNV notassociated with serous PED. Lim et al14 noteda deterioration in VA in 82% of 20 patients treated by ICGA-guided laser,and Brancato et al15 found a decrease in VAafter ICGA-guided laser in 82% of eyes with CNV beneath the PED and in 62.5%of eyes with CNV at the margin of the PED.

The Verteporfin in Photodynamic Therapy study reported that PDT is beneficialin eyes with subfoveal occult CNV with no classic CNV.3 Thelesions included in the Verteporfin in Photodynamic Therapy study could containfeatures that obscured the distinction of classic and occult CNV on FA, namely,blood, hypofluorescence due to sources other than visible blood, and serousPED. Both type 1 (fibrovascular PED) and type 2 (leakage of undetermined source)occult CNV were treated, and no separate analysis of these 2 subgroups wasdone. Eyes with serous PED occupying more than 50% of the lesion were ineligiblefor verteporfin. Consequently, there are currently no explicit recommendationsfor PDT with verteporfin for eyes with subfoveal CNV and serous PED, especiallyin which the main component of the lesion is serous PED.

To the best of our knowledge, there are as yet no peer-reviewed publishedstudies on series of patients with CNV and serous PED treated with PDT. However,unpublished data and abstracts are available: Pece and Brancato16 reportedon 32 PDT-treated eyes of 28 patients with CNV associated with PED followedup for a mean duration of 5.7 months, and Moisseiev et al17 reportedon 15 patients with vascularized PED in AMD, in lesions where PED is the predominantcomponent, who received PDT, with a follow-up of 3 to 19 months. Lommatzschet al18 reported decreased VA of more than3 lines in 10 (83%) of 12 eyes with vascularized PED treated with PDT, within3 to 9 months after treatment. Copt and Zografos19 showedthat 18 (90%) of 20 eyes with vascularized PED who received PDT lost morethan 15 letters of VA from baseline. The results of these series are presentedin Table 5. The visual outcomereported in our cohort was decreased VA of 3 or more lines in 56% of the patients,during a follow-up period of 12 to 36 months (mean, 19 months). Our resultsare similar to those of the smaller series by Moisseiev et al,17 worsethan those of the larger series by Pece and Brancato,16 andbetter than those of the series by Lommatzsch et al18 andCopt and Zografos.19 Although caution mustbe exercised when different samples are compared, some of the differencesmay be attributed to the variability in the follow-up periods. It is importantto note as well that best-corrected VA from Early Treatment Diabetic RetinopathyStudy charts was used in clinical trials for PDT,13 whereasbest-corrected Snellen VA was used in our retrospective series. Since changesin Snellen lines do not equate with changes in lines on Early Treatment DiabeticRetinopathy Study charts, further caution must be exercised when differentseries are compared.

Table Graphic Jump LocationTable 5. Comparison of Visual Acuity Among Series

The anatomic response to PDT in our patients was disappointing. Thelesion size decreased in only 4 eyes, remained stable in 11, and increasedin 14 (Table 4).

Tears of RPE occurred in 4 eyes (12%) (Table 3), compared with the rate of 12% in the study by Pece andBrancato,16 33% in the series by Lommatzschet al,18 and 15% in the study by Copt and Zografos.19 One of our patients with an RPE tear sustained profoundvisual loss to hand motions because of subretinal hemorrhage, and the other3 patients had a final VA of 20/30 to 20/200. It is not clear whether theseRPE tears are complications of the treatment or represent the natural courseof the disease.

Acute RPE tears may occur as a natural complication of CNV associatedwith PED, or after laser treatment, because of contraction of the underlyingCNV or the pressure caused by the sub-RPE fluid on the taut serous PED.2022 The visual impactof the tear depends on the foveal involvement of the rupture or on the presenceof hemorrhages. Several studies reported increased rates of RPE tear afterPDT with verteporfin for eyes with CNV associated with PEDs,18,19,23,24 butthe mechanism of RPE tear after PDT remains unknown. Immediate optical coherencetomography performed after PDT for subfoveal CNV showed subretinal and intraretinalfluid accumulation caused by leakage from the neovascular complex, which wasconfirmed by ICGA.25 The fluid accumulationstarted 120 minutes after PDT and was maintained for up to 5 days. It is thereforepossible that this fluid beneath the PED exerts additional tension on thetaut RPE, leading to RPE tear.

Subretinal hemorrhage occurred in 5 eyes (one of them with an RPE tear),causing profound visual loss in 4 of them. Three of the eyes had a final VAof hand motions or light perception, one had a VA of 20/800, and one had aVA of 20/200. There was a statistically significant correlation between thepresence of subretinal hemorrhage and profound visual loss (P = .03, Fisher exact test).

In conclusion, the visual and anatomic results of our series show that,while 15 (44%) of the 34 eyes lost fewer than 3 lines of Snellen VA afterPDT, 4 eyes (12%) sustained profound visual loss, 3 of them because of massivesubretinal hemorrhage and 1 because of RPE tear. In addition, 4 eyes (12%)developed RPE tear. No correlation was found between the location of the CNVor the lesion size and the final VA. Although the small sample size precludesdefinitive recommendations, our study shows a high rate of visual and anatomiccomplications after PDT in eyes with CNV associated with serous PED.

Corresponding author and reprints: Ruth Axer-Siegel, MD, Departmentof Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tikva 49 100,Israel (e-mail: seegs@netvision.net.il).

Submitted for publication July 23, 2003; final revision received October31, 2003; accepted December 3, 2003.

This study was presented in part at the meeting of the American Societyof Retinal Specialists; August 18, 2003; New York, NY.

Treatment of Age-Related Macular Degeneration With Photodynamic Therapy(TAP) Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-relatedmacular degeneration with verteporfin: one-year results of 2 randomized clinicaltrials: TAP report 1. Arch Ophthalmol. 1999;1171329- 1345
PubMed Link to Article
Bressler  NMTreatmentof Age-Related Macular Degeneration With Photodynamic Therapy(TAP) Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-relatedmacular degeneration with verteporfin: two-year results of 2 randomized clinicaltrials: TAP report 2. Arch Ophthalmol. 2001;119198- 207
PubMed
Verteporfin in Photodynamic Therapy Study Group, Verteporfin therapy of subfoveal choroidal neovascularization in age-relatedmacular degeneration: two-year results of a randomized clinical trial includinglesions with occult with no classic choroidal neovascularization—verteporfinin photodynamic therapy report 2. Am J Ophthalmol. 2001;131541- 560
PubMed Link to Article
Macular Photocoagulation Study Group, Subfoveal neovascular lesions in age-related macular degeneration. Arch Ophthalmol. 1991;1091242- 1257
PubMed Link to Article
Yannuzzi  LAHope-Ross  MSlakter  JS  et al.  Analysis of vascularized pigment epithelial detachments using indocyaninegreen videoangiography. Retina. 1994;1499- 113
PubMed Link to Article
Chang  TSFreund  KBde la Cruz  ZYannuzzi  LAGreen  WR Clinicopathologic correlation of choroidal neovascularization demonstratedby indocyanine green angiography in a patient with retention of good visionfor almost 4 years. Retina. 1994;14114- 124
PubMed Link to Article
Lee  BLLim  JlGrossniklaus  HE Clinicopathologic features of indocyanine green angiography-imaged,surgically excised choroidal neovascular membranes. Retina. 1996;1664- 69
PubMed
Nakajima  MShimada  HSato  MYuzawa  M Comparison between indocyanine green angiography and histopathologicalobservations of choroidal neovascular membrane in age-related macular degeneration. Nippon Ganka Gakkai Zasshi. 1997;101584- 592
Meredith  TABraley  REAaberg  TM Natural history of serous detachments of the retinal pigment epithelium. Am J Ophthalmol. 1979;88643- 651
PubMed
Elman  MJFine  SLMurphy  RPPatz  AAuer  C The natural history of serous retinal pigment epithelial detachmentsin patients with age-related macular degeneration. Ophthalmology. 1986;93224- 230
PubMed Link to Article
Poliner  LSOlk  RJBurgess  DGordon  ME Natural history of retinal pigment epithelial detachments in age-relatedmacular degeneration. Ophthalmology. 1986;93543- 550
PubMed Link to Article
Haddad  WMCoscas  GSoubrane  G Eligibility for treatment and angiographic features at the early stageof exudative age-related macular degeneration. Br J Ophthalmol. 2002;86663- 669
PubMed Link to Article
Slakter  JSYannuzzi  LASorenson  JAGuyer  DRHo  ACOrlock  DA A pilot study of indocyanine green videoangiography-guided laser photocoagulationtreatment of occult choroidal neovascularization. Arch Ophthalmol. 1994;112465- 472
PubMed Link to Article
Lim  JIAaberg  TMCapone  A  JrSternberg  P  Jr Indocyanine green angiography-guided photocoagulation of choroidalneovascularization associated with retinal pigment epithelial detachment. Am J Ophthalmol. 1997;123524- 532
PubMed
Brancato  RIntroini  UBolognesi  GPacelli  GTrabucchi  GPece  A ICGA-guided laser photocoagulation of occult choroidal neovascularizationin age-related macular degeneration: indocyanine green angiography. Retina. 2000;20134- 142
PubMed Link to Article
Pece  ABrancato  R Visudyne PDT of choroidal neovascularization associated with retinalpigment epithelial detachment in age-related macular degeneration.  Paper presented at: 25th Annual Meeting of the Macula Society June14 2002; Barcelona, Spain.
Moisseiev  JLowenstein  AZolf  RDesatnik  H Photodynamic therapy for pigment epithelium detachment in patientswith age-related macular degeneration.  Paper presented at: 25th Annual Meeting of the Macula Society June14 2002; Barcelona, Spain
Lommatzsch  ARadermacher  MSpital  GPauleikhoff  D Photodynamic therapy of pigment epithelium detachments in AMD [ARVOabstract]. Invest Ophthalmol Vis Sci. 2002;suppl439
Copt  RPZografos  L Retinal pigment epithelial tear after photodynamic therapy for choridalneovascularization caused by age-related macular degeneration [ARVO abstract]. Invest Ophthalmol Vis Sci. 2002;suppl440
Cantrill  HLRamsay  RCKnobloch  WH Rips in the pigment epithelium. Arch Ophthalmol. 1983;1011074- 1079
PubMed Link to Article
Axer-Siegel  RLichter  HRosenblatt  IPriel  EYassur  YWeinberger  D Simultaneous indocyanine green and fluorescein angiography in retinalpigment epithelium tear using the confocal scanning laser ophthalmoscope. Am J Ophthalmol. 1999;128331- 339
PubMed Link to Article
Moorfields Macula Study Group, Retinal pigment epithelial detachments in the elderly: a controlledtrial with argon laser photocoagulation. Br J Ophthalmol. 1982;661- 16
PubMed Link to Article
Gelisken  FInhoffen  WPartsch  MSchneider  UKreissig  I Retinal pigment epithelial tear after photodynamic therapy for choroidalneovascularization. Am J Ophthalmol. 2001;131518- 520
PubMed Link to Article
Pece  AIntroini  UBottoni  FBrancato  R Acute retinal pigment epithelial tear after photodynamic therapy. Retina. 2001;21661- 665
PubMed Link to Article
Costa  RAFarah  MECardillo  JACalucci  DWilliams  GA Immediate indocyanine green angiography and optical coherence tomographyevaluation after photodynamic therapy for subfoveal choroidal neovascularization. Retina. 2003;23159- 165
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

A, Fluorescein angiogram showingchoroidal neovascularization (CNV) (arrow) beneath pigment epithelium detachment(PED) (arrowheads). B, Leakage from CNV (arrow) and fluorescein pooling ofthe PED (arrowheads). C, Indocyanine green angiogram (ICGA) demonstratingCNV (arrow) beneath the hypofluorescent PED (arrowheads). D, Late-phase ICGAshowing staining of the CNV (arrow) outlined against the hypofluorescent PED(arrowheads).

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Place holder to copy figure label and caption
Figure 2.

Contiguous choroidal neovascularization(CNV). A, Fluorescein angiogram (FA) showing hyperfluorescent choroidal neovascularization(CNV) (arrow) at the margin of pigment epithelium detachment (PED) (arrowheads).B, Late-phase FA showing leaking CNV (arrow) and fluorescein pooling in thePED. C, Indocyanine green angiogram (ICGA) showing the outline of the CNV(arrow) and the hypofluorescent PED (arrowheads). D, Late-phase ICGA demonstratingslight staining of the CNV and the hypofluorescent PED (arrowheads).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Remote choroidal neovascularization(CNV). A, Fluorescein angiogram (FA) showing hyperfluorescence located belowthe fovea (arrow) and blocked fluorescence superiorly (arrowheads). B, Late-phaseFA demonstrating leakage from the CNV (arrow) and pooling in the pigment epitheliumdetachment (PED) (arrowheads). C, Indocyanine green angiogram (ICGA) showsa hyperfluorescent spot (arrow) corresponding in location to the CNV shownon the FA. The PED is hypofluorescent (arrowheads). D, Late-phase ICGA showsfocal CNV (arrow) and blocked fluorescence corresponding to the PED (arrowheads).

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Tables

Table Graphic Jump LocationTable 1. Visual Acuity (Snellen) Before and After Treatment
Table Graphic Jump LocationTable 2. Distribution of Change in Visual Acuity by Location of ChoroidalNeovascularization*
Table Graphic Jump LocationTable 3. Visual Acuity of Eyes With Retinal Pigment Epithelial Tear
Table Graphic Jump LocationTable 4. Location of Choroidal Neovascularization and Change in LesionSize (n = 29)*
Table Graphic Jump LocationTable 5. Comparison of Visual Acuity Among Series

References

Treatment of Age-Related Macular Degeneration With Photodynamic Therapy(TAP) Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-relatedmacular degeneration with verteporfin: one-year results of 2 randomized clinicaltrials: TAP report 1. Arch Ophthalmol. 1999;1171329- 1345
PubMed Link to Article
Bressler  NMTreatmentof Age-Related Macular Degeneration With Photodynamic Therapy(TAP) Study Group, Photodynamic therapy of subfoveal choroidal neovascularization in age-relatedmacular degeneration with verteporfin: two-year results of 2 randomized clinicaltrials: TAP report 2. Arch Ophthalmol. 2001;119198- 207
PubMed
Verteporfin in Photodynamic Therapy Study Group, Verteporfin therapy of subfoveal choroidal neovascularization in age-relatedmacular degeneration: two-year results of a randomized clinical trial includinglesions with occult with no classic choroidal neovascularization—verteporfinin photodynamic therapy report 2. Am J Ophthalmol. 2001;131541- 560
PubMed Link to Article
Macular Photocoagulation Study Group, Subfoveal neovascular lesions in age-related macular degeneration. Arch Ophthalmol. 1991;1091242- 1257
PubMed Link to Article
Yannuzzi  LAHope-Ross  MSlakter  JS  et al.  Analysis of vascularized pigment epithelial detachments using indocyaninegreen videoangiography. Retina. 1994;1499- 113
PubMed Link to Article
Chang  TSFreund  KBde la Cruz  ZYannuzzi  LAGreen  WR Clinicopathologic correlation of choroidal neovascularization demonstratedby indocyanine green angiography in a patient with retention of good visionfor almost 4 years. Retina. 1994;14114- 124
PubMed Link to Article
Lee  BLLim  JlGrossniklaus  HE Clinicopathologic features of indocyanine green angiography-imaged,surgically excised choroidal neovascular membranes. Retina. 1996;1664- 69
PubMed
Nakajima  MShimada  HSato  MYuzawa  M Comparison between indocyanine green angiography and histopathologicalobservations of choroidal neovascular membrane in age-related macular degeneration. Nippon Ganka Gakkai Zasshi. 1997;101584- 592
Meredith  TABraley  REAaberg  TM Natural history of serous detachments of the retinal pigment epithelium. Am J Ophthalmol. 1979;88643- 651
PubMed
Elman  MJFine  SLMurphy  RPPatz  AAuer  C The natural history of serous retinal pigment epithelial detachmentsin patients with age-related macular degeneration. Ophthalmology. 1986;93224- 230
PubMed Link to Article
Poliner  LSOlk  RJBurgess  DGordon  ME Natural history of retinal pigment epithelial detachments in age-relatedmacular degeneration. Ophthalmology. 1986;93543- 550
PubMed Link to Article
Haddad  WMCoscas  GSoubrane  G Eligibility for treatment and angiographic features at the early stageof exudative age-related macular degeneration. Br J Ophthalmol. 2002;86663- 669
PubMed Link to Article
Slakter  JSYannuzzi  LASorenson  JAGuyer  DRHo  ACOrlock  DA A pilot study of indocyanine green videoangiography-guided laser photocoagulationtreatment of occult choroidal neovascularization. Arch Ophthalmol. 1994;112465- 472
PubMed Link to Article
Lim  JIAaberg  TMCapone  A  JrSternberg  P  Jr Indocyanine green angiography-guided photocoagulation of choroidalneovascularization associated with retinal pigment epithelial detachment. Am J Ophthalmol. 1997;123524- 532
PubMed
Brancato  RIntroini  UBolognesi  GPacelli  GTrabucchi  GPece  A ICGA-guided laser photocoagulation of occult choroidal neovascularizationin age-related macular degeneration: indocyanine green angiography. Retina. 2000;20134- 142
PubMed Link to Article
Pece  ABrancato  R Visudyne PDT of choroidal neovascularization associated with retinalpigment epithelial detachment in age-related macular degeneration.  Paper presented at: 25th Annual Meeting of the Macula Society June14 2002; Barcelona, Spain.
Moisseiev  JLowenstein  AZolf  RDesatnik  H Photodynamic therapy for pigment epithelium detachment in patientswith age-related macular degeneration.  Paper presented at: 25th Annual Meeting of the Macula Society June14 2002; Barcelona, Spain
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