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. 1999 Feb;83(2):168–172. doi: 10.1136/bjo.83.2.168

Indocyanine green guided laser photocoagulation in patients with occult choroidal neovascularisation

A Weinberger 1, H Knabben 1, U Solbach 1, S Wolf 1
PMCID: PMC1722945  PMID: 10396192

Abstract

AIMS—To determine whether indocyanine green (ICG) guided laser photocoagulation of occult choroidal neovascularisations (OCNV) is beneficial for patients with occult choroidal neovascularisation secondary to age related macular degeneration (AMD).
METHODS—A prospective pilot study was performed in 21 eyes with OCNV secondary to AMD that could be identified extrafoveolarly or juxtafoveolarly in an early ICG angiographic study. Laser photocoagulation was applied to the neovascular membrane identified in the early ICG angiographic study.
RESULTS—Visual acuity ranged from 20/400 to 20/20 (logMAR 0.54 (SD 0.29)) before and hand movements and 20/30 (logMAR 0.81 (0.69)) at the last follow up after laser photocoagulation. During the follow up (30 (13) months) vision improved in four eyes (two lines), in seven eyes the initial visual acuity could be stabilised (two lines), in five eyes vision dropped moderately (three to five lines), and in five eyes vision decreased severely (six or more lines). Recurrences (seven patients) or persistent CNV (six patients) was observed in 13 patients.
CONCLUSION—This preliminary study of ICG guided laser photocoagulation of occult extrafoveal and juxtafoveal choroidal neovascularisations suggests that this technique may improve the visual prognosis of these patients. Further prospective controlled studies are necessary to confirm these data.

 Keywords: indocyanine green angiography; occult choroidal neovascularisation; age related macular degeneration; laser photocoagulation; experimental treatment

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Figure 1  .

Figure 1  

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Cumulative percentage of patients with severe visual loss. Data from the Macular Photocoagulation Study (MPS)13 and from Bressler et al31 for the natural course of occult CNV are included in the diagram.

Figure 2  .

Figure 2  

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Scattergram depicting initial and final visual acuity. Points within the dotted lines indicate stabilised visual acuity, points above improved, and points under these lines decreased visual acuity.

Figure 3  .

Figure 3  

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Fundus photograph of a patient with occult CNV (FA) and visible neovascular network in the early ICG angiographic study, visual acuity was 20/70.

Figure 4  .

Figure 4  

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Fluorescein angiogram of a study patient showing diffuse leakage in the macular area and cystoid macular oedema.

Figure 5  .

Figure 5  

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Early phase indocyanine green angiogram reveals a discrete neovascular network above the fovea with a feeding vessel at its nasal superior rim. The white arrows delineate the boarders of the CNV, the dark arrow points to the feeding vessel. Same patient as in Figure 3.

Figure 6  .

Figure 6  

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Follow up ICG angiogram 18 months after initial treatment. Visual acuity was 20/200. One re-treatment was performed. Same patient as in Figure 3.      

Figure 7  .

Figure 7  

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Follow up fluorescein angiogram 18 months after initial treatment. Visual acuity was 20/200. One re-treatment was performed. Same patient as in Figure 3.

Figure 8  .

Figure 8  

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Fundus photograph of the patient 18 months after initial laser photocoagulation, visual acuity was 20/200.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bergink G. J., Deutman A. F., van den Broek J. F., van Daal W. A., van der Maazen R. W. Radiation therapy for subfoveal choroidal neovascular membranes in age-related macular degeneration. A pilot study. Graefes Arch Clin Exp Ophthalmol. 1994 Oct;232(10):591–598. doi: 10.1007/BF00193119. [DOI] [PubMed] [Google Scholar]
  2. Bressler N. M., Maguire M. G., Murphy P. L., Alexander J., Margherio R., Schachat A. P., Fine S. L., Stevens T. S., Bressler S. B. Macular scatter ('grid') laser treatment of poorly demarcated subfoveal choroidal neovascularization in age-related macular degeneration. Results of a randomized pilot trial. Arch Ophthalmol. 1996 Dec;114(12):1456–1464. doi: 10.1001/archopht.1996.01100140654002. [DOI] [PubMed] [Google Scholar]
  3. Chakravarthy U., Houston R. F., Archer D. B. Treatment of age-related subfoveal neovascular membranes by teletherapy: a pilot study. Br J Ophthalmol. 1993 May;77(5):265–273. doi: 10.1136/bjo.77.5.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chan C. K., Kempin S. J., Noble S. K., Palmer G. A. The treatment of choroidal neovascular membranes by alpha interferon. An efficacy and toxicity study. Ophthalmology. 1994 Feb;101(2):289–300. doi: 10.1016/s0161-6420(94)31349-2. [DOI] [PubMed] [Google Scholar]
  5. Finger P. T., Berson A., Sherr D., Riley R., Balkin R. A., Bosworth J. L. Radiation therapy for subretinal neovascularization. Ophthalmology. 1996 Jun;103(6):878–889. doi: 10.1016/s0161-6420(96)30592-7. [DOI] [PubMed] [Google Scholar]
  6. Freund K. B., Yannuzzi L. A., Sorenson J. A. Age-related macular degeneration and choroidal neovascularization. Am J Ophthalmol. 1993 Jun 15;115(6):786–791. doi: 10.1016/s0002-9394(14)73649-9. [DOI] [PubMed] [Google Scholar]
  7. Guyer D. R., Puliafito C. A., Monés J. M., Friedman E., Chang W., Verdooner S. R. Digital indocyanine-green angiography in chorioretinal disorders. Ophthalmology. 1992 Feb;99(2):287–291. doi: 10.1016/s0161-6420(92)31981-5. [DOI] [PubMed] [Google Scholar]
  8. Guyer D. R., Yannuzzi L. A., Slakter J. S., Sorenson J. A., Hope-Ross M., Orlock D. R. Digital indocyanine-green videoangiography of occult choroidal neovascularization. Ophthalmology. 1994 Oct;101(10):1727–1737. doi: 10.1016/s0161-6420(13)31433-x. [DOI] [PubMed] [Google Scholar]
  9. Hayashi K., de Laey J. J. Indocyanine green angiography of choroidal neovascular membranes. Ophthalmologica. 1985;190(1):30–39. doi: 10.1159/000309489. [DOI] [PubMed] [Google Scholar]
  10. Kini M. M., Leibowitz H. M., Colton T., Nickerson R. J., Ganley J., Dawber T. R. Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham eye study. Am J Ophthalmol. 1978 Jan;85(1):28–34. doi: 10.1016/s0002-9394(14)76661-9. [DOI] [PubMed] [Google Scholar]
  11. Kuck H., Inhoffen W., Schneider U., Kreissig I. Diagnosis of occult subretinal neovascularization in age-related macular degeneration by infrared scanning laser videoangiography. Retina. 1993;13(1):36–39. doi: 10.1097/00006982-199313010-00009. [DOI] [PubMed] [Google Scholar]
  12. Kuhn D., Meunier I., Soubrane G., Coscas G. Imaging of chorioretinal anastomoses in vascularized retinal pigment epithelium detachments. Arch Ophthalmol. 1995 Nov;113(11):1392–1398. doi: 10.1001/archopht.1995.01100110052025. [DOI] [PubMed] [Google Scholar]
  13. Schleicher U. M., Andreopoulos D., Wolf S., Schmachtenberg A., Ammon J., Reim M. Radiotherapy of macular degeneration. Experience with two fractionation schemes. Front Radiat Ther Oncol. 1997;30:253–258. [PubMed] [Google Scholar]
  14. Slakter J. S., Yannuzzi L. A., Sorenson J. A., Guyer D. R., Ho A. C., Orlock D. A. A pilot study of indocyanine green videoangiography-guided laser photocoagulation of occult choroidal neovascularization in age-related macular degeneration. Arch Ophthalmol. 1994 Apr;112(4):465–472. doi: 10.1001/archopht.1994.01090160041020. [DOI] [PubMed] [Google Scholar]
  15. Sorenson J. A., Yannuzzi L. A., Slakter J. S., Guyer D. R., Ho A. C., Orlock D. A. A pilot study of digital indocyanine green videoangiography for recurrent occult choroidal neovascularization in age-related macular degeneration. Arch Ophthalmol. 1994 Apr;112(4):473–479. doi: 10.1001/archopht.1994.01090160049021. [DOI] [PubMed] [Google Scholar]
  16. Soubrane G., Coscas G., Français C., Koenig F. Occult subretinal new vessels in age-related macular degeneration. Natural History and early laser treatment. Ophthalmology. 1990 May;97(5):649–657. doi: 10.1016/s0161-6420(90)32530-7. [DOI] [PubMed] [Google Scholar]
  17. Stevens T. S., Bressler N. M., Maguire M. G., Bressler S. B., Fine S. L., Alexander J., Phillips D. A., Margherio R. R., Murphy P. L., Schachat A. P. Occult choroidal neovascularization in age-related macular degeneration. A natural history study. Arch Ophthalmol. 1997 Mar;115(3):345–350. doi: 10.1001/archopht.1997.01100150347006. [DOI] [PubMed] [Google Scholar]
  18. Thomas M. A., Grand M. G., Williams D. F., Lee C. M., Pesin S. R., Lowe M. A. Surgical management of subfoveal choroidal neovascularization. Ophthalmology. 1992 Jun;99(6):952–976. doi: 10.1016/s0161-6420(92)31888-3. [DOI] [PubMed] [Google Scholar]
  19. Wald K. J., Elsner A. E., Wolf S., Staurenghi G., Weiter J. J. Indocyanine green videoangiography for the imaging of choroidal neovascularization associated with macular degeneration. Int Ophthalmol Clin. 1994 Summer;34(3):311–325. doi: 10.1097/00004397-199403430-00029. [DOI] [PubMed] [Google Scholar]
  20. Wolf S., Knabben H., Krombach G., Schaaf A., Solbach U., Reim M. Indocyanine-green angiography in patients with occult choroidal neovascularization. Ger J Ophthalmol. 1996 Sep;5(5):251–256. [PubMed] [Google Scholar]
  21. Wolf S., Remky A., Elsner A. E., Arend O., Reim M. Indocyanine green video angiography in patients with age-related maculopathy-related retinal pigment epithelial detachments. Ger J Ophthalmol. 1994 Aug;3(4-5):224–227. [PubMed] [Google Scholar]
  22. Wolf S., Wald K. J., Elsner A. E., Staurenghi G. Indocyanine green choroidal videoangiography: a comparison of imaging analysis with the scanning laser ophthalmoscope and the fundus camera. Retina. 1993;13(3):266–269. doi: 10.1097/00006982-199313030-00025. [DOI] [PubMed] [Google Scholar]
  23. Yannuzzi L. A., Hope-Ross M., Slakter J. S., Guyer D. R., Sorenson J. A., Ho A. C., Sperber D. E., Freund K. B., Orlock D. A. Analysis of vascularized pigment epithelial detachments using indocyanine green videoangiography. Retina. 1994;14(2):99–113. doi: 10.1097/00006982-199414020-00003. [DOI] [PubMed] [Google Scholar]
  24. Yannuzzi L. A., Slakter J. S., Sorenson J. A., Guyer D. R., Orlock D. A. Digital indocyanine green videoangiography and choroidal neovascularization. Retina. 1992;12(3):191–223. [PubMed] [Google Scholar]

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