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S. Wolf, A. Nestler, P. Gaebler, M.B. Reichel, U.E. K. Schnurrbusch, A. Moessner, M. Verdugo; Three year follow–up of occult choroidal neovascularization in patients with age–related macular degeneration: Changes in visual acuity . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2359.
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Purpose: To assess the changes in visual acuity, lesion composition, and lesion size in patients with occult choroidal neovascularization over a period of three years. Methods: In a prospective study we included patients with occult CNV secondary to ARMD. Inclusion criteria were visual acuity of 20/80 or better, presence of exudative ARMD with an occult CNV and no other ocular disease. Examinations included ETDRS visual acuity, binocular ophthalmoscopy, fluorescein and ICG angiography with a scanning laser ophthalmoscope (HRA, Heidelberg Engineering GmbH, Germany) and color fundus photography. From the fluorescein angiograms the size of the occult lesion was assessed using the tracking tool of the Heidelberg Eye Explorer. All examinations were performed at baseline, 6 weeks, 3, 6, 12, and in 6 months intervals thereafter. Results: Sixty patients (32 female, 28 male) were included into the "natural history study of occult CNV". Age ranged from 52–88 years (mean: 71 ± 8 years). Visual acuity ranged from 20/80 to 20/20 at baseline. Within 36 months 14 patients experienced a moderate visual loss (≥ 3 ETDRS lines), 15 patients a severe visual loss (≥ 6 ETDRS lines). In 14 patients the visual acuity remained without a significant change (±2 ETDRS lines). Eight patients developed a predominately classic CNV and 14 patients developed a minimal classic lesion during follow–up. Lesion size was increased (at least 20%) in 33 patients at the 36 months visit. Lesion size was increased (at least 20%) in 35 patients at the 36 months visit. Only 20 of these patients had experienced a visual loss. Conclusions: This prospective study indicates that moderate or severe visual loss in patients with occult CNV secondary to ARMD occurs in about 50% of patients within a follow–up period of 36 months. The study indicates that visual loss is related to increase of lesion size and lesion composition.
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