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M. Niemeyer, S. Michels, R. Birngruber, U. Schmidt-Erfurth; Three-Dimensional Imaging of Photodynamic Effects in Choroidal Neovascularization and Collateral Choroid . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1098.
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Purpose: To identify changes in perfusion and leakage activity following photodynamic therapy (PDT) using a three-dimensional angiography system. Method: Fluorescein (FA) and indocyanine green angiography (ICGA) using a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph) were performed in patients (n=30) which received standard verteporfin PDT. Early and late tomographic series of 32 angiographic sections over a depth of 4 mm were taken 1 week before and 5 hours, 1 day, 1 week and 3 months following PDT. Three-dimensional fluorescence patterns were analyzed topographically and changes in perfusion and/or leakage were documented over time. Results: Before PDT, CNV was detected as an exudative vascular lesion in 100% by 3D-FA and in 96% by 3D-ICGA. 5 hours following PDT, CNV was still visible/perfused in 100%(FA)/92%(ICGA) of eyes and leakage intensity was even further enhanced in 65% (FA)/30%(ICGA) of treated eyes. This increase in leakage above baseline was also seen at day 1, but was less intensive in either modality. At 1 week, the exudative activity had regressed and had reached its minimum intensity at 50% of the original exudative activity. The collateral choroid appeared well perfused in 92%(FA)/88%(ICGA) of pretreatment 3D-images. Massive exudation from the PDT-exposed choroid was seen at 5 hours post PDT in 92% by 3D-FA and 78% of 3D-ICGA. At 1 day this new collateral leakage was reduced to half (FA) and a third (ICGA) of its intensity. In contrast, at one week, collateral perfusion defects were observed in 36% by 3D-FA and 79% by 3D-ICGA. Choroidal perfusion defects were restored in 3D-FA at 3 months, but persisted in 57% of 3D-ICGA images. Conclusion: 3D-angiographic topography demonstrates characteristic vascular changes following verteporfin PDT. Increased leakage shortly after treatment precedes the regression of CNV. Massive exudation followed by perfusion defects seen in the collateral choroid suggest a lack of selectivity probably due to an overdose treatment.
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