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A.A. Castellarin, T.M. Aaberg, Sr., D.F. Martin, B.G. Hubbard, E. Garcia-Valenzuela, C. Drews-Botsch, P. Sternberg Jr; Compliance With Photodynamic Therapy Treatment Guidelines: A Retrospective Review . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1741.
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Purpose:To determine compliance with treatment guidelines for Photodynamic Therapy (PDT) and interobserver agreement on angiographic assessment by retrospective interpretation of fluorescein angiograms of Choroidal Neovascularization (CNV). Methods: Ninety-five angiograms of patients with Wet AMD were reviewed retrospectively by five retina specialists masked as to treatment. All the angiograms were obtained digitally and reviewed using a 17" high resolution monitor. Only one eye was reviewed per patient. Among the eyes, 63 were previously considered eligible for PDT and subsequently treated. Reviewers were to classify type of membrane (classic, occult, mixed), percentage of classic vs occult, location (subfoveal, juxtafoveal, extrafoveal), and size. Reviewers were to indicate treatment recommendations (PDT vs focal laser vs no treatment), based on the recent guidelines from the TAP and VIP studies. Reliability was measured by percent agreement and kappa coefficient. Results: Thirty-nine eyes were considered eligible for treatment. Among those, 36 were considered eligible for PDT, and 3 for focal laser. Fifty-six eyes were not considered eligible for treatment. Of the 63 eyes previously treated with PDT, 25 (39.7%) were not considered eligible for treatment. Of the 25 deemed ineligible for treatment, reasons included: minimally classic 15(60%), not subfoveal 3(12%), extensive subretinal blood masking extent of CNV 3(12%), and other 4(16%). Of the 32 eyes previously considered not eligible for treatment, only 2 (6%) were judged to be eligible for PDT. Conclusions: This study suggests considerable difficulty in angiographic interpretation and treatment decision making with regard to Photodynamic Therapy. Greatest variability was related to determination of the percentage of classic component. Use of digital angiography may reduce accuracy of interpretation.
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