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R.A. Costa, D. Calucci, L.A. Melo Jr, J.A. Cardillo, M.E. Farah; Neovascular Ingrowth Site Photothrombosis of "Classic" or "Predominantly Classic" Subfoveal Choroidal Neovascularization Caused by Age-Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1792.
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Purpose: To evaluate the visual, angiographic, and anatomical outcomes after neovascular ingrowth site photothrombosis for the management of "classic" or "predominantly classic" subfoveal choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). Methods: Interventional noncomparative case series. After neovascular ingrowth site identification, twelve consecutive AMD patients were submitted to focal treatment of such sites by the use of continuous 810 nm laser and intravenous indocyanine green (ICG) infusion. Prospective evaluation with fluorescein and ICG angiography as well as optical coherence tomography (OCT) was performed at regular intervals up to 12 months following treatment. Results: With treatment, visual acuity improved 3 or more ETDRS lines in 8 (66.6%), improved 1 or 2 lines in 3 (25%) and remained stable in 1 (8.3%). The mean change in vision from baseline after the procedure was statistically significant (p < 0.00001, repeated measures ANOVA), with an improvement of 1.51 and 2.6 lines over baseline observed, respectively, at 1 and 48 weeks (p = 0.00003 and p = 0.00001, Dunnett’s test). Non perfusion of the entire neovascular complex was achieved in all patients within the first week following treatment. Sluggishness of CNV blood flow was seen 48 weeks after treatment, and OCT disclosed considerable resolution of the exudative manifestations with all patients presenting foveal heights below 180 microns. Complications included transient occlusion of retinal capillaries in three patients over the site of laser application. Conclusions: The use of 810 nm continuous light after intravenous ICG dye bolus induced selective CNV hipoperfusion in all treated eyes. This finding was either consistent with the visual acuity improvement or maintenance observed in these patients as well as with the considerable restoration of the retinal architecture seen in OCT evaluation 12 months after neovascular ingrowth site photothrombosis. View OriginalDownload SlideView OriginalDownload Slide
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