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K.B. Shah, J.E. Kim, T.B. Connor, W.J. Wirostko, D.P. Han; Transpupillary Thermotherapy Plus Indocyanine Green Dye Enhancement for the Treatment of Occcult Subfoveal Choroidal Neovascularization in Age Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1819.
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Purpose: To report our experience with transpupillary thermotherapy with ICG enhancement for the treatment of occult subfoveal CNV in AMD. Methods: Patients were randomized to TTT or TTT plus ICG (TTT+) at initial treatment and followed prospectively. A complete ophthalmologic examination including ETDRS visual acuity (VA), fundus photographs, fluorescein angiogram (FA), and Indocyanine Green Angiography (ICG) were obtained at each visit. TTT was delivered with an infrared diode laser (Iridex Corporation, Mountain View, CA) at 810 nm with a 3.0 mm spot size, 60 second duration, and 800 mW. TTT+ was given a bolus of ICG dye (0.5mg/kg) infusion and treated 5 minutes later with a 3.0 mm spot size, 60 second duration, and 500 mW. One spot encompassed the entire CNV. Outcome measures were proportion of eyes with < 3 lines of VA loss, number of re-treatments, and final exudative response based on clinical exam, FA, and ICG angiography. Results: 21 eyes in 21 patients were treated. The age range of the 12 patients treated with TTT was 63-93 years (mean: 79). The age range of the 9 patients treated with TTT+ was 62-93 years (mean: 77). The initial VA ranged from 20/32 to 20/200 for TTT group and 20/50 to 20/125 for TTT+ group. More than one treatment was needed in 5 of 12 (42%) eyes in TTT group and 7 of 9 (77%) eyes in TTT+ group (range: 1 - 3). All eyes had at least 6 months of follow-up. For the TTT group, < 3 lines of VA loss was present in 7 of 12 (58%) eyes at 6 months, 6 of 9 eyes (67%) at 12 months, and 4 of 6 (67%) eyes at 18 - 24 months of follow up. For the TTT+ group, < 3 lines of VA loss was seen in 5 of 9 (56%) eyes at 6 months, 4 of 6 (67%) eyes at 12 months, and 3 of 3 (100%) eyes at 18 - 24 months. In the final examination, there was no active CNV exudation in 6 of 12 (50%) of the TTT group and 5 of 9 (56%) of the TTT+ group. The final visual acuity was 20/50 to 20/800 (mean: 20/125) in the TTT group and 20/40 to 20/800 in the TTT+ group (mean: 20/160). No complications were encountered in either group. Conclusion: TTT with ICG enhancement was as effective and safe as TTT alone in preserving VA for occult subfoveal CNV in AMD. Reasons for no difference between the two groups include need for adjustments in ICG concentration, laser power and/or the timing of laser application following ICG infusion.
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