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T.M. Johnson, B.M. Glaser; High Speed ICG Guided Focal Laser Treatment of Retinal Angiomatous Proliferations . Invest. Ophthalmol. Vis. Sci. 2003;44(13):5034.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Retinal angiomatous proliferations (RAP) are a form of primary intraretinal neovascularization that may occur in 10-15 % of patients with exudative macular degeneration. Patients present with cystoid retinal edema, intraretinal hemorrhages and a focal hot spot on static ICG imaging. This study is designed to examine the role of high speed ICG imaging in the identification of RAP lesions and the role of focal laser in the treatment of this condition. Methods: A prospective case series of 12 eyes of 11 consecutive patients with macular degeneration and associated RAP lesions was conducted. RAP lesions were identified using clinical fundus examination, fluorescein angiography, static and high speed ICG imaging. Confluent yellow laser (568 nm) was applied to completely ablate the intraretinal neovascularization and any associated intraretinal vascular anastamoses. Outcome measures included ETDRS visual acuity and resolution of subretinal fluid and intraretinal edema on OCT. Results: Patients presented with initial visual acuities ranging from 20/32 to 20/640. 100 % of patients had intraretinal edema and subretinal fluid on presentation. Static angiography demonstrated occult neovascularization without a clear leakage source. An ill defined ICG hot spot was present in all cases. High speed ICG imaging was required in all patients to clearly define the intraretinal neovascularization. High speed ICG was essential for localization of early, small RAP lesions. A mean of 2.1 laser treatments per eye was required. With an average follow up of 4.8 months 92 % had a reduction or resolution of subretinal fluid and retinal edema. 84 % had stabile or improvement of visual acuity. 42 % of patients gained 1 or more line of visual acuity. No significant complications were encountered. Conclusions: High speed ICG imaging is an important method for the identification of retinal angiomatous proliferations. High speed ICG is able to localize early RAP lesions that are not well defined with traditional imaging techniques. Focal laser ablation of RAP lesions appears to be a safe and effective method of management. Earlier therapy may offer improved visual outcomes.
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