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Ursula Schmidt-Erfurth, Stephan Michels, Irene Barbazetto, Horst Laqua; Photodynamic Effects on Choroidal Neovascularization and Physiological Choroid. Invest. Ophthalmol. Vis. Sci. 2002;43(3):830-841.
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purpose. To evaluate the effect of photodynamic therapy (PDT) on perfusion and
vascular integrity of choroidal neovascularization (CNV) and collateral
methods. In a prospective clinical trial, patients with subfoveal CNV were
treated with PDT and verteporfin. Indocyanine green angiography
(ICG-A), using a confocal laser scanning system with tomographic
sections, was performed continuously 1 week before and 1, 4, and 12
weeks after and a mean long-term follow-up of 16.5 months after the
final PDT. Vascular changes were localized tomographically and
quantified on the level of the CNV and collateral choroid according to
early lesion size, late hyperfluorescence, and persistence or
recurrence. Data were analyzed separately from 38 eyes in a single- and
12 eyes in a multiple-treatment regimen.
results. CNV lesions were significantly reduced in size and late
hyperfluorescence. However, 54% of lesions primarily demonstrated
persistence, typically of the choroidal feeding complex, which was only
detectable by ICG-A. Regrowth from the feeding vessel occurred
regularly, but did not reach baseline dimensions. Collateral choroid
exposed to photoactivation exhibited choriocapillary occlusion.
Progressive recanalization was documented within 4 to 12 weeks after
both single and multiple PDT. Residual changes in the choroidal filling
pattern often persisted during long-term follow-up.
conclusions. Tomographic ICG-A after PDT reveals persistence of CNV and/or the
feeder vessel and a reduction in perfusion within the entire
photosensitized area, including the surrounding choroid. Repair
mechanisms occur slowly in neovascular and normal choroidal
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