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C. Clemens, C. Milojcic, F. G. Holz, N. Eter; Pigment Epithelial Detachments in AMD Evaluated by Spectral-Domain Oct, Near-Infrared Reflectance, Fluorescein and Indocyanine Green Angiography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):87.
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To compare the characteristics of spectral domain OCT (SD-OCT), near-infrared reflectance (NIR), fluorescein angiography (FL-A) and indocyanine green angiography (ICG-A) in patients with pigment epithelium detachments (PED) secondary to age-related macular degeneration (AMD)
Seventy-eight eyes of 75 patients with PED were included. Simultaneous SD-OCT and cSLO images (Spectralis HRA+OCT, Heidelberg Engineering) were obtained. CSLO imaging modes included FL-A and ICG-A and NIR.
On SD-OCT 51 of 78 (65 %) cases had circumfluent subretinal fluid accumulation around the margin of the PED. In all patients these areas correlated with a distinct low reflectance in NIR images. On FL-A, subretinal fluid appeared hypofluorescent compared to the hyperfluorescent pooling phenomenon underneath the PED. The latter displayed diffuse hyperfluorescent distribution in the majority of cases, while 16 % of these appeared "donut-shaped" showing central shading extending beyond the foveal avascular zone (FAZ).On ICG-A corresponding to circumfluent subretinal fluid a reduced fluorescence signal was noted. The area of the actual PED was hypofluorescent in 87 % and hyperfluorescent in 13% of cases in the late phase of 20 min. On FL-A and ICG-A signs of choroidal neovascularization (CNV) were detected in 76% of patients. Circumfluent subretinal fluid accumulation was independent of the presence of CNV.
Simultaneous acquisition of SD-OCT tomographic scans and topographic multimodal cSLO images allows for accurate correlation of morphological alterations. In dependence on the anatomical location of extracellular fluid associated with PED characteristic corresponding phenomena are notable on NIR, FL-A or ICG-A. The prognostic relevance of such characteristics for anti-VEGF treatment response is currently being assessed in an ongoing investigator initiated trial (EudraCT-Nr. 2008-004675-22).
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