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C. Veronese, G. Levi, G. Staurenghi; Use of A Novel Device to Treat Feeder Vessels of Naive AMD-Related CNV Lesions or Those With Unsuccessful Response to Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2241.
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To report results using a novel device to identify and close the Feeder Vessels (FVs) in naive Age-related Macular Degeneration (AMD) choroidal neovascularization (CNV) lesions or in those that failed to respond to previous anti-VEGF therapy.
Study of 27 patients presenting with subfoveal classic and/or occult CNV, based on fluorescein angiography (FA) and indocyanine green angiography (ICGA). 16 patients (57%) were previously treated with anti-VEGF without success, 12 patients (43%) presented with new lesions. Visual acuity (VA) was measured using ETDRS chart. The FVs were visualized with a diagnostic-treatment device (OPTTX, Novadaq, Canada), in which the optical system of a fundus camera is modified to acquire high-speed, high resolution ICG for FV identification and photocoagulation of the FV with a 810 nm laser. High-speed ICGA follow-up was performed immediately after treatment. The number of treatments and sites of the FVs in relation to the macula as well as FA, ICGA, and VA results were assessed. Other treatment techniques such as anti-VEGF (Avastin) were offered to the patient, if warranted.
The patients were followed for 6 months. 8 women/19 men (mean age, 71 years) were included. 6 (22%) patients presented with purely classic CNV, 4 (15%) with occult CNV and 17 (63%) with minimally classic CNV. Patients received 1-4 treatments. Sites of FVs were as follows: 10 superior-nasal, 8 inferior-nasal, 7 superior-temporal and 11 inferior-temporal. At 6 month, 14 patients were evaluable. VA improved 2 lines or more in 4 patients (29%), decreased 2 lines or less in 5 patients (36%) and was stable in 5 patients (36%). After the first FV Treatment , 21 FVs (78%) were completely closed, 4 FVs were partially closed (15%) and only 2 FVs (7%) were opened. No complications related to FV treatment were observed, 2 subretinal hemorrhages remote from the site of the treatment were observed.
The device used uniquely facilitates identification and treatment of FVs located at a distance from all CNV lesions types. The final VA results at 6 months demonstrates that the vast majority (86%) of the patients remained stable, and the technique appeared to be safe and reproducible. This study suggests that FV treatment can be used as an alternative to the anti-VEGF drugs. Moreover, it appears FV treatment can be safely applied before or after anti-VEGF treatment.
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