Abstract
Introduction::
Fundus fluorescein angiography is the gold standard for investigating and for deciding on a treatment plan for age related macular degeneration (ARMD). Fundus fluorescein angiographic appearance of age related macular degeneration before and after treatment with photodynamic therapy is well documented. Intravitreal injections of anti vascular endothelial growth factors such as avastin (bevacizumab) is one burgeoning treatment for age related macular degeneration.
Purpose::
The aim of this study was to analyse the fundus fluorescein angiographic appearances of a cohort of patients with age related macular degeneration that were treated successfully with serial intravitreal avastin(bevacizumab) injections.
Methods::
15 patients with choroidal neovascularisation and 15 patients with pigment epithelial detachment treated with 2.5mg of intravitreal avastin had fundus fluorescein angiography preformed 5-7 weeks following each intravitreal injection.
Results::
In the cohort with choroidal neovascular membranes the early phase of the angiogram demonstrated nonperfusion of the lesion with no apparent change in the vascular pattern compared to the pre-treated lesion. The treated lesion had a border of hypoflourescence with an otherwise normal choroidal blood flow in contrast to the halo of hypoflouresence often seen in patients treated with photodynamic therapy. There were no alterations in the density of the pigment epithelium seen following treatment.During the intermediate and late phases progressing hypoflouresence was detectable within the area corresponding to the original choroidal neovascular membrane.The fundus fluorescein angiographic appearance in those patients in whom the pigment epithelial detachment flattened demonstrated a combined appearance of a speckled pattern of hyper and hypoflouresence combined with a spoke like appearance of hyper and hypoflouresence corresponding with the bio microscopic findings of hyper and hypopigmentation.
Conclusions::
The fundus flourescein angiographic appearance of the blood vessles in patients treated with intravitreal avastin (bevacizumab) suggests that there is less damage to the neurosensory retina, the underlying retinal pigment epithelium and adjacent choriocapillaris. These angiographic findings support the clinical findings of maintenance or improvement in visual acuity with this treatment.
Keywords: age-related macular degeneration • growth factors/growth factor receptors • imaging/image analysis: clinical