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I. Mantel, A. Ambresin, L. Zografos; Photothrombosis for Exudative Extrafoveal Polyps in IPCV . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2164.
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Treatment for idiopathic polypoidal choroidal vasculopathy (IPCV) is not well established. In cases of exudative changes threatening central vision, conventional thermal laser, PDT and feeder vessel coagulation have been reported to be efficient. In this prospective non–comparative case series we investigate the effect of photocoagulation, enhanced by prior injection of ICG (photothrombosis). The rational is a better uptake of the red dye laser energie through the green ICG in the polyps.
A consecutive series of 6 patients (3 male and 3 female) have been treated with photothrombosis for extrafoveal polyps in IPCV, associated with subfoveal exudation and visual loss. Patients were assessed by full ophthalmic examination, angiography with fluorescein and ICG, as well as OCT. They were followed at 1,3,6 and 12 months after treatment, repeating the same examination. They were evaluated for visual acuity, the amount of exudation and the angiographic presence of polyps.
Mean age was 76 years. All patients but one completed their 12 month visit. At their first follow–up visit, the subretinal fluid was entirely absorbed in 3 cases and significantly reduced in the other 3 cases. All treated polyps had disappeared angiographically. At 12 months, only one patient showed persistant exudation from polyps that were previously hidden under blood. Average visual acuity at baseline was logMAR 0.87 and improved to logMAR 0.52 at the final visit. Three out of 6 patients had significant improvement of their visual acuity by at least 3 lines. Reasons for absent improvement were subfoveal hard exudates in 2 cases and persistant hemorrhagic pigment epithelium detachment in 1 case. We did not observe any treatment related complications.
Photothrombosis with red dye laser, enhanced by prior injection of ICG appears to be a potentially effective and safe treatment for exudative extrafoveal polyps in IPCV. Functional results however may be limited by subfoveal precipitation of hard exudates or hidden, untreated polyps.
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