Feeder Vessel Treatment with Millipulse Diode Laser on Occult Subfoveal Choroidal New Vessels in Age-related Macular Degeneration (AMD) Using High Speed ICG-Angiography

Abstract

Abstract: : Purpose: To decrease the perfusion of occult subfoveal choroidal new vessels (OCNV) in AMD with millipulse diode laser located on extra-foveal feeder vessel (FV) and correlate the functional and angiographic results Methods: Prospective study including patients with OCNV. Diagnosis was achieved with fluorescein angiography (FA) and infra-red ICG-Angiography (confocal scanning laser ophthalmoscope, Heidelberg Retinal Analyser HRA, Heidelberg, Germany).The high speed angiography (acquisition of 12 pictures /second) was performed to detect FV. The dye injection was immediately followed by IV flash of glucose solution 5%. After detection of the afferent (artérial) FV, the localisation related to the center of the fovea was detected by an automatic overlay on the red-free slide. Millipulse laser diode photocoagulation was directed on the identified FV ( 300 mV to 800 mV ; 100 impacts ; 100 milliseconds ;75 to 125 µ). Immediate control with HS – ICG was obtained .Complete clinical evaluation , biomicroscopy, FA, ICG –A, and visual acuity testing (ETDRS) was perfomed before and after treatment(1, 3, and 6 months). Retreatments (1 up to 3) were suggested on the basis of control high-speed ICG angiography. Results: 50 patients ( 50 eyes ) were included. Thirty five females and 15 males with a mean age of 72 years (range from 52 to 84) were followed from 3 months to 6 months.Out of the 50 eyes, 39 FV were detected. 28 out of the 39 were extra-foveal and amenable to laser treatment. FV were multiple in 10/39 eyes. FV was occluded in 15 out of 28 after the first laser session. At the 3-month control, 6 eyes were retreated. At the 6-month control, 4 cases with repermeabilisation (out of 21) were observed. At the 6-month control, 13 FV were still occluded and visual acuity ( VA) was stable in 25 eyes . Conclusion: Feeder vessel treatment is a technique, requiring high-speed ICG angiography for detection of the feeder vessels located at distance from the subfoveal OCNV and resulting in with localised and minimal scars. Though our results on final visual acuity mainly achieved stabilization on VA, the technique appeared to be safe and reproducible. In patients non-eligible for others managements, FV treatment seemed to be a efficient alternative.

Keywords: age-related macular degeneration • choroid: neovascularization • imaging methods (CT, FA, ICG, MRI, OCT, RTA, S