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M.L. Roh, B.M. Glaser; Feeder Vessel Treatment of Occult with No Classic Choroidal Neovascularization in Age-Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1776.
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Purpose: This is a retrospective evaluation of the effect of feeder vessel treatment in the management of occult with no classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: 37 eyes of 31 patients with newly diagnosed exudative AMD, with angiographic evidence of occult with no classic CNV were evaluated. 81% of patients were female, 19% male. All patients were Caucasian with ages ranging from 62 to 92 with an average age of 77. All patients had a minimum of one-year follow-up. Feeder vessels were identified by means of dynamic high-speed indocyanine green videoangiography using a Heidelberg Retina Angiograph, Heidelberg Engineering, Germany, confocal scanning laser ophthalmoscope. Laser photocoagulation using an 810nm Diode laser was applied using the millipulse technique to a segment of each feeder vessel outside the fovea . Results: After one year, visual acuity was stable or improved in 24/37 (64.8%) eyes. Nine eyes (24.3%) achieved greater than 3 lines of improvement in visual acuity. Eight eyes (21.6%) had worse visual acuity by 1-3 lines, and five eyes (13.5%) had loss of 3-6 lines of vision. Average number of treatments was 3.6. Overall, 75% of treatments were performed within the first 3 months. Determination of treatment adequacy was based upon angiographic evidence of feeder vessel closure or attenuation. Review of stereoscopic fundus photos showed that 86% of eyes had resolution of subretinal fluid at one year. Preoperative visual acuity and size of lesion were not significant factors prognostic of postoperative visual acuity. Feeder vessel closure did have a significant positive correlation with improvement in visual acuity. Conclusions: To date there have been no effective treatments for occult with no classic CNV secondary to AMD with this level of visual improvement. The Verteporfin in Photodynamic Therapy (VIP) Study Group (AJO, May 2001) reported 34% of their photodynamic therapy (PDT) treated patients with occult with no classic CNV, having stable or improved vision, with only 3% having greater than 3 lines of visual improvement at one year. In our study, 64.8% of treated eyes had stable or improved vision with 24.3% achieving greater than 3 lines of visual improvement. In this small series, feeder vessel treatment has been shown to yield resolution of exudative manifestations and stabilize or improve vision in a majority of the patients treated and should be considered as a treatment option for occult with no classic CNV associated with AMD.
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