Simultaneous Fluorescein and Indocyanine Green Angiography for Exudative Macular Degeneration

Thermal Laser Monotherapy for Extrafoveal Polypoidal Choroidal Vasculopathy

INTRODUCTION

Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid. Diagnosis is mainly based on polypoidal aneurysm-like lesions seen in indocyanine green (ICG) angiography. Various therapeutic options have been proposed.

METHODS

Outcomes of 10 cases with extrafoveal PCV and consecutive macular edema treated with thermal laser are reported. Diagnosis of PCV was confirmed by ICG angiography.

RESULTS

Upon successful occlusion of the polyps in 10 eyes after thermal laser treatment demonstrated in ICG angiography, a regression of central foveal edema was seen in optical coherence tomography and color fundus photography. Visual acuity improved from logMAR 0.8 to logMAR 0.3. Follow-up ranged from 4 months to 15 years, with a median of 1 year. Two eyes had a recurrence of exudative maculopathy 5 and 7 years after laser treatment, respectively.

CONCLUSION

A careful differentiation between various subforms of exudative maculopathy using fluorescein and ICG angiography can identify certain selected patients with extrafoveal PCV, for whom thermal laser monotherapy can be a therapeutic option.

Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment

BACKGROUND

Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age-related macular degeneration. Currently, no evidence-based guidelines exist for its diagnosis and treatment.

METHODS

A panel of experts analyzed a systematic literature search on PCV together with results of the EVEREST trial, the only published randomized controlled clinical trial in PCV. At a subsequent Roundtable meeting, recommendations for the management of PCV were agreed based on this analysis and their own expert opinion.

RESULTS

Diagnosis of PCV should be based on early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography. Recommended initial treatment of juxtafoveal and subfoveal PCV is either indocyanine green angiography-guided verteporfin photodynamic therapy or verteporfin photodynamic therapy plus 3 × 0.5 mg ranibizumab intravitreal injections 1 month apart. If there is incomplete regression of polyps by indocyanine green angiography, eyes should be retreated with verteporfin photodynamic therapy monotherapy or verteporfin photodynamic therapy plus ranibizumab. If there is complete regression of polyps by indocyanine green angiography, but there is leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab.

CONCLUSION

Practical guidance on the clinical management of PCV is proposed based on expert evaluation of current evidence.

Use of optical coherence tomography, fluorescein angiography and indocyanine green angiography in a screening clinic for wet age-related macular degeneration

AIMS

To assess the utility of optical coherence tomography (OCT) in a nurse-led, fast-track clinic for new age-related macular degeneration (AMD) referrals, and to see how often indocyanine green angiography (ICGA) led to an additional diagnosis to that provided by fundus fluorescein angiography (FFA).

METHOD

Retrospective audit of a consecutive series of 134 new patients referred with suspected wet AMD. When visual acuity was >or=6/60 an OCT was performed. If the OCT was consistent with "wet" AMD, the patient underwent simultaneous FFA/ICGA. The sensitivity and specificity of this clinic was calculated. The number of additional diagnoses made using ICGA was recorded.

RESULTS

23/134 (17.16%) patients had OCT only and were not subsequently found to have wet AMD. FFA/ICGA was performed in 111 patients, showing wet AMD in 90 (81%) patients. OCT as used in our clinic had a sensitivity of 1 and a specificity of 0.65 for detecting wet AMD. ICGA provided additional diagnoses in 19 (14.17%) patients. ICGA detected a specific vascular abnormality in 58% of the occult lesions.

CONCLUSIONS

OCT proved to be an effective screening tool for wet AMD in this clinic, with excellent sensitivity and reasonable specificity. ICGA provided an additional diagnosis in a significant number of cases, but did not define a vascular abnormality in all occult cases.