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Feeder vessel treatment of CNV helps stabilize visual acuity
The possibility of combining the treatment with photodynamic therapy is being investigated.
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PARIS – Feeder vessel treatment of subfoveal occult choroidal neovascularization in age-related macular degeneration patients gives good anatomic results, produces minimal extrafoveal scars and preserves central vision, according to a presentation here.
“Feeder vessel treatment is aimed at cutting off the blood supply to retrofoveal occult neovascular membranes, which are characteristic of the wet form of AMD,” said Florence Coscas, MD, at the French Society of Ophthalmology (SFO) meeting.
“In this way, neovascularization is reduced and leakage is decreased without directing the laser on the fovea,” she said. “We applied the treatment in 50 eyes where CNV was visible on fluorescein angiography and indocyanine green angiography. In all the patients the neovascular membranes were at a stage where hemorrhage and leakage were present.”
Encouraging results
The study group comprised 35 men and 15 women. Mean age was 72 years (range 52 to 84). The follow-up was 6 to 9 months.
Detection of the feeder vessel was obtained by high-speed angiography with scanning laser ophthalmology (Heidelberg Retinal Analyzer). For better visualization of the feeder vessel, a more concentrated indocyanine green (ICG) solution was used.
“We were able to detect the feeder vessels in 39 eyes. Multiple vessels were present in 10 cases. All feeder vessels were afferent, of very recent formation, with few branches, coming from the periphery of the macula. Twenty-eight of them were extrafoveal and accessible to the laser,” Dr. Coscas said.
Localized laser photocoagulation was applied. After laser treatment, an immediate ICG examination was performed.
In 15 cases the feeder vessel was occluded after the first treatment. Six eyes were re-treated at 3 months. At 6 months, four of the 21 occluded vessels became permeable again. All permeable vessels were re-treated at 6 months. At 9 months, feeder vessels were occluded in 13 cases and had a decreased volume in 12 cases. Visual acuity was stable in 21 patients.
“Our results are encouraging. We are now evaluating the possibility of combining feeder vessel treatment with photodynamic therapy,” Dr. Coscas concluded.
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For Your Information:
- Florence Coscas, MD, can be reached at 113 bd Saint Germain, 75006 Paris, France; (33) 1-43-29-56-59; fax : (33) 1-43-29-14-56; e-mail: flcs@club-internet.fr.