DETECTING RECURRENT CHOROIDAL NEOVASCULARIZATION - COMPARISON OF CLINICAL EXAMINATION WITH AND WITHOUT FLUORESCEIN ANGIOGRAPHY

Objective/Design: To evaluate prospectively the ability of three retin a specialists to detect recurrent choroidal neovascularization (CNV) a fter clinical examination alone and then with fluorescein angiography at 3 and 6 weeks and at 3, 6, 9, and 12 months after laser photocoagul ation. Setting: Single tertiary retinal referral center. Patients: All patients who had laser treatment for CNV within 14 months of their st udy visit. One hundred thirty-seven eyes of 134 patients were evaluate d during 401 visits. Main Outcome Measures: Sensitivity, specificity, positive predictive value, and negative predictive value of clinical e xamination with biomicroscopy to detect recurrent CNV when defined as leakage on the periphery of the laser-treated area on the fluorescein angiogram. Results: Ninety-seven definite or probable recurrences in 5 6 eyes were identified on the fluorescein angiogram. Clinical examinat ion had a sensitivity of 59%, specificity of 94%, positive predictive value of 76%, and negative predictive value of 88%. These figures vari ed somewhat by underlying cause, age, time since treatment, and lesion location. Using either a reported or measured loss of vision with the results of biomicroscopy as an indication of recurrence increased the sensitivity to 77% but reduced the specificity to 81%. Conclusions: C linical examination probably cannot replace fluorescein angiography in detecting all recurrent CNV after laser treatment. However, for follo w-up visits in which recurrent CNV was not suspected on biomicroscopy, definite or questionable recurrent CNV was identified on the fluoresc ein angiogram only 12% of the time, while the absence of recurrent CNV using this method was confirmed 88% of the time.