ICG-guided laser photocoagulation of occult choroidal neovascularization

Purpose: Age related macular degeneration (AMD) is the most common cause of legal blindness in the Western world in people over 50 years of age. The m ost severe visual loss occurs in patients with AMD complicated by choroidal neovascular membranes (CNV). Indocyanine green angiography (ICG) account f or visualization in up to 60% of the cases that are classified as occult on fluorescein angiography (up to 70% of the cases). ICG-guided laser photoco agulation of CNV is currently a mater of debate. We conducted a pilot study to determine wether it could be beneficial for patients presenting with oc cult CNV on fluorescein angiography. Material and methods: Twenty consecutive patients (20 eyes) with occult CNV in AMD were included. All showed occult CNV on fluorescein angiography and a well defined juxtaor extrafoveal hot spot or plaque hyperfluorescence on ICG. Fibrovascular retinal pigment epithelial detachments were excluded. T he patients had serial controls, including fluorescein angiography and ICG, at 15 days, 1, 2, 3, 6, 9 and 12 months after photocoagulation. Results: At the end of follow-up Visual acuity (VA) was stable (within +/- 3 lines) compared to the initial one in 80% (16) of the cases. A complete r esolution of exsudative signs was observed in 75% (15) of the cases. Conclusions: ICG-guided laser photocoagulation of occult CNV in AMD account for better visual acuity than natural course of the disease at 12 months f ollow-up. However, a prospective randomized clinical trial is warranted to evaluate definitivealy this treatment approach.