ICGA-guided laser photocoagulation of occult choroidal neovascularization in age-related macular degeneration

Purpose: To evaluate the efficacy of indocyanine green angiography (ICGA)-g uided laser photocoagulation in eyes with fluorescein angiographic evidence of occult choroidal neovascularization (O-CNV) in patients with age-relate d macular degeneration (ARMD) with or without pigment epithelium detachment (PED). Methods: Eighty eyes of 79 consecutive patients with O-CNV underwent laser treatment of a clearly outlined extrafoveal ICGA hyperfluorescent area, pre sumed to be focal CNV. Four types of presumed CNV were treated: Group 1 (20 eyes), CNV beneath the FED; Group 2 (23 eyes), CNV at the margin of the FE D; Group 3 (10 eyes), parapapillary CNV and FED; and Group 4 (27 eyes), mac ular CNV without FED. Median follow-up was 17.5 months (range, 6-24 months) . Results: After 1 year, 15% of the eyes in Group 1, 30% in Group 2, 100% in Group 3, and 52% in Group 4 had obliteration of the presumed CNV. After 1 y ear, visual acuity was stable or improved in 18% of Group 1, in 37.5% of Gr oup 2, in 100% of Group 3, and in 73% of Group 4. The remaining eyes worsen ed. Conclusions: Indocyanine green angiography-guided laser treatment may impro ve or stabilize visual acuity in some eyes with O-CNV, The best outcome is seen in eyes with presumed parapapillary CNV, probably made up of choroidal telangiectases in many cases. The type and location of the presumed CNV in fluence prognosis after laser treatment considerably. A randomized, control led clinical study appears necessary to investigate the efficacy of ICGA-gu ided laser treatment in different types of presumed CNV. The inclusion crit eria for further trials need to be defined with precision, as data from pat ients with different choroidal vascular abnormalities have been pooled unti l now.