ICGA-guided laser photocoagulation of feeder vessels of choroidal neovascular membrane in age-related macular degeneration

Purpose: To report the ability of indocyanine green angiography (ICGA) with a confocal scanning laser ophthalmoscope (SLO) to identify feeder vessels of choroidal neovascular membranes (CNVM) secondary to age-related macular degeneration (ARMD) and to show the feasibility of inducing complete closur e of the CNVM by photocoagulation targeted exclusively to the feeder vessel s. Methods: Five consecutive patients with exudative ARMD in whom ICGA with th e confocal SLO showed extrafoveal feeder vessels supplying choroidal neovas cular nets had laser photocoagulation done only to the feeder vessels. In t wo patients, two separate membranes were seen. Results: Laser photocoagulation resulted in closure of the feeder Vessels a nd the CNVM in four patients. Complete closure was achieved with one treatm ent in one patient and with two treatments in three patients. In one patien t, two treatments failed to close the feeder vessel and the CNVM, but a thi rd, more intense laser treatment resulted in temporary closure of the feede r vessel and CNVM, which recanalized 2 to 4 weeks later with development of a large rip in the retinal pigment epithelium. In one patient, two separat e CNVMs grew from the edge of the laser scars, but they were not directly r elated to the original CNVM and its feeder vessel, and were treated success fully. The same eye later developed subfoveal occult CNVM with gradual dete rioration of visual acuity, In the other four patients, visual acuity impro ved in two and was unchanged in two. Conclusions: Indocyanine green angiography with the confocal SLO can identi fy choroidal feeder vessels supplying CNVM secondary to ARMD, Laser treatme nt to such extrafoveal feeder vessels, particularly in membranes that are l arge or subfoveal, may be effective in closing the feeder Vessel and CNVM w ith preservation of the fovea and central vision. More than one treatment m ay be required, however, and failures and complications may be expected wit h this treatment modality.