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      Fluorescein Angiography Compared to Three-Dimensional Measurements by the Retinal Thickness Analyzer in Classic Choroidal Neovascularization

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          Abstract

          Purpose: To compare and correlate imaging of classic subfoveal choroidal neovascularization (CNV) with noninvasive 3-dimensional imaging by the retinal thickness analyzer (RTA) to conventional fluorescein angiography (FA). Methods: A total of 29 eyes of 29 consecutive patients with predominantly classic CNV eligible for photodynamic therapy underwent FA and RTA imaging. The FA dimensions of the CNV were measured independently by two graders. With the RTA, masked to FA the size of the CNV itself as imaged in 3-dimensional reconstruction, the size of significantly thickened retina overlying the CNV and the maximum retinal thickness were measured. Results: The mean diameter of the CNV determined from 3-dimensional RTA reconstructions showed an excellent correlation with measurements from FA (r = 0.91, p < 0.001). The area of retinal thickening was by a mean of 0.7 mm in diameter larger and correlated moderately well with the size of the CNV on FA (r = 0.65, p < 0.001). In contrast, there was no correlation between the absolute retinal thickness and the CNV size on FA. Conclusions: Noninvasive quantitative mapping of predominantly classic CNV by RTA is feasible and also allows 3-dimensional measurement of the lesion itself. The results correlate well with FA assessment but visualize different properties of the disease.

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          Most cited references 9

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          Ultrahigh resolution optical coherence tomography in non-exudative age related macular degeneration.

          To describe the appearance of the non-exudative forms of age related macular degeneration (AMD) as imaged by ultrahigh resolution optical coherence tomography (UHR-OCT). A UHR-OCT ophthalmic imaging system, which utilises a femtosecond laser light source capable of approximately 3 mum axial resolution, was employed to obtain retinal cross sectional images of patients with non-exudative AMD. Observational studies of the resulting retinal images were performed. 52 eyes of 42 patients with the clinical diagnosis of non-exudative AMD were imaged using the UHR-OCT system. 47 of the 52 (90%) eyes had the clinical diagnosis of drusen and/or retinal pigment epithelial (RPE) changes. In these patients, three patterns of drusen were apparent on UHR-OCT: (1) distinct RPE excrescences, (2) a saw toothed pattern of the RPE, and (3) nodular drusen. On UHR-OCT, three eyes (6%) with a clinical diagnosis of non-exudative AMD had evidence of fluid under the retina or RPE. Two of these three patients had findings suspicious for subclinical choroidal neovascularisation on UHR-OCT. With the increased resolution of UHR-OCT compared to standard OCT, the involvement of the outer retinal layers are more clearly defined. UHR-OCT may allow for the detection of early exudative changes not visible clinically or by angiography.
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            Comparison of fluorescein angiography and optical coherence tomography for patients with choroidal neovascularization after photodynamic therapy.

            To investigate retinal morphology by means of fluorescein angiography (FA) and optical coherence tomography (OCT) in patients who had undergone photodynamic therapy (PDT) with verteporfin at their 3-month-interval examination. Sixty patients with predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration were evaluated with FA and OCT 3 months after their last PDT. FA images were evaluated in a masked fashion for staining of and leakage from the lesion and also for cystoid loculation of fluorescein in the macula. OCT was used to evaluate foveal thickness and the presence of subretinal fluid or cystoid spaces within the retina, also in a masked fashion. The median age of the 60 patients was 78 years, and the median visual acuity of the eyes examined was 20/100. The median number of previous PDT sessions was 2. Fluorescein staining was seen in 57 eyes (95%), and fluorescein leakage was seen in 50 eyes (83%). Cystoid loculation of fluorescein was seen in 21 eyes (35%). By OCT, cystoid spaces in the macula were seen in 42 patients (70%), and subretinal fluid was seen in 15 patients (25%). Leakage seen shown by FA was correlated with the OCT finding of cystoid spaces but not with the OCT finding of subretinal fluid. Some patients had leakage during FA that did not have any observable induced OCT abnormality attributable to fluid accumulation. After PDT leakage from CNV seen during FA is associated with intraretinal fluid, often seen in loculated cystoid spaces, but not with subretinal fluid.
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              Angiographic findings in patients with exudative age-related macular degeneration.

              Exudative age-related macular degeneration (ARMD) is the leading cause for severe visual loss in the elderly. A series of clinical trials has established the efficacy of laser photocoagulation and photodynamic therapy (PDT) in special subgroups of patients with exudative ARMD. We analyzed the fluorescein and indocyanine green angiograms (ICG) of patients with exudative ARMD to characterize the nature of the CNV in order to estimate the percentage of patients amenable for one of the therapies. Patients with acute symptoms related to exudative ARMD were recruited for the study. All patients underwent fluorescein and ICG angiography. We analyzed the type of the CNV (classic, occult, or mixed) and location relative to the fovea from the fluorescein angiograms. Additionally, we recorded the presence of a visible capillary network in the early ICG angiograms, as well as hot spots and plaque hyperfluorescence in the late ICG angiographic frames. We included 191 patients aged 53-92 years in the study. The angiograms revealed in 17 (9%) patients classic CNV (12 subfoveal), in 114 (60%) occult CNV, and in 60 (31%) mixed CNV. Of these 19 had a classic component >50%. In the early ICG angiograms a capillary network was visible in 50 eyes with occult CNV. Hot spots were present in 29 eyes and a hyperfluorescent plaque in 54 eyes. In total, only 18% of eyes included in our study were eligible for laser photocoagulation or for photodynamic therapy (PDT). These numbers highlight the deficiencies of current treatment modalities for exudative ARMD. For this reason, alternative treatment should be further investigated to offer better treatment to patients with exudative ARMD.
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                Author and article information

                Journal
                ORE
                Ophthalmic Res
                10.1159/issn.0030-3747
                Ophthalmic Research
                S. Karger AG
                0030-3747
                1423-0259
                2007
                March 2007
                02 February 2007
                : 39
                : 2
                : 98-102
                Affiliations
                aDepartment of Ophthalmology, Ludwig-Maximilians University, Munich, and bDepartment of Ophthalmology, Zentralklinikum Augsburg, Augsburg, Germany
                Article
                99245 Ophthalmic Res 2007;39:98–102
                10.1159/000099245
                17284936
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, References: 18, Pages: 5
                Categories
                Original Paper

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