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Age-Related Macular Degeneration (part 4)

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Hậu-nghiên cứu giai đoạn ICG thể hiện rò rỉ của chất nhuộm ICG vào PED. Một tấm bảng lớn "không hoạt động" CNV bây giờ là hiển nhiên trong điểm vàng trung tâm. Điều trị bằng laser được áp dụng chỉ hai điểm nóng | 152 Ciardella et at. A B C D E F Figure 19 Hot spot at the margin of a plaque. A Clinical photograph demonstrating a turbid PED with lipid exudates in the temporal macula. Central RPE mottling and thickening is noted. B Late-phase FA study demonstrating the presence of a serous PED and a central are a of diffuse ooze suggestive of occult CNV. No classic CNV is evident. C Early-phase ICG study demonstrating two hot spots of CNV in the inferior macula and at the inferonasal edge of the PED. D Late-phase ICG study demonstrating leakage of the ICG dye into the PED. A large plaque of dormant CNV is now evident in the central macula. Laser treatment was applied only to the two hot spots of active CNV. The large plaque of subfoveal CNV was left untreated. E Three months following treatment there is complete flattening of the PED and resolution of the lipids. No change is noted in the central lesion. F Late-phase ICG study 3 months after treatment demonstrating hypofluorescence at the site of the active CNV and of the previous PED. The large plaque of CNV is unchanged. See also color insert Fig. 7.19A E. Copyright Marcel Dekker Inc. All rights reserved. Marcel Dekker Inc. jS 270 Madison Avenue New York New York 10016 Indocyanine Green 153 In a recent report by Kuhn et al. RCAs were identified as occurring in 93 of patients with CNV associated with a serous PED. These authors reported a poor success rate from laser treatment as well 38 . Slakter and co-workers followed prospectively 150 patients with newly diagnosed exudative AMD 37 . All had clinical and fluorescein angiographic evidence of occult CNV and each demonstrated focal areas of hyperfluorescence on ICG angiography felt to be representative of CNV. Thirty-one 21 of the 150 eyes were found to have a RCA. In 82 eyes the occult CNV was associated with a serous PED. Twenty-two 27 of these patients were noted to have RCA. In the remaining 68 cases occult CNV without serous PED nine eyes 13 were found to have a RCA. .