ICG-guided laser photocoagulation of juxtafoveal and extrafoveal occult choroidal neovascularization

Abstract 

· Background: The most common cause of legal blindness in the Western world in people over 50 years of age is age-related macular degeneration (AMD) complicated by choroidal neovascular membranes (CNV). We conducted a prospective pilot study to evaluate the functional and anatomical results of indocyanine green (ICG)-guided laser photocoagulation of juxta- and extrafoveal occult CNV. · Methods: Seventeen consecutive patients (17 eyes) with occult CNV in AMD were included. All showed occult CNV appearing as late-phase fluorescein leakage of undetermined source on fluorescein angiography and as a well-defined hot spot or plaque hyperfluorescence on ICG angiography. Fibrovascular retinal pigment epithelial detachments (PED) and serohemorrhagic PED were excluded. Laser photocoagulation was performed using an argon green laser. The patients had serial follow-up examinations, including fluorescein and ICG angiography, at 15 days and 1, 2, 3, 6, 9 and 12 months after photocoagulation. · Results: At the end of the follow-up, the visual acuity (VA) was stable (within ±3 lines of the initial VA) in 76% (13) of the eyes. A moderate decrease in VA was observed in 24% (4). A complete resolution of exudative signs was observed in 65% (11).  · Conclusion: ICG-guided laser photocoagulation of occult CNV, presenting at baseline examination as late-phase fluorescein leakage of undetermined source and as a well-defined hyperfluorescent lesion on ICG angiography, may constitute a subgroup of occult CNV that benefits from ICG-guided laser photocoagulation. A multicentric randomized controlled clinical study is, however, mandatory to confirm this result.