Indocyanine Green Angiography (ICG) Guided Photodynamic Therapy of Vascularized Pigment Epithelium Detachment in AMD

Constantin J. Pourneras, A.D. Kapetanios (Geneva/Athens)

Purpose: Photodynamic therapy (PDT) is a promising new tool in the treatment of neovascular age related macular degeneration (AMD). Vascularized pigment epithelium detachments (PED) represent a type of occult choroidal neovascularisation (CNV) in AMD. We conducted a prospective pilot study to evaluate the efficacy of ICG guided PDT in PED.
Methods: In 10 consecutive eyes with AMD, vascularized PED and subfoveal hot spot or subfoveal hyperfluorescent plaque, in ICG, PDT was performed. PDT was guided only to the subfoveal hot spot or to the subfoveal hyperfluorescent plaque. The patients had serial follow-up examinations, including fluorescein and ICG angiography and ICG-guided PDT re-treatment if necessary, every 3 months.
Results: All patients had a minimum of 24 months follow-up. No eye showed a decrease of visual acuity (VA); in contrast there was an increase of VA of at least 2 lines in 8 eyes, with a decrease of the PED. Two eyes developed
a tear of the RPE during the first 3 months after PDT. There was no development of large subretinal hemorrhages during the follow – up period.
Conclusions: This pilot study shows that PDT may be beneficial in patients with AMD and vascularized PED with the presence of a subfoveal hot spot or a subfoveal hyperfluorescent plaque when the treatment is ICG guided. A randomized controlled clinical study is, however, mandatory to confirm these results.



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