Feeder vessel photocoagulation for subfoveal CNV: Author’s reply

Abstract

I apologize that we did not state the definition of AMD. Our eligibility criteria included the presence of drusen and/or retinal pigment epithelial atrophy in the studied eyes and/or fellow eyes. As Freund et al pointed out, there may be fewer age-related changes of the retinal pigment epithelium in our clinical photographs. Japanese patients with AMD seem to have fewer age-related changes, such as soft or exudative drusen and pigment epithelial atrophy, than white patients. However, the majority of these patients have the typical natural course of AMD in that choroidal neovascular membranes have enlarged over a period of weeks to months, resulting in large fibrous scars, accompanied by significant loss of central vision. Since Spaide et al published the article entitled, “Indocyanine Green Angiography (ICGA) of Idiopathic Polypoidal Choroidal Vasculopathy,”1Spaide R.F. Yannuzzi L.A. Slakter J.S. et al.Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy.Retina. 1995; 15: 100-110Crossref PubMed Scopus (522) Google Scholar we have paid attention to distinguishing between idiopathic polypoidal choroidal vasculopathy (IPCV) and AMD, and we were surprised to discover more patients with IPCV than we expected. The patients with typical IPCV lesions and ICGA findings, as described previously,1Spaide R.F. Yannuzzi L.A. Slakter J.S. et al.Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy.Retina. 1995; 15: 100-110Crossref PubMed Scopus (522) Google Scholar, 2Yannuzzi L.A. Ciardella A. Spaide R.F. et al.The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy.Arch Ophthalmol. 1997; 115: 478-485Crossref PubMed Scopus (385) Google Scholar were excluded from our study on feeder vessel photocoagulation of subfoveal CNV secondary to AMD. The ICG angiograms presented in our article were taken using a 20° field size and enlarged, thus abnormal vessels on these angiograms seem to be dilated, as Freund et al mentioned. However, these did not show any tubular and polypoidal elements, and it also was not clear on two-dimensional images whether these vessels were located within the inner choroid or anterior to the choroid. In addition, the patients presented in the article had unilateral disease and did not have multiple and recurrent serosanguineous detachment of the RPE and neurosensory retina. Thus, these patients could be diagnosed as having AMD. However, the early stages of IPCV may show neither IPCV lesions nor typical ICGA findings. If it is true, a small number of the studied patients may be included in the expanding spectrum of IPCV that Yannuzzi et al stated.2Yannuzzi L.A. Ciardella A. Spaide R.F. et al.The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy.Arch Ophthalmol. 1997; 115: 478-485Crossref PubMed Scopus (385) Google Scholar However, in the majority of the patients in our article, ICGA did not show polypoidal or aneurysmal vasculature but did show cartwheel or lacy patterns of CNV. Freund et al mentioned that feeder vessel photocoagulation is not likely to be of benefit in AMD. Large feeder vessels, identified by using fluorescein angiography or ICGA with digital video cameras, are indeed difficult to occlude permanently. A scanning laser ophthalmoscope using a 20° field size may be indispensable for the identification and effective treatment of them; otherwise, as we mentioned in the article, there may be a difference in the efficacy of this treatment when comparing white patients and pigmented patients.