Extrafoveal Choroidal Neovascularization Research Articles

Five-Year Follow-up of Fellow Eyes of Patients With Age-Related Macular Degeneration and Unilateral Extrafoveal Choroidal Neovascularization

To assess the visual prognosis of patients with age-related macular degeneration and unilateral extrafoveal choroidal neovascularization (CNV), and to determine the risk of CNV developing in fellow eyes that were initially unaffected. Five-year prospective follow-up study of fellow eyes of 228 patients enrolled in a randomized clinical trial of laser photocoagulation of extrafoveal CNV. Visual acuity was measured and macular photographs were taken at 6-month intervals. Five-year change in visual acuity of fellow eyes from baseline, incidence of legal blindness (visual acuity of < or = 20/200 in the better eye), and cumulative incidence of CNV in fellow eyes free of neovascular maculopathy at the time of study enrollment. Photographically documented CNV developed in 33 (26%) of 128 fellow eyes that were initially free of neovascular maculopathy, and was associated with poor visual acuity at the end of the 5-year follow-up period. Among 67 patients who had bilateral neovascular maculopathy initially and were examined 5 years later, 33 (49%) were legally blind compared with 13 (12%) of 106 patients who had unilateral neovascular maculopathy initially. In all 13 of the latter group, CNV had developed in the fellow eye. Patients with age-related macular degeneration and CNV in one eye are at high risk of legal blindness within 5 years, and, thus, should be followed up carefully to ensure that laser treatment can be applied to CNV in either eye whenever it is likely to improve the visual prognosis.

Pretreatment Fundus Characteristics as Predictors of Recurrent Choroidal Neovascularization

To the Editor. —The Macular Photocoagulation Study (MPS) demonstrated that argon laser treatment reduced severe visual loss in eyes with extrafoveal choroidal neovascularization (CNV) secondary to senile (age-related) macular degeneration or ocular histoplasmosis syndrome.1However, recurrent CNV was observed in 59% of treated eyes in the senile macular degeneration study (SMDS), and in 30% of treated eyes in the Ocular Histoplasmosis Study (OHS). Recurrence was accompanied by an increased frequency of severe visual loss. We conducted a study of preoperative fundus characteristics that had not been examined in the MPS to identify clues to the pathogenesis of recurrent CNV that might lead to better treatment of patients. In collaboration with the MPS Fundus Photograph Reading Center (MPS-RC), the following six preoperative angiographic characteristics of CNV and surrounding retina were assessed: fluorescein leakage pattern (classic, smudge, or ooze), amount of fluorescein leakage (minimal to severe), contiguous peripheral blocked fluorescence, degree

Important Points in Management of Patients with Choroidal Neovascularization

The efficacy of argon blue-green laser treatment for extrafoveal choroidal neovascularization (CNV) in aging macular degeneration, presumed ocular histoplasmosis syndrome and idiopathic choroidal neovascularization has recently been proven by the Macular Photocoagulation Study. These results are applicable only to eyes managed according to certain principles of therapy and post-treatment follow-up. These include the use of a recent fluorescein angiogram and retrobulbar anesthetic, aiming for complete obliteration of the CNV. Meticulous post-treatment follow-up is critical. This includes daily patient monitoring of the Amsler grid, and prompt examinations if distortion is noted. Excellent quality fluorescein angiography is mandatory. This is repeated frequently and studied promptly. Residual or recurrent extrafoveal CNV requires prompt re-treatment.