98th Annual Meeting DOG 2000

V 461

Makula-lifting and indocyanine green-enhanced endolaser coagulation of occult subfoveal neovascularization in age related macular degeneration

J. E. Nasemann, E. Frieling, M. Andrassi

Introduction: New treatment modalities are necessary to treat occult subfoveal neovascularization in age related macular degeneration. A new method is described that avoids thermal damage to sensory retina but allows for safe occlusion of choroidal neovascularization.

Methods: After a standard three port vitrectomy a retinotomy is created temporal to the macula. A small amount of viscoelastic substance is injected under the fovea lifting up the entire macular area. After iv. injection of 50 mg indocyanine green (ICG) an 810 nm endophotocoagulation is performed transretinally covering the area of leakage detected on a preoperative fluorescein angiogram. The viscoelastic is removed in part at end of operation.

Patients: After obtaining informed consent operations were performed in 24 patients with mean preoperative visual acuities between 20/200 and 60/200. All patients suffered from occult choroidal neovascularization with rapid visual deterioration.

Results: Due to the macular detachment no whitening or burn of sensory retina was observed intraoperatively. No or only mild edema was visible at the level of the retinal pigment epithelium depending on the laser power. Postoperativ angiograms showed a complete occlusion of choriocapillaris and occult neovascularization even with low laser energy (300 mW for 2 seconds). Postoperatively visual acuity ranged between 10/200 and 20/200. The macula was flat and dry within two weeks postop in 11 of 24 patients.

Discussion: Makulalifting and ICG-enhanced infrared endolaser coagulation is a new method to treat occult choroidal neovasculaization in AMD. The method allows for a complete occlusion of new vessels without visible damage to sensory retina.

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