Hilft die Indocyaningrün-Angiographie zur Indikationsstellung der Lasertherapie bei einer exsudativen senilen Makuladegeneration ?

BACKGROUND: Only a few patients with neovascularized age-related macular degeneration (AMD) have clinical and fluorescein angiographic manifestations that meet eligibility criteria for photocoagulation therapy. Angiography with indocyanine green (ICG) may expand those criteria. MATERIAL AND METHODS: Fifty-two patients with exudative AMD were studied by fluorescein and ICG angiography (using the Rodenstock scanning laser ophthalmoscope). The ICG-angiograms were studied in relation to the questions, how often subretinal neovascularizations (SNV) were visible and how often the results were helpful for laser treatment. RESULTS: In 18 cases (about one third) a SNV was detected by ICG-angiography and in 8 (15%) the result allowed a laser treatment. "Ideal" SNV presented as neovascular trees with a visible feeder-vessel. Other cases showed a circumscribed area of diffuse hyperfluorescence especially in the late phase. Macular edema often prevented the resolution of subretinal membranes. CONCLUSIONS: Only randomised studies will be able to show whether the combination of fluorescein and ICG angiography allows the possibility of treating more patients with SNV than fluorescein angiography alone. In the following circumstances this might be the case: 1. If in subfoveal SNV a feeder-vessel could be delineated with ICG-angiography that might be treated selectively. 2. If an occult SNV might be reclassified as manifest SNV due to findings provided by ICG-angiography. 3. Examination of patients with ICG-angiography immediately after laser photocoagulation might be a way of proving the completeness of the treatment.