Aim: To describe the types and location of choroidal neovascularisation (CNV) in exudative age-related macular degeneration (AMD), including vascularised pigment epithelial detatchments (PED), and most recently described subtypes, such as retinal choroidal anasmostosis, also termed ''retinal angiomatous proliferation'' (RAP). Methods: Prospective multicentre consecutive descriptive case series. A total of 207 consecutive cases of newly diagnosed exudative AMD undergoing fluorescein angiography (FA) were recruited by 7 French referral hospital-based or private centres. Indocyanine green angiography (ICG) also was performed, when judged necessary by investigators. Types and location of CNV were classified by two independent experts and adjudicated by a third when discordant. Results: All patients had FA, while ICG was performed in 50% of subjects. A total of 17.6% had classic CNV only, 5.4% and 8.3% had predominantly and minimally classic CNV, respectively. Occult CNV could be classified in occult CNV without PED (32.7%) and occult CNV with PED, ie, vascularised PED (23.9%). RAP was observed in 15.1% of cases, and accounted for 30% of vascularised PED. In 5.8% of the cases there was haemorrhagic AMD and 4.8% had fibrovascular scars. Lesions were mainly subfoveal (80%). Agreement between the centre's ophthalmologist and the final validated expert classification was moderate (k = 0.52 for location and 0.59 for type of lesion). Conclusion: This study confirms that newly diagnosed cases of exudative AMD are mainly occult and subfoveal. RAP appeared as a common lesion in patients with newly diagnosed exudative AMD.A ged-related macular degeneration (AMD) is the leading cause of blindness in industrialised countries, representing 50% of all blindness cases.1 It is currently the third most common cause of blindness worldwide, behind cataract and glaucoma.1 More than 80% of severe visual loss in AMD is due to choroidal neovascularisation (CNV) and its consequences: exudation, bleeding and disciform scarring.2 At the time of completion of the present study, the only approved treatments for exudative AMD in France were laser photocoagulation and verteporfin photodynamic therapy (PDT). The choice of treatment with these laser-based therapies depended on the location, composition and size of the lesion. Fluorescein angiography has been used to define lesion size and composition. It allows distinction between well demarcated classic CNV, and ill-defined occult CNV. This angiographic distinction is of major importance for the choice of treatment; laser photocoagulation being preferred in cases of extrafoveal or juxtafoveal classic CNV, while PDT was preferred in cases of subfoveal predominantly classic and occult only CNV.3-5 The location and exact boundaries of occult CNV often are difficult to determine precisely on fluorescein angiography due to obscuration of the neovascular membrane by overlying turbid exudates, blood and/or pigment, and rapid fluorescein pooling beneath a serous PED. As the vast majority of CNV at diagnos...

No abstract

Background/aim: Malattia leventinese (ML) is an inherited macular degeneration characterised by the presence of small radial drusen. Despite extensive descriptions of this study of the fundus, angiographic features of ML have been inadequately described. The aim is to describe the indocyanine green angiography (ICG) features observed in ML. Methods: 10 eyes from five consecutive ML patients (aged 27-44 years) were prospectively included. A complete ophthalmological examination including colour fundus photographs, autofluorescence, fluorescein angiography (FA), and ICG was performed. Results: ICG differentiated two types of drusen. Large round aggregated drusen were consistently hypofluorescent in the early phases and presented as hyperfluorescent spots surrounded by halos of hypofluorescence in the late phases. Conversely, small radial drusen were mostly hyperfluorescent in the early phases with decreased fluorescence in the late phases of the ICG sequence. FA also showed differences in staining between the two types of drusen. Conclusions: ICG angiography revealed marked differences between the large round and small radial drusen observed in ML. The large central drusen presented with an unusual pustuliform feature on the late phases of the ICG sequence. This distinct feature may be useful in the diagnosis of late stage disease when drusen consolidation could obscure the radial drusen.

No abstract

No abstract