Clinical appilication of video infrared fluorescein angiography to improve results of laser photocoagulation for senile disciform macular degeneration

1.应用荧光素血管造影术(FA)和吲哚青绿视频血管造影术(IA)检测老年性盘状黄斑变性相关的脉络膜新生血管膜(CNV)。我们评估了IA作为激光光凝前检查的临床可靠性。结果如下：(1)IA特别适用于广泛的视网膜下出血和/或渗出性视网膜色素上皮脱离的眼睛。(2)根据IA的表现，一些脉络膜新生血管膜被激光光凝清除。(3)一些清晰的CNV在IA上表现为四种不同的表现。第一种是FA所显示的典型表现。第二种是IA早期缓慢的低荧光充盈。第三种是无渗漏，即在IA的晚期，CNV很少或没有渗漏。在第四种类型中，(4)当FA和IA的检查结果不同时，需要对IA检查结果进行仔细的评估，以提高检查的成功率。吲哚青绿视频血管造影可见中心凹下脉络膜新生血管的部分区域可见滋养血管。因此，我们尝试了8只眼的滋养血管治疗，以期避免黄斑中心凹感光细胞的破坏。7只眼需要额外的治疗，其中5只眼形成了没有水肿的疤痕组织。尽管我们观察到所有病例在治疗后立即渗漏减少，但由于中心凹下CNV持续的荧光素渗漏，3只眼需要光凝整个CNV。当检测到滋养血管时，建议在凝固中心凹下CNV之前先处理滋养血管。

1. We performed fluorescein angiography (FA) and indocyanine green video-angiography (IA) to detect choroidal neovascular membranes (CNVs) associated with senile disciform macular degeneration. we evaluated the clinical reliability of IA as a pretreatment examination for laser photocoagulation. The results were as follows :(1) IA was especially useful for eyes with extensive subretinal hemorrhage and/or exudative detachements of the retinal pigment epithelium.(2) Based on the IA findings, some choroidal neovascular membranes were obliterated with laser photocoagulation.(3) Some well-defined CNV,which were detectable with FA,showed four distinct findings on IA.The first consisted of the typical findings shown on FA.The second was slow filling with hypofluorescence in the early Phase of IA.The third was no leakage, i.e., little or no leakage from the CNV in the later phase of IA.In the fourth type, the CNV could not be demonstrated with IA.(4) We need careful evaluation on IA findings to improve the successful results when findings in FA and IA differed.2. Feeder vessel were visible in some areas of subfoveal choroidal neovascularization on indocyanine green video-angiography. We thus attempted feeder vessel treatment on eight eyes in hopes of avoiding foveal photoreceptor destruction. Additional treatments were required in seven eyes, 5 of which developed scar tissue without edema. Even though we observed decreased leakage immediately after treatment in all cases, three eyes required photocoagulation of the entire CNV due to persistent fluorescein leakage from a subfoveal CNV.When feeder vessels are detected, it is advisable to treat the feeder vessels before coagulating the subfoveal CNV.