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

1. 我们采用荧光素血管造影（FA）和吲哚菁绿视频血管造影（IA）检测与老年性盘状黄斑变性相关的脉络膜新生血管膜（CNVs）。我们评估了IA作为激光光凝预处理检查的临床可靠性。结果表明：(1)内窥镜特别适用于视网膜下广泛出血和/或视网膜色素上皮渗出性脱离的眼睛。(2)基于IA检查结果，用激光光凝法抹去部分脉络膜新生血管膜。(3)一些用FA检测到的定义明确的CNV，在IA上显示出四个不同的结果。第一组是FA的典型表现。二是IA早期低荧光缓慢充盈。第三种是无渗漏，即在IA后期CNV很少或没有渗漏。在第四种类型中，不能用IA证明CNV。(4)当FA和IA的结果不同时，我们需要仔细评估IA的结果，以提高成功的结果。吲哚菁绿血管造影显示，在中央凹下脉络膜新生血管的部分区域可见供血血管。因此，我们尝试在8只眼睛上进行喂食血管治疗，希望避免中央凹光感受器的破坏。7只眼睛需要额外的治疗，其中5只眼睛出现了无水肿的疤痕组织。尽管我们观察到所有病例在治疗后立即减少了渗漏，但由于中央凹下CNV的荧光素持续渗漏，三只眼睛需要对整个CNV进行光凝。当检测到供血血管时，建议在凝固中央凹下CNV之前对供血血管进行处理。

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.