Clinical obervation upporting a theoretical model of choriocapillari blood flow in treatment of choroidal neovacularization aociated with age-related macular degeneration

PURPOE: To report clinical obervation conitent with concluion from a previou theoretical invetigation indicating that photocoagulation of choroidal neovacularization (CNV) efferent veel can be, in ome intance, an effective treatment. DEIGN: Interventional cae erie. METHOD: In five eye with age-related macular degeneration (five patient with mean age ± D of 65 ± 11 year, range 55–79 year) requiring treatment of CNV. In each cae, the appropriate treatment wa location and photocoagulation of the CNV efferent veel, ince the afferent veel were not identifiable or were located beneath the fovea. Targeted veel were determined to be draining veel by analyi of pretreatment high-peed indocyanine green (ICG) angiogram, and ucceful veel cloure by photocoagulation wa demontrated by pottreatment ICG angiogram. The eye ubequently were followed from 2 to 12 month. REULT: After photocoagulation of efferent veel, CNV-related retinal edema wa ignificantly reduced or reolved within 1 to 4 day. Viual acuity became tabilized in three eye and improved in two eye. In a few day, metamorphopia diappeared in four of the eye and wa table for a period longer than the duration of the aociated efferent veel cloure. Initial efferent veel cloure by photocoagulation perited on average for 7 to 15 day, after which additional treatment wa required. It i ignificant that in no cae did hemorrhage reult from the photocoagulation treatment. CONCLUION: Thee obervation are conitent with the earlier theoretical tudy prediction that photocoagulation of efferent CNV veel can be effective in reducing CNV-aociated edema. That no hemorrhage wa induced by photocoagulation i conitent with the theoretical concept that there appear to be no direct hydrotatic connection between the CNV and it afferent veel. Rather, that connection appear to be a functional one made through the choriocapillari, which may diipate exce CNV hydrotatic preure produced by occluion of a draining veel. However, thi finding i not intended to be a recommendation to attempt CNV efferent veel photocoagulation.