Coscas F, Stanescu D, Coscas G, Soubrane G
Service Hospitalo-Universitaire d'Ophtalmologie du Créteil, Université Paris XII, 40, Avenue Verdun, 94010 Créteil.
J Fr Ophtalmol. 2003 Jun;26(6):602-8.
To report on the results of feeder vessel treatment for choroidal neovascularization in age-related macular degeneration (AMD).
Retrospective study of 40 patients presenting subfoveal classic choroidal neovascularization (CCNV) and/or occult choroidal neovascularization (OCNV) with or without fibrovascular pigment epithelium detachment (PED), based on fluorescein angiography (FA) and indocyanine green angiography (ICG). Visual acuity was measured using Snellen lines and/or ETDRS. The feeder vessels were visualized with high-speed ICG angiography (confocal scanning laser ophthalmoscope, Heidelberg HRA, Heidelberg, Germany). Feeder vessels were identified as very thin vessels with early filling and rapid emptying. Feeder vessel closure was achieved by laser photocoagulation treatment with either minipulse infrared laser therapy (810 nm), microburst, or yellow laser (568 nm). Post-treatment high-speed ICG angiography follow-up was recommended to the patient immediately or the day after the treatment. The number of treatments and location of the feeder vessels in relation to the macula as well as FA, ICG, and visual acuity results were assessed. If necessary, other treatment techniques such as photodynamic therapy (PDT) or transpupillary thermotherapy (TTT) were offered to the patient when leakage was still present.
The patients were followed for an average of 6.2 months (2-9 months). Twenty-six women and 14 men (mean age, 72 years; range, 51-95) were included. Eight patients demonstrated classic neovascularization, 32 presented occult neovascularization, including 17 cases of vascularized PED and 15 retrofoveal plaques. The average number of treatments was 1.8 (range, 1-4 treatments). Location of feeder vessels were as follows: nine superior-macular, 18 inferior-macular, six nasal-macular and 11 temporal-macular. Visual acuity improved two lines or more in nine patients (22.5%), decreased 2 lines or less in five patients (12.5%) and was stable in 26 patients (65%). After feeder vessel treatment, seven patients showed improvement of the anatomical aspect of the AMD lesions, with a reduction in leakage. Except for one subretinal hemorrhage, no complications after feeder vessel treatment were observed.
Feeder vessel treatment is a technique requiring high-speed ICG angiography to detect the feeder vessels located at a distance from the subfoveal OCNV, CCNV, and PED. Although the final visual acuity result was for the most part stabilization, the technique appeared to be safe and reproducible. In patients who were not eligible for other therapies such as PED, feeder vessel treatment seemed to be a reasonable alternative.
报告年龄相关性黄斑变性（AMD）中脉络膜新生血管的供血血管治疗结果。
对40例出现黄斑下典型脉络膜新生血管（CCNV）和/或隐匿性脉络膜新生血管（OCNV）伴或不伴纤维血管性色素上皮脱离（PED）的患者进行回顾性研究，基于荧光素血管造影（FA）和吲哚菁绿血管造影（ICG）。使用Snellen视力表和/或ETDRS测量视力。通过高速ICG血管造影（共焦扫描激光眼底镜，德国海德堡HRA）观察供血血管。供血血管被识别为早期充盈和快速排空的非常细的血管。通过使用微脉冲红外激光治疗（810nm）、微脉冲或黄色激光（568nm）进行激光光凝治疗实现供血血管封闭。建议患者在治疗后立即或第二天进行治疗后高速ICG血管造影随访。评估治疗次数、供血血管相对于黄斑的位置以及FA、ICG和视力结果。如有必要，当仍有渗漏时，为患者提供其他治疗技术，如光动力疗法（PDT）或经瞳孔温热疗法（TTT）。
患者平均随访6.2个月（2 - 9个月）。纳入26名女性和14名男性（平均年龄72岁；范围51 - 95岁）。8例表现为典型新生血管，32例表现为隐匿性新生血管，包括17例血管化PED和15例黄斑后斑块。平均治疗次数为1.8次（范围1 - 4次治疗）。供血血管位置如下：9例位于黄斑上，18例位于黄斑下，6例位于黄斑鼻侧，11例位于黄斑颞侧。9例患者（22.5%）视力提高两行或更多，5例患者（12.5%）视力下降两行或更少，26例患者（65%）视力稳定。供血血管治疗后，7例患者AMD病变的解剖学情况有所改善，渗漏减少。除1例视网膜下出血外，未观察到供血血管治疗后的并发症。
供血血管治疗是一种需要高速ICG血管造影来检测位于距黄斑下OCNV、CCNV和PED一定距离处的供血血管的技术。尽管最终视力结果大多是稳定的，但该技术似乎是安全且可重复的。对于不符合其他治疗（如PED治疗）条件的患者，供血血管治疗似乎是一种合理的选择。
