Detachment of subfoveal choroidal neovascularization in age-related macular degeneration.
OBJECTIVE
To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD).


METHODS
Interventional case reports.


METHODS
Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography.


RESULTS
One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment.


CONCLUSIONS
Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.
Rumelt
Shimon
S
Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.
Kaiserman
Igor
I
Rehany
Uri
U
Ophir
Avinoam
A
Pikkel
Joseph
J
Loewenstein
Anat
A
D000368:Aged; D002829:Choroid / Q000473:pathology*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004396:Coloring Agents; D005451:Fluorescein Angiography; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D006979:Hyperthermia, Induced; D007208:Indocyanine Green; D007368:Interferometry; D008027:Light; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D010778:Photochemotherapy; D014054:Tomography; D014792:Visual Acuity
D004396:Coloring Agents; D007208:Indocyanine Green