Selective occlusion of subfoveal choroidal neovascularization in pathologic myopia using a new technique of ingrowth site treatment.
OBJECTIVE
To evaluate the visual and angiographic effects as well as optical coherence tomography findings after a new technique of ingrowth site treatment of subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia with the use of indocyanine green (ICG)-mediated photothrombosis.


METHODS
Interventional, noncomparative case series.


METHODS
In the setting of a tertiary referral center, patients with pathologic myopia in whom fluorescein and conventional ICG angiography demonstrated distinct CNV vessels supplying the subfoveal neovascular complex were submitted to focal ingrowth site treatment using a new therapeutic modality termed ICG-mediated photothrombosis. Prospective evaluation including visual acuity assessment, fluorescein and ICG angiography, and optical coherence tomography (OCT) evaluation was performed at weeks 1, 12, 24, and 48 after treatment.


RESULTS
Six consecutive patients (six eyes) had treatment using a single session of ICG-mediated photothrombosis at the CNV ingrowth site. Obliteration of the entire neovascular complex was achieved immediately after treatment in all patients. At last follow-up, visual acuity improvement of 1 or more Early Treatment Diabetic Retinopathy Study lines was observed in five of six patients, and fluorescein angiography showed an absence (four eyes) or minimal leakage (two eyes) from CNV. Indocyanine green angiography demonstrated selective obliteration of the neovascular complex. Accordingly, reduction of retinal edema was observed in the OCT evaluation in all patients. There was no significant complication related to the procedure.


CONCLUSIONS
The use of lower irradiances of 810- nm continuous light application and intravenous ICG infusion for neovascular ingrowth site photothrombosis induced selective CNV hypoperfusion, as demonstrated by fluorescein and ICG angiography in patients with pathologic myopia. These findings were either consistent with the visual acuity improvement observed in five of six patients or with the partial restoration of the retinal architecture seen in OCT evaluation 12 months after treatment.
Costa
Rogério A
RA
Instituto da Visão-IPEPO,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. roger.retina@globo.com
Calucci
Daniela
D
Teixeira
Luiz F
LF
Cardillo
Jose A
JA
Bonomo
Pedro P
PP
D000328:Adult; D002199:Capillary Permeability; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis / Q000098:blood supply*; D006801:Humans; D007208:Indocyanine Green / Q000627:therapeutic use*; D007368:Interferometry; D008027:Light; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000150:complications*; D010778:Photochemotherapy / Q000379:methods*; D011446:Prospective Studies; D013927:Thrombosis / Q000209:etiology*; D014054:Tomography / Q000379:methods; D014792:Visual Acuity
D007208:Indocyanine Green