Near-infrared reflectance imaging of neovascular age-related macular degeneration.
OBJECTIVE
To evaluate various types of neovascular age-related macular degeneration (AMD) by near-infrared fundus reflectance (NIR) as compared to fundus fluorescein angiography (FFA) and to test NIR for assessment of leakage due to choroidal neovascularization (CNV).


METHODS
Thirty-three patients with neovascular AMD (cases) and 20 age-matched patients with non-exudative AMD and healthy subjects (controls) were examined with a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2). NIR images of neovascular AMD were qualitatively compared to the corresponding FFA and to age-matched controls. CNV membranes and exudation areas were manually segmented on FFA and NIR and analyzed quantitatively.


RESULTS
Of all cases included, five eyes had classic CNV, six had minimal classic lesions, 15 occult CNV's and seven eyes had retinal angiomatous proliferation (RAP). A dark halo on NIR was found in all cases and showed high correspondence to leakage on FFA (r (2) = 0.93; p < 0,0005). In classic CNV and minimal classic CNV, the classic part of the lesion on FFA revealed strong correlation to a dark core surrounded by a bright reflecting ring on NIR (r (2) = 0.88; p < 0.0005). Occult parts on FFA of minimal classic CNV and occult CNV lesions appeared as poorly demarcated, jagged areas of increased NIR. RAP was characterized by speckled NIR located at the intraretinal neovascular complex.


CONCLUSIONS
NIR imaging in neovascular AMD revealed characteristic alterations depending on the type of CNV. These changes may reflect histological differences of the lesions. Leakage caused local darkening of NIR, presumably originating from increased light-scattering and absorbance by fluid accumulation and sub-cellular structure alterations.
Theelen
Thomas
T
Department of Ophthalmology (400), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. t.theelen@ohk.umcn.nl
Berendschot
Tos T J M
TT
Hoyng
Carel B
CB
Boon
Camiel J F
CJ
Klevering
B Jeroen
BJ
D002199:Capillary Permeability; D020256:Choroidal Neovascularization / Q000145:classification / Q000175:diagnosis*; D005122:Exudates and Transudates; D005451:Fluorescein Angiography; D006801:Humans; D007259:Infrared Rays; D007834:Lasers; D008268:Macular Degeneration / Q000175:diagnosis*; D009887:Ophthalmoscopy; D011446:Prospective Studies; D012171:Retinal Vessels / Q000473:pathology*