Photodynamic therapy (PDT) increases the eligibility for feeder vessel (FV) treatment of choroidal neovascolarization (CNV) due to age-related macular degeneration (ARMD)

Purpose: PDT has been proven to be beneficial in reducing the risk of severe visual loss in selected patients with ARMD complicated by subfoveal CNV. One of the major draw- backs of PDT is the high rate of persistence and/or recurrences and the frequent re-treat- ments needed to achieve a permanent closure of CNV. Recently, the treatment of the vessel that nourishes the CNV (i.e. the FV) has been proposed as an alternative rational approach. However, the rate of identification of the FV in newly formed CNV, is about 20- 25% The aim of this study was to evaluate if previous PDT can improve the detection of the FV in patients with ARMD and subfoveal CNV. Methods: One-hundred-fifty-six eyes of 145 patients affected by ARMD complicated by subfoveal CNV were selected for PDT with Verteporfyn. They matched the clinical criteria for the eligibility to PDT with predomi- nantly classic CNV. Before treatment each patient underwent both fluorescein (FA) and indocyanine, green dynamic angiography CICGA) with a Rodenstock scanning laser oph- thalmoscope. Results: With ICGA 35 eyes out of 156 C22.4%) showed evidence of one or mom arterial choroidal FVs. All eyes were treated with PDT. After 3 months all patients repeated FA and ICGA. One-hundred-thirty-three eyes (85.2%) showed persistence of the CNV associated to early and late leakage of fluorescein. In 112 eyes out of 133 CS4.2%) dynamic ICGA allowed identifying one or more choroidal arterial FVs. Sixteen patients refused the second PDT. In these eyes FV closure was then applied with a yellow thermal laser. .Dynamic ICGA was then performed 1 day, 1 week, 1 month, 3 and 6 months after FV treatment Two eyes needed retreatment of the FV. In one eye a new FV appeared. One eye, despite repeated attempts, a subfoveal CNV with a patent FV persisted. Conclusion: These preliminary observations show (i) that previous PDT can improve the identi- flcation of the FV in patients with ARMD and subfoveal CNV and (ii) that a combined approach (PDT and FV closure) can be considered in order to reduce the need of repeated PDT treatments. CR: None