TY - JOUR
T1 - Occult choroidal neovascularization
T2 - Influence on visual outcome in patients with age-related macular degeneration
AU - Bressler, Neil M.
AU - Marsh, Marta J.
AU - Maguire, Maureen G.
AU - Alexander, Judith
AU - Phillips, Deborah A.
AU - Javornik, Noreen B.
AU - Hmer, Cheryl J.
AU - Bressler, Susan B.
AU - Chandra, Suresh R.
AU - Flood, Timothy P.
AU - Klem, Michael L.
AU - Lewis, Mary Lou
AU - Schachat, Andrew P.
AU - Singerman, Lawrence J.
AU - Stevens, Thomas S.
AU - Hawkins, Barbara S
AU - Fine, Stuart L.
PY - 1996/4
Y1 - 1996/4
N2 - Objective: To determine whether the presence of occult choroidal neovascularization (CNV) influenced the anatomic and visual acuity outcomes in a randomized clinical trial of krypton red laser photocoagulation to treat juxtafoveal neovascular lesions in age-related macular degeneration. Design, Setting, and Patients: The fluorescein angiograms obtained at the baseline examination at tertiary retinal referral centers between April 1, 1981, and December 31, 1987, as part of the Macular Photocoagulation Study (MPS) Age- Related Macular Degeneration Study-Krypton Laser were evaluated retrospectively at the MPS Fundus Photograph Reading Center by two senior readers independently (with open adjudication of any differences) from 1992 to 1994. Criteria for classifying classic and occult CNV by the MPS Group were established by 1989, 2 years after the last patient had been assigned randomly to treatment or observation in the krypton laser study. Main Outcome Measures: Treatment coverage of classic and occult CNV, persistent CNV, recurrent CNV, and visual acuity from scheduled follow-up examinations for up to 5 years were analyzed for the absence or presence of occult CNV at baseline. Results: The number of eyes with classic CNV but no occult CNV, classic and occult CNV, and occult CNV but no classic CNV were almost identical for the eyes assigned randomly to treatment or observation. Classic CNV almost always was covered completely with intense laser treatment; nevertheless, recurrent CNV developed in more than half of these eyes within 1 year after initial laser treatment. In contrast, in more than half of the eyes with occult CNV, more than 50% of the occult CNV was not covered with heavy laser treatment. Laser treatment was clearly beneficial for eyes with classic CNV but no occult CNV and almost equivalent to no treatment for eyes with classic and occult CNV. The few eyes with occult CNV but no classic CNV precluded conclusions about the value of treatment in this subgroup. Conclusions: These results strengthen previous re ports that laser treatment is beneficial for eyes with juxtafoveal choroidal neovascular lesions when classic CNV is present, even though CNV often recurs. Treatment of classic CNV alone in eyes with classic and occult CNV was not beneficial in this study. Distinguishing classic CNV from occult CNV can aid in the selection of patients who will benefit most from laser treatment.
AB - Objective: To determine whether the presence of occult choroidal neovascularization (CNV) influenced the anatomic and visual acuity outcomes in a randomized clinical trial of krypton red laser photocoagulation to treat juxtafoveal neovascular lesions in age-related macular degeneration. Design, Setting, and Patients: The fluorescein angiograms obtained at the baseline examination at tertiary retinal referral centers between April 1, 1981, and December 31, 1987, as part of the Macular Photocoagulation Study (MPS) Age- Related Macular Degeneration Study-Krypton Laser were evaluated retrospectively at the MPS Fundus Photograph Reading Center by two senior readers independently (with open adjudication of any differences) from 1992 to 1994. Criteria for classifying classic and occult CNV by the MPS Group were established by 1989, 2 years after the last patient had been assigned randomly to treatment or observation in the krypton laser study. Main Outcome Measures: Treatment coverage of classic and occult CNV, persistent CNV, recurrent CNV, and visual acuity from scheduled follow-up examinations for up to 5 years were analyzed for the absence or presence of occult CNV at baseline. Results: The number of eyes with classic CNV but no occult CNV, classic and occult CNV, and occult CNV but no classic CNV were almost identical for the eyes assigned randomly to treatment or observation. Classic CNV almost always was covered completely with intense laser treatment; nevertheless, recurrent CNV developed in more than half of these eyes within 1 year after initial laser treatment. In contrast, in more than half of the eyes with occult CNV, more than 50% of the occult CNV was not covered with heavy laser treatment. Laser treatment was clearly beneficial for eyes with classic CNV but no occult CNV and almost equivalent to no treatment for eyes with classic and occult CNV. The few eyes with occult CNV but no classic CNV precluded conclusions about the value of treatment in this subgroup. Conclusions: These results strengthen previous re ports that laser treatment is beneficial for eyes with juxtafoveal choroidal neovascular lesions when classic CNV is present, even though CNV often recurs. Treatment of classic CNV alone in eyes with classic and occult CNV was not beneficial in this study. Distinguishing classic CNV from occult CNV can aid in the selection of patients who will benefit most from laser treatment.
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U2 - 10.1001/archopht.1996.01100130396006
DO - 10.1001/archopht.1996.01100130396006
M3 - Article
C2 - 8602776
AN - SCOPUS:1942525885
SN - 0003-9950
VL - 114
SP - 400
EP - 412
JO - Archives of ophthalmology
JF - Archives of ophthalmology
IS - 4
ER -