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Three-dimensional Topography of Classic and Occult Neo-vascularization

1Schmidt-Erfurth U., 1Oldag M., 1Teschner S., 1Laqua H., 2Birngruber R.,
1Medizinische Universität zu Lübeck, Klinik für Augenheilkunde (Lübeck)
2Medizinisches Laserzentrum Lübeck GmbH (Lübeck)

Purpose: Conventional angiography often fails to document classic as well as occult types of choroidal neovascularization (CNV). A novel topographic three-dimensional method was introduced to identify CNV membranes and characterize typical patterns of classic and occult subtypes.
Method: 94 patients with classic and 64 patients with occult CNV based on criteria of conventional fluorescein angiography (FA) underwent topographic evaluation. A confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph) was used to generate tomographic series with 32 single frames over a depth of 4 mm. The axial distribution of flourescence was analyzed and reproduced in a three-dimensional display. Early and late phases of FA and indocyanine green angiography (ICGA) were characterized and correlated with conventional FA/ICGA images.
Classic CNV imposed as well-defined prominence with steep borders and central concavity. The neovascular convolute was surrounded by a circular halo of reduced choroidal perfusion. Progressive exudation led to a marked increase in prominence in late phase FA. By ICGA, classic CNV was more precisely demarcated, but less prominent. 90% of all classic CNV was already detectable by early topographic, and not by early conventional ICGA. In contrast, occult CNV lesions showed a flat convex configuration. 67% of occult lesions were exclusively identified by topographic FA/ICGA and not by conventional imaging. A choroidal halo was not associated with this lesion type. 90% of CNV were larger by topographic than by conventional FA/ICGA.
Conclusion: Topographic angiography allows an improved identification of CNV lesions. Characteristic differences in the vascular structure of classic and occult types may increase insight into pathogenesis and progression.