Fluorescein angiography in age-related macular degeneration. Frequency of lesions treatable with photocoagulation

Background The treatment of late age-related Macular Degeneration (AMD) according to the results of prospective clinical studies is indicated in classical choroidal neovascularisations (NV), which can be delineated from the center of the fovea. To evaluate the effectiveness of this therapy, the knowledge of the frequency of treatable lesions in the spectrum of late AMD is important. Patients and Methods The frequency of different manifestations of late AMD and of lesions treatable with photocoagulation according to the results of prospective clinical studies was recorded in a consecutive serie of 2503 fluorescein angiogramms inpatients with symptomatic late AMD. Results Classical choroidal NV could be detected in 35.4% of the patients. In 5.5% of the patients these NV were extra- or juxtafoveolar and therefore laser treatment could be recommended. 10.2% of the patients demonstrated small (<1 PD) subfoveal classical NV and 20.4% of the patients showed large (>1 PD) subfoveal NV or membranes associated with large subfoveal, subretinal hemorrhages. Occult choroidal NV could be seen in 41.8% of the patients. These occult NV were larger 1 PD in 21.9% of the patients and small (<1 PD) in 19.9% of the patients. Pigment epithial detachments (FED) could be seen in 14.6% of the patients (9.9 vascular PED, 3.7% avascular PED, 1.0% rip of the retinal pigment epithelium). Disciform scars were present in 7.2% of the angiogramms. Conclusions The spectrum of late AMD can be differentiated in several clinical features. In this consecutive serie of 2503 symptomatic AMD patients only appr. 6% % of the patients could be treated with laser treatment according to the results of prospective clinical studies. Because in addition the success of this treatment is very limited, the development of new therapeutic options is one of the major tasks in ophthalmology.