[Monitoring the patient after treatment: angiographic aspects of recurrence and indications for retreatment]

Abstract

Objectives: Dynamic phototherapy with intravenous injection of Verteporfin (Visudyne) is a relatively recent therapeutic concept based on a photochemical reaction. Its statistically significant efficacy has been demonstrated in treating choroidal newvessels and age-related macular degeneration. This occlusion is often temporary, thus requiring repeated treatments in persistent cases and/or recurrences. Angiographic monitoring of the patient, over the short or medium term and then later over the long term, will identify these cases.

Methods: The indications for retreatment are based on very close follow-up with fluorescein angiographic results, and the persistence or reappearance of leakage should be analyzed and clearly distinguished from staining phenomena. Leakage is an essential element and the main diagnostic criterion of recurrence. Associated criteria could be envisaged based on follow-up angiographic examinations at different stages of progression: early, at 4 or 6 weeks (often a good indicator of progression), or at 3 months, currently indispensable.

Results: With a relatively stable lesion with no progression or extension, the angiographic examination will make it possible to decide whether a treatment is needed: either retreatment if there is leakage or no treatment if the lesion is fibrous. To assist in therapeutic decisions, a number of arguments must be gathered based on fluorescein angiography but also on indocyanine green angiography (ICG), which will analyze neovascularization, and optical coherence tomography (OCT) examination, which will bring out the presence or absence of fluid at the lesion, as well as functional signs of visual acuity. In difficult cases, the angiographic examination will determine the source of the major decreases in acuity that can be caused by hemorrhages, breaks (which are not necessarily absolute contraindications for retreatment), or acute choroidal ischemia.

Conclusions: Fluorescein and IGC angiographic follow-up and OCT examinations will screen and analyze persistence or reperfusion of choroidal neovessels as well as the extension or reappearance of lesions and, on the other hand, the presence or absence of fibrotic staining phenomena and scarring. The changes in central visual acuity and different functional signs are indicators of patient management and therapeutic indications.