Morphometric Analysis of Angiograms of Exudative Lesions in Age-RelatedMacular Degeneration

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Abstract
The development of choroidal neovascularization (CNV) is a devastatingcomplication of age-related macular degeneration (AMD) and leads to seriouslosses of central vision. Longitudinal cohort studies and the early randomizedcontrolled clinical trials undertaken by the Macular Photocoagulation StudyGroup have added to our understanding of the natural history of CNV expansion.1-5 Thesestudies have determined that patterns of visual loss are affected by clinicaland angiographic features of the exudative macular lesion at presentation.6,7 It is widely accepted that angiogramsperformed using a standardized protocol and subjected to a methodical gradingprocess yield robust information on visual and morphological outcomes. Thistype of analysis and interpretation of fluorescein angiograms has led to theclassification of CNV into distinct morphological subtypes.3,8 Theclassification is based on the spatial and temporal characteristics of fluoresceinleakage, which is seen as hyperfluorescence, and the relative areas occupiedby the different lesion components.3,8 Recentclinical trials vindicate such detailed classification, as treatment effectshave been shown to be dependent on the morphological composition of the CNV.9-11 Some angiographicstudies12,13 have documented growthrates in AMD lesions. In these studies, linear measurements on lesion diameterwere made, but analyses of the effect of lesion components on lesion growthand subclassification based on proportions of CNV were not undertaken.12,13 Scrutiny of the literature yieldedno information on expansion rates of components of the neovascular lesionor the effect of lesion components on overall changes in lesion size.
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