[Angiographic aspects of senile macular degeneration: spontaneous course]

Between 1971 and 1981, 45 patients (50 eyes) with a senile macular degeneration were seen at an early stage of the disease. These patients were followed for 6 to 72 months (mean follow-up 32 months). The early morphological features and evolution of the lesions were analysed by fluorescein angiography. Three different angiographic types of subretinal new vessels were identified in this study. These were: angiographically visible vascular networks (27 cases) subretinal new vessels hidden behind retinal pigment epithelium modifications (9 cases); and subretinal new vessels associated with pigment epithelial detachment (14 cases). In the first group subretinal new vessels were clearly visible on the angiogram, as a distinct network of cart wheel-like capillary plexuses which fill very early in the arterial phase. Progressive leakage of dye hides this capillary plexus during the late phase. In the second group a pigment epithelial detachment, usually identified on biomicroscopic examination, was associated with neovascularization visible as a hyperfluorescent hot spot or as an uneven hyperfluorescence on the border of the RPE detachment. Other angiographic features are a non-circular shape, irregular filling of the pigment epithelial detachment, and uneven late hyperfluorescence. In the third group, occult neovascularization was usually located behind the retinal pigment epithelium. When subretinal neovascularization was suspected by the presence of a disciform lesion, angiography, showed an irregular pattern of delayed hyperfluorescence with late leakage. These features permit putative diagnosis without precise localization. This clinical study attempted to establish the evolution and prognosis of three clinical forms of subretinal new vessels, in order to more accurately establish the indications of photocoagulation treatment.