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Purpose: Retinal detachment leads to the widespread cellular remodeling of the retina. The purpose of this study was to identify protein changes that accompany these cellular alterations by comparing the proteomic profiles of sham and experimentally detached rabbit retina. Elucidation of the proteins most dramatically affected by retinal detachment would add further understanding to the pathophysiology of this condition, and potentially identify therapeutic targets useful in preventing the deleterious effects of detachment, including photoreceptor cell death and the activation of non-neuronal microglial and Müller cells., Methods: Retinal detachments were induced in the right eyes of six New Zealand Red pigmented rabbits. Sham surgery was performed in the right eyes of six other rabbits that were used as controls. At seven days, the eyes were enucleated and the retinal tissue was harvested. The individual retinal samples were subjected to high resolution two-dimensional polyacrylamide gel electrophoresis. Differentially expressed protein spots were processed for identification by liquid chromatography-tandem mass spectrometry. Further investigation was undertaken with western blotting, and immunocytochemical studies on a further set of four sham and four detached retinas., Results: Eighteen protein spots were found to be at least twofold differentially expressed between the sham and detached retinas. These protein spots were identified as: vimentin; tubulin β-2C; fragments of α-enolase; fructose-bisphosphate aldolase A; ATP synthase subunit β; mitochondrial creatine kinase; N-terminal fragments of albumin; prohibitin; and transducin-β(1)., Conclusions: The differentially expressed proteins determined in this study may play an important role in the cellular responses of the retina after its detachment, subsequent ability to recover following surgical reattachment, as well as in serious complications such as subretinal fibrosis and proliferative vitreoretinopathy.

Purpose: To examine the effect of intravitreally injected bevacizumab (Avastin) on the histological and angiographic morphology of choroidal neovascularization (CNV) in a masked and placebo-controlled animal study., Methods: Choroidal neovascularization was induced surgically in 11 porcine eyes by perforating Bruch's membrane with a retinal perforator. After closure of the ports used for the vitrectomy, which was performed to facilitate the Bruch's membrane rupture, 0.05 ml of either bevacizumab or Ringer-Lactat (placebo) was injected into the vitreous cavity. Eyes were enucleated after 14 days. Fundus photographs and fluorescein angiograms (FAs) were obtained immediately prior to enucleation. Sections of formalin- and paraffin-embedded eyes were examined by light microscopy and by immunohistochemical staining., Results: Placebo-injected eyes exhibited the highest propensity to leak, with five of six eyes leaking on FA, whereas only one of five bevacizumab-injected eyes exhibited leakage. On histological examination, all 11 eyes contained CNV membranes of similar size, regardless of treatment. The number of vascular endothelial cells was significantly reduced (p = 0.03) in CNV membranes from eyes that had been injected with bevacizumab when compared with CNV membranes from placebo-injected eyes. There was a trend towards more retinal pigment epithelium cells (p = 0.16) and fewer glial fibres (p = 0.08) in membranes from bevacizumab-treated eyes compared with placebo-treated eyes. Bevacizumab was identified immunohistochemically in the inner limiting membrane (ILM) and to a lesser degree in the remaining retina. Strong staining was also detected in both retinal blood vessels and entire CNV membranes with no cellular predisposition. Vascular endothelial growth factor expression was found in the CNV membranes, in the ILM, in the ganglion cell layer, in Müller cells throughout the neuroretina and in retinal blood vessels., Conclusions: Bevacizumab significantly reduced the proliferation of vascular endothelial cells in CNV membranes and showed a strong trend towards a reduction of leakage from these membranes. After a single injection, bevacizumab did not exhibit a size reducing effect on CNV, but it was still present in the membranes 14 days after intravitreal injection.

Cognitive dysfunction, unexplained deafness or retinal branch artery occlusions in otherwise healthy persons are challenging conditions, in particular when occurring in young adults. Susac's syndrome is characterized by the clinical triad of encephalopathy, hearing loss and retinal branch arterial occlusions affecting mainly young women. Appropriate diagnosis and management requires multidisciplinary management of the disease.

Purpose: The aim of the study was to determine the type and magnitude of detectable changes in pig multifocal electroretinography (mfERG) induced by the vitreoretinal surgical procedures necessary to gain access to the subretinal space., Methods: Twenty pigs underwent posterior segment surgery. Six animals had a vitrectomy (V), six had in addition a retinal bleb detachment (V + B); five had in addition a retinal diathermia on the bleb (V + B + D) and three received a retinotomy in the diathermized retinal area (V + B + D + R). mfERG evaluation was performed at baseline and 1 and 6 weeks postoperatively. Selected eyes were enucleated for histological evaluation., Results: The retinal detachments blebs all reattached spontaneously. All four surgical sequences resulted in slight, non-significant changes in the mfERG peaks. A trend towards an amplitude reduction of the mfERG peaks N1, P1 and N2 were observed within the first postoperative week. After 6 weeks, all amplitudes had normalized. Of the implicit times only that of peak N1 (after retinal diathermia) was prolonged significantly at 1 week (P = 0.037). However, it returned to the preoperative level after 6 weeks. Histologically, the retinal detachment bleb was characterized by transient double layering of the retinal pigment epithelium (RPE) and loss photoreceptor outer segments., Conclusion: Access to the subretinal space in pigs can be gained without permanent detectable changes in the mfERG. A short-term retinal detachment was found to cause only reversible electrophysiological and histological changes in the outer retina, which suggests that this procedure is tolerated well in the porcine retina. The size of the known destructive lesion (retinotomy) was too small to be detected, given the spatial resolution of the mfERG method applied. In the future, the presented protocol can be used to assess the functional outcome of surgery and transplantation in the subretinal space in pigs.

Purpose: To develop a reproducible surgical technique for the induction of choroidal neovascularization (CNV) in the subretinal space of porcine eyes and to analyse the resulting CNV clinically and histologically., Methods: Two different modifications of a surgical technique previously described were compared with the original method. In ten porcine eyes retinal pigment epithelial (RPE) cells were removed using a silicone tipped cannula, in ten porcine eyes Bruch's membrane was perforated once with a retinal perforator without prior RPE removal and in ten eyes RPE removal was followed by a single perforation of Bruch's membrane. Fifteen of the eyes, five from each group, were enucleated 30 minutes after surgery, while the remaining eyes were enucleated after 14 days. Prior to enucleation, at day 14, fundus photographs and fluorescein angiograms were obtained. Eyes were examined by light microscopy and by immunohistochemical staining. In addition to these 30 eyes, two eyes underwent surgery with the purpose of subsequent scanning electron microscopic (SEM) examination., Results: In eyes enucleated immediately after surgery neuroretinas overlying the induced lesions were intact without apparent atrophy of cells regardless of the surgical technique applied. The process of RPE removal was found to induce breaks in Bruch's membrane and both the size and the number of breaks varied between eyes. CNV membranes were identified in 15 of 15 eyes enucleated after 14 days. CNV membranes induced by perforation of Bruch's membrane without prior RPE removal were significantly thicker than membranes from eyes undergoing both RPE removal and Bruch's perforation (p = 0.03) and also thicker than membranes from eyes with only RPE-removal (p < 0.01). CNV membranes from eyes with perforation of Bruch's membrane without prior RPE removal had a higher cellular content and were more richly vascularized and also exhibited the highest propensity to leak in fluorescense angiograms., Conclusion: All three surgical techniques were capable of inducing CNV, but the one applying perforation of Bruch's membrane without RPE removal was easier to reproduce and involved fewer variables than the techniques utilizing RPE removal. The presence of RPE cells seems to affect both the morphology and cellular composition of induced CNV.

New drugs for age-related macular degeneration present a major advance in the treatment of the most common cause of blindness in Iceland. Vascular endothelial growth factor antibodies reduce the risk of blindness and improve vision in patients with age-related macular degeneration.

Purpose: To assess retinal vascular permeability and vessel diameter changes after intravitreal triamcinolone acetonide (IVTA) injection in eyes with persistent foveal thickening after photocoagulation for diabetic macular oedema (DMO)., Methods: We calculated the blood-retinal barrier permeability as measured by vitreous fluorophotometry, artery and venous vessel diameter at the temporal vascular arcades as measured on digital fundus photos, and retinal thickness as measured by optical coherence tomography. Seven patients with type 2 diabetes and DMO were examined immediately before and 1 week after IVTA 2 mg. The study was designed as an open-label interventional case series using the fellow eyes as untreated controls., Results: One week after IVTA, we observed that, compared with baseline values, blood-retinal barrier permeability had decreased to 27.2 +/- 3.6% (p < 0.0001), retinal artery diameter had decreased to 94.9 +/- 0.02% (p = 0.05), retinal vein diameter had decreased to 89.2 +/- 0.03% (p = 0.02) and foveal thickness had decreased to 68.7 +/- 6.9% (p = 0.004). Visual acuity (VA) improved by 7.4 +/- 2.2 letters (p = 0.01). No significant change was observed in control eyes except that mean VA deteriorated by 2.6 +/- 0.9 letters (p = 0.03). Changes in permeability were closely correlated to changes in retinal thickness (R = 0.84) and venoule diameter (R = 0.93) in treated eyes., Conclusions: Intravitreal injection of triamcinolone acetonide in eyes with DMO is followed by a marked reduction in retinal vascular leakage and a concomitant reduction in retinal vessel calibre.

Subfoveal neovascularization is the most frequent cause of severe visual loss in patients with age-related macular degeneration (AMD). Pharmacologic inhibition of vascular endothelial growth factor (VEGF) is a new principle of treatment of this condition. The effects of intravitreal pegaptanib administered every sixth week for 48 weeks in three different dosages were examined in a prospective, double-masked, randomised trial against subconjunctival sham injection with change in visual acuity as the outcome parameter in 1,186 patients with subfoveal neovacularization in AMD. 70% of the patients treated with pegaptanib avoided moderate visual loss, compared to only 55% of the control group (p < 0.001 for 0.3 mg pegaptanib versus the control group, p < 0.001 for 1.0 mg and p = 0,03 for 3.0 mg). The improved visual prognosis was detectable beginning six weeks after the first injection (p < 0.002). Adverse events included endophthalmitis (1.3% of patients), traumatic lens damage (0.7%), retinal detachment (0.6%) and severe visual loss in one patient (0.1%). Intravitreal pegaptanib improves the visual prognosis in neovascular AMD. The long-term effect and safety of the treatment are not known.

Background: Carbonic anhydrase inhibitors (CAIs) increase blood flow in the brain and probably also in the optic nerve and retina. Additionally they elevate the oxygen tension in the optic nerve in the pig. We propose that they also raise the oxygen tension in the retina. We studied the oxygen tension in the pig retina and optic nerve before and after dorzolamide injection. Also the retinal vessel diameters during carbonic anhydrase inhibition were studied., Methods: A polarographic oxygen electrode was placed transvitreally immediately over the retina or the optic disc in anaesthetised pigs. The oxygen tension was recorded continually and 500 mg dorzolamide was injected intravenously. Retinal vessel diameters were analysed from monochromatic fundus photographs taken before and after injection of dorzolamide., Results: Baseline retinal oxygen tension (RPO2) was 3.34+/-0.50 kPa (mean +/- SD, n=6) and baseline optic nerve oxygen tension (ONPO2) was 3.63+/-1.00 kPa. RPO2 was increased by 0.36+/-0.11 kPa (n=6, P=0.025) and ONPO2 by 0.73+/-0.34 kPa (n=6, P=0.003) 30 min after dorzolamide administration. The retinal arterioles was significantly dilated by 13+/-7% (n=5, P=0.016) and the retinal venules by 12+/-8% (n=5, P=0.030) 30 min after injection of dorzolamide., Conclusion: Retinal and optic nerve oxygen tension increased with systemic administration of dorzolamide. The retinal vessels dilated, probably causing increased blood flow inducing the observed increase in RPO2. The increased oxygenation of retina by CAI may offer therapeutic possibilities in ischaemic diseases of the retina and optic nerve.

Purpose: To examine patient survival in age-related maculopathy in a 14-year follow-up study., Design: Population-based 14-year cohort study., Participants: Nine hundred forty-six residents, aged 60 to 80 years, living in the Osterbro district of Copenhagen, Denmark, participated in the first examination conducted from 1986 to 1988. These participants were followed until death or until May 1, 2002, whichever came first., Methods: Participants underwent an extensive ophthalmologic examination at Rigshospitalet, the National University Hospital of Copenhagen. Standardized protocols for physical examination, blood samples, and data from the National Central Person Register, the National Death Register, and the National Patient Register were used., Main Outcome Measures: Mortality and age-related maculopathy., Results: By May 1, 2002, 60.9% (577 of 946) of the participants of the baseline study cohort had died. The adjusted 14-year cumulative mortality hazard ratio for subjects with early and late age-related maculopathy at baseline was 1.26 (95% confidence interval [CI], 1.06-1.51). We identified a strong correlation between mortality and age-related maculopathy among women (relative risk, 1.59; 95% CI, 1.23-2.07) but not among men., Conclusions: When adjusting for survival-related factors, age-related maculopathy is a significant risk indicator for poorer survival in women and may be a marker of underlying serious systemic factors or aging processes specific to women.

Purpose: To present and discuss four cases of bilateral endogenous endophthalmitis., Methods: An observational study of four patients aged 55-80 years, seen within a 2-year period. All had diagnostic and therapeutic vitrectomy. The antibiotic therapy was guided by analyses of cultures of blood and vitreous., Results: Blood cultures demonstrated Streptococcus pneumoniae in two patients and Staphylococcus aureus and Morganella morganii, each in one patient. The findings corresponded with culture findings from vitreous material in two patients. The primary foci for the metastatic spread of infection were endocarditis, discitis and a subdural abscess of the lumbar spine, urinary tract infection, and infection of a recent hip alloplasty, respectively, in the four patients. Five eyes became blind, whereas three eyes recovered to visual acuity of 0.25-0.67., Conclusions: Endogenous bacterial endophthalmitis usually leads to total loss of vision. The disease is acute and the time span for intervention limited. We believe that an active therapeutic approach including intravitreal antibiotics and vitreoretinal surgery saved three eyes from blindness.

Purpose: To investigate the age-specific prevalence and causes of visual impairment and blindness in an epidemiologic study of an adult Scandinavian population., Design: Population-based, cross-sectional study., Participants: The study population was composed of 9980 persons, ages 20 to 84, from the general population of Copenhagen, Denmark., Methods: This study is based on the third Copenhagen City Heart Study (CCHS III). Participants who reported visual impairment or blindness or had difficulty reading newspaper type and used prescribed eye medications were contacted from 1999 through 2000 and asked to complete a standardized interview concerning their ophthalmologic history. Verification of objective ophthalmologic data was done with a validated questionnaire response method., Main Outcome Measures: Best-corrected visual acuity in the better eye and primary causes of visual impairment and blindness. Visual impairment was defined as visual acuity worse than 20/40 but better than 20/200, and blindness was defined as visual acuity of 20/200 or worse., Results: The age-standardized prevalence rates of visual impairment and blindness were 0.66% and 0.20%, respectively, and rose significantly with age (P<0.001). For persons 20 to 64 years, myopia-related retinal disorders, diabetic retinopathy, optic neuropathy, and retinitis pigmentosa were the most common causes of impaired vision. For persons 65 to 84 years, cataract was the most common cause of visual impairment, whereas age-related macular degeneration was the major cause of blindness., Conclusions: Visual impairment and blindness are strongly associated with increasing age, and the causes are determined by age. Among persons aged 20 to 64 years, an intervention for the predominating eye diseases might have some effect. Among those aged 65 to 84 years, cataract surgery could reduce visual impairment by one third.

Purpose: To provide an overview of some of the current activities in eye research in the Nordic countries., Methods: The presentations at the biannual Nordic Congress of Ophthalmology, held in Tampere, Finland in 2002, were reviewed and the contributions found most noteworthy are included in this article along with a limited discussion of each research field. However, space requirements prevented the inclusion of many interesting scientific contributions., Results: Important contributions in various subfields of eye research and ophthalmology are reviewed. These include cornea, cataract, paediatric ophthalmology, glaucoma, diabetic eye disease, age-related macular degeneration, physiology and pharmacology and oncology., Conclusions: Eye research is very active in the Nordic countries and significant contributions are being made to ophthalmology in several fields on a world scale. We hope to continue to review Nordic contributions to eye research after each Nordic Congress of Ophthalmology and plan to make the reviews more systematic and comprehensive in the future.

Purpose: To report four cases of Eales' disease in Inuit from Greenland diagnosed within a 6.5-year period. There are no previous reports on Eales' disease among Greenlanders., Methods: Four younger Inuit, three males and one female, were diagnosed with Eales' disease based on fundus changes and exclusion of possible differential diagnoses. Several studies point to a possible relation between Eales' disease and tuberculosis (TB); examination of possible exposure to TB was part of the clinical investigation., Results: Retinal changes made panretinal laser photocoagulation necessary in all cases. Four eyes in three patients were vitrectomized. Three patients received oral corticosteroid treatment. The final visual outcome was relatively good, with a visual acuity below 6/60 (3/36) in only one vitrectomized eye. All patients had been exposed to TB., Conclusion: Eales' disease seems to be rather common in the small population of Inuit (56,000) in Greenland. Attention is required to ensure diagnosis and appropriate treatment, including laser photocoagulation, leading to a reasonably good prognosis.

Purpose: To establish and characterize cultures of porcine retinal pigment epithelial (pRPE) cells in order to produce confluent monolayers of cells for transplantation., Methods: Primary pRPE cell cultures were established. Cell morphology was assessed by phase contrast and electron microscopy. Growth was determined by the crystal violet dye uptake assay. DNA synthesis and content were measured by incorporation of 3H-thymidine and flow cytometry., Results: This primary culture resulted in cells with well-preserved morphology that could be propagated in up to six passages. The deterioration observed over time in cultures was not due to a constant high rate of cell turnover as postconfluency cell proliferation was limited. However, a large fraction of the cells had a high DNA content despite a lack of active DNA synthesis., Conclusions: The present method yields pRPE cells of high purity and proliferative capacity with preserved epithelial phenotype. However, aberrant DNA profiles and the deterioration of cell morphology observed over time in this graft material represent serious problems in RPE transplantation.

The retinal pigment epithelium (RPE) of the eye transports water and lactate ions in the direction from retina to choroid. The water transport is important in maintenance of retinal adhesion and the transport of lactate ions serves to regulate the lactate levels and pH of the subretinal space. This study investigates by means of a non-invasive technique the mechanism of coupling between transport of H(+), lactate ion, and water in the monocarboxylate transporter (MCT1) located in the apical (retinal) membrane of a mammalian RPE. Primary cultures of porcine RPE cells were grown to confluence and placed in a perfusion chamber in which the solution facing the retinal membrane could be changed rapidly. Two types of experiments were performed: Changes in cell water volume were measured by self-quenching of the fluorescent dye Calcein, and changes in intracellular pH were measured ratiometrically using the fluorescent dye BCECF. In lactate-free solutions, mannitol addition to the retinal bath caused intracellular acidification and cell shrinkage, given by a single osmotic water permeability of 1.2+/-0.1 x 10(-4)cmsec(-1) (osmoll(-1))(-1). In solutions containing 50 mmoll(-1) lactate, however, the mannitol-induced cell shrinkage was faster and the cells alkalinized. These effects were not linear functions of the magnitude of the imposed osmotic gradients: Both volume effects and changes in intracellular pH showed apparent saturation with increasing gradients. Abrupt isosmotic replacement of Cl(-) with lactate in the concentration range from 3 to 50 mmoll(-1) caused an immediate cell swelling as well as an immediate intracellular acidification; both effects showed apparent saturation with increasing lactate concentration. The K(m) values were: 11+/-2 mmoll(-1) for the water fluxes and 13+/-4 mmoll(-1) for the H(+) and lactate fluxes. The data suggest that H(2)O is cotransported along with H(+) and lactate ions in MCT1 localized to the retinal membrane. The study emphasizes the importance of this cotransporter in the maintenance of water homeostasis and pH in the subretinal space of a mammalian tissue and supports our previous study performed by an invasive technique in an amphibian tissue.

Background: Macular hole is a retinal disease primarily affecting elderly women. Its overall prevalence in the Danish population is estimated to be 0.14%. The majority of cases are unilateral. The fully developed macular hole evolves through a series of stages starting with an impending hole. About half of impending macular holes regress spontaneously. The remaining half progress to full thickness macular holes. In a patient with a macular hole in one eye, the risk of development of a macular hole in the fellow eye is less than 2% if posterior vitreous detachment is present. If the posterior vitreous is attached, the risk is approximately 15%. If an impending hole is found in the other eye, the risk rises to 50%., Treatment and Outcomes: Macular hole surgery is able to close full thickness macular holes in approximately 90% of cases. Visual acuity of 20/50 or better can be obtained in approximately half of patients with recent onset of symptoms. Complications include retinal detachment, endophthalmitis, late reopening of an initially successfully closed hole and retinal pigment epithelial abnormalities. Retinal detachment should be expected in less than 5% of cases.

Purpose: To report a case of retinal cavernous haemangioma localized to the fovea., Methods: Clinical examination, fluorescein angiographic study and magnetic resonance imaging are reported., Results: A 9-year-old girl presented with acute loss of vision in the right eye. Ophthalmoscopy showed intraretinal bleeding in the macula, while fluorescein angiography showed a lesion typical of a small cavernous retinal haemangioma, localized in the central macula. Family history was negative., Conclusion: Central cavernous retinal haemangioma is a rare cause of central visual loss and should be distinguished from other retinal vascular abnormalities with more profound systemic implications for the patient.

Purpose: To investigate the consequences of transplantation of a new basement membrane to the subretinal space (SRS) as a substitution of Bruch's membrane., Methods: Porcine anterior lens capsules (ALC) were transplanted to the subretinal space of 20 eyes from 19 young Danish landrace pigs. All pigs underwent a three port localized pars plana vitrectomy. Seventeen eyes received naked ALC. In three experiments the ALC was embedded in gelatine, in order to prevent curling of the ALC. The observation period varied between zero and 49 days. The pigs were examined by ophthalmoscopy and fundus photography. Histopathological examination of enucleated eyes was performed at the end of the experiment., Results: ALCs transplanted to the subretinal space were well-tolerated and caused no inflammation when Bruch's membrane was left undamaged. After 11 days host RPE and glial cells started to cover the ALC in a competitive fashion. When Bruch's membrane was damaged, ingrowths of choroidal vessels and fibroblasts was prominent. The use of gelatine to flatten the ALC did not prevent curling, and gelatine caused pronounced inflammation., Conclusions: It is possible to transplant porcine ALC to the SRS of the pig. ALCs are well-tolerated in the SRS and are covered with well-differentiated monolayers of host RPE-cells, if Bruch's membrane is left intact.

Purpose: This study presents an evaluation of cataract surgery on diabetic patients. One experienced surgeon carried out phaco emulsification on all subjects and the same surface-coated one-piece PMMA-lens-type was implanted. The lens fluorescence and the blood-aqueous barrier (BAB) were then evaluated as experimental preoperative risk indicators., Results: During follow-up, 10 out of 39 diabetic patients progressed unilaterally in diabetic retinopathy or developed macular oedema, a significant relative risk. Neither lens fluorescence, BAB, HbA1c, level of retinopathy, type/duration of diabetes, diabetes treatment or antihypertensive treatment differed significantly between the group of patients with postoperative progression of retinopathy/macular oedema and those without. Results indicated NIDDM (non-insulin-dependent diabetes mellitus/type 2 diabetes) patients might have increased risk of a postoperative macular oedema., Conclusion: When diabetic retinopathy (DR) is not in a proliferative phase it should not be regarded as a contraindication to modern cataract surgery. Neither lens fluorescence nor BAB is valuable as a risk indicator for postoperative progression of DR.

Age-related macular degeneration (AMD) is a common macular disease affecting elderly people in the Western world. It is characterised by the appearance of drusen in the macula, accompanied by choroidal neovascularisation (CNV) or geographic atrophy. The disease is more common in Caucasian individuals than in pigmented races. In predominantly Caucasian populations, the age-standardised prevalence of AMD in at least one eye is 7760 cases per million. The age-standardised cumulated 1-year incidence of AMD in at least one eye is 1051 cases per million individuals. AMD is the most important single cause of blindness among Caucasian individuals in developed countries. Blindness resulting from AMD rarely occurs before age 70, and most cases occur after age 80. The age-standardised 1-year incidence of legal blindness resulting from AMD is 212 cases per million. Two-thirds of AMD cases have CNV (exudative cases); the remainder has only geographic atrophy. In cross-sectional population-based studies about 45% of eyes with AMD have visual acuity reduced to 20/200 or worse. This is true both for exudative AMD and pure geographic atrophy. Age and genetic predisposition are known risk factors for AMD. Smoking is probably also a risk factor. Preventive strategies using macular laser photocoagulation are under investigation, but their efficacy in preventing visual loss is as yet unproven. There is no treatment with proven efficacy for geographic atrophy. Optimal treatment for exudative AMD requires a fluorescein angiographic study and a physician capable of interpreting it. For CNV not involving the foveal centre, the only evidence-based treatment is laser photocoagulation. For AMD cases with subfoveal CNV, good visual acuity, and predominantly classic fluorescence pattern on fluorescein angiography, photodynamic therapy with verteporfin is the treatment of choice. Photodynamic therapy is also effective in eyes with pure occult CNV and evidence of recent disease progression. For new subfoveal CNV with poor vision and recurrent CNV, laser photocoagulation can be considered.