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P. N. Dayani, G. K. Shah, A. Tewari, K. J. Blinder, H. Hollands, S. Sharma; Long-term Efficacy of Photodynamic Therapy With Verteporfin for Choroidal Neovascularization Secondary to Ocular Histoplasmosis Syndrome. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1435.
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To report the long-term outcome of patients treated with photodynamic therapy (PDT) for subfoveal and juxtafoveal choroidal neovascularization (CNV) secondary to ocular histoplasmosis syndrome (OHS).
A retrospective chart review was conducted for all patients treated with PDT for OHS with a minimum of 36 months of follow-up.
Our search yielded 39 eyes (35 patients) with a median follow-up of 46 months. The median age at initial therapy was 44 years of age, and 69% of patients were female. Fourteen eyes (36%) had progressed despite previous treatment, which included thermal laser photocoagulation therapy (n=9), submacular surgery (n=4), and prior PDT (n=1). Twenty-three (59%) of the treated lesions were subfoveal, and 16 were juxtafoveal. The median greatest linear dimension of the lesions was 1600 mm (range 200-3400 mm). The median number of PDT treatments was 3. Six patients (15%) required only one treatment, and fourteen (36%) required more than four PDT treatments.Mean pretreatment visual acuity was significantly higher amongst patients with juxtafoveal lesions (logMAR 0.232, Snellen 20/35) compared with those with subfoveal (logMAR 0.688, Snellen 20/100) lesions (p=0.013). The mean post-treatment visual acuity was statistically similar between juxtafoveal (logMAR 0.473, Snellen 20/60) and subfoveal (logMAR 0.794, Snellen 20/125) lesions (p=0.134). Change in visual acuity from presentation was not statistically significant amongst the two groups. Visual acuity remained stable or improved in 61% of patients with subfoveal lesions and 38% of juxtafoveal lesions. Similar percentage of patients with subfoveal and juxtafoveal lesions lost 3 or more lines of vision (30% and 25% respectively). The majority (73%) of these patients, however, had aggressive lesions that had failed previous therapy or required submacular surgery. Following initial PDT therapy, 11 patients underwent subsequent submacular surgery. Mean final visual acuity was significantly lower amongst patients requiring submacular surgery (logMAR 1.11, Snellen 20/250) compared with the remainder of the patients (logMAR 0.486, Snellen 20/60, p=0.006).
PDT with verteporfin has long-term efficacy for the treatment of both juxtafoveal and subfoveal CNV secondary to OHS.
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