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C. Francais, F. Devin, A. El Maftouhi, C. Favard, F. Coscas, L. Laroche, G. Coscas; Photodynamic Therapy for Juxtafoveal or Extrafoveal Choroidal Neovascularization in ARMD: Results of Pilot Study . Invest. Ophthalmol. Vis. Sci. 2005;46(13):308.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the visual and angiographic outcome of juxta–foveal or extra–foveal predominantly classic CNV in ARMD treated with "limited size PDT"at six months. Methods: 10 patients presenting predominantly classic juxtafoveal or extrafoveal CNV were treated by limited size spot PDT rather than laser photocoagulation. The spot diameter was determined by the size of CNV by means of both fluorescein and ICG angiography (Topcon Imagnet) or OCT (Carl Zeiss Meditec), to match the CNV area. ETDRS visual acuity measurements and Fluorescein / ICG angiography or OCT were performed at close intervals (3, 6, 12 and 24 weeks) to detect and retreat subfoveal progression with PDT. Results: Location on CNV was juxtafoveal (n=2) and extrafoveal (n=8). The initial visual acuity range was 20/125 to 20/32. Three weeks after PDT, the CNV activity was reduced (2 closed network, 5 with significant decrease of size, l still perfused without leakage). All patients had an increased vision. At 6 weeks, only 2 eyes were retreated by PDT for extension of CNV size and visual loss (2 and 1 lines) while 8 eyes remained stable in terms of CNV size and visual acuity. At 12 weeks, CNV size remained stable; 2 eyes were retreated for reduced acuity (2 lines) associated with recurrence of serous retinal detachment on OCT. At 24 weeks, visual acuity ranged from 20/200 to 20/25 and 8 eyes had maintained or improved vision (6 with occluded CNV network, 2 CNV remained perfused, but not increased). Two eyes needed to be retreated for subfoveal extension. Conclusions: The "limited size PDT" may be a safe and effective alternate treatment for juxta or extrafoveal predominantly classic CNV in ARMD to reduce the risk of visual loss or severe paracentral scotoma induced by laser photocoagulation. A closer monitoring may help treat at an earlier stage than in the classic PDT protocol. It may be also useful to compare the efficacy of PDT and laser photocoagulation in the management of juxtafoveal or extrafoveal CNV.
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