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J. Rouleau, M. Sébag, D. Gauthier, J.D. Arbour, G. Marcil; Photodynamic therapy for peripapillary choroidal neovascularisation (CNV) or CNV located nasal to the fovea. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3178.
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© ARVO (1962-2015); The Authors (2016-present)
Background:Laser photocoagulation for neovascular lesions nasal to the fovea has shown some benefical results. However, this kind of treatment can produce severe visual loss, visual field defects and thermal papillitis. Purpose:To evaluate the effect of photodynamic therapy on CNV in the papillomacular bundle, either peripapillary or located nasal to the fovea. Methods:A retrospective noncomparative review of a consecutive series of patients. Of the 8 patients (9 eyes) included in the study, the etiology of the CNV was ARMD (5), ocular histoplasmosis (3) and angioid streaks with ARMD (1). Photodynamic therapy was applied by a Coherent laser (Opal Photoactivator; Coherent Medical Group, Santa–Clara, USA) and by using verteporfin (Visudyne; Novartis Ophtalmic AG, Basel, Switzerland) at a dose of 6mg/m2 of body surface administered intravenously 15 minutes before laser treatment. The diameter of treatment spot was calculated from the fluorescein angiography while respecting a minimal distance of 200 micron from the optic disc edge. When it was impossible to treat the CNV entirely with one laser spot, the spot was moved on the CNV surface during the treatment without being closer than 200 micron of the optic disc. All CNV measurements was done from computed fluorescein angiography. Results: Visual acuity before treatment varied from 20/40 to 20/100. Of all CNV, 67% had a peripapillary location and 33% was located nasal to the fovea, adjacent to a peripapillary atrophy or fibrosis. The pre–treatment CNV were juxta–foveolar in 67%, sub–foveolar in 22% and extra–foveolar in 11%. Larger CNV diameter varied from 3500 micron to 6800 micron before photodynamic therapy. 44,5% of the CNV were of classic type, 44,5% were occult and 11% were mixed. The preliminary results indicate that CNV treated showed a reduction of the greater lesion diameter size after photodynamic therapy in 67% and one had a progression of fibrovascular scar extending through the foveal zone. Visual acuity after one treatment was between 20/25 and 20/80, mean time of 76 days after treatment. Five patients gained visual acuity after treatment (from 1 to 6 Snellen lines). One patient lost 4 Snellen lines after one treatment and received two other treatment sessions. His final visual acuity was 20/400 from fibrovascular scar extending through the foveal zone. No damage to the optic nerve or to the papillo–macular nerve fiber bundle were found. Conclusions: Photodynamic therapy is possibly useful for peripapillary CNV and CNV located nasal to the fovea. Although progression of the membrane can occur.
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