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E. Mcloone, M. Stevenson, A. Muldrew, U. Chakravarthy; Baseline Morphological Features are Predictors of Visual and Morphologic Outcomes following Photodynamic Therapy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1739.
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Purpose: Verteporfin photodynamic therapy (PDT) is a recognised method of treating classic and predominantly classic choroidal neovascularisation(CNV).We assessed visual and morphological outcomes following PDT as a function of baseline morphological features. Methods: Data from sixty eight eyes (64 subjects) was included. All subjects underwent fully corrected distance acuity (DVA) measurements in both eyes at baseline and all subsequent visits. Treatment and re-treatments were carried out using criteria similar to that employed in TAP. Morphological features assessed on stereo angiography included the total area of the lesion, area of classic and occult CNV, the location and extent of blood and the presence or absence of atrophy, drusen and fibrosis. Results: The mean follow up time was 15 months (range 6 to 24). 65% of the study cohort had lost fewer than 3 logMAR lines of DVA at the final visit. On regression analysis with baseline DVA as the dependent variable, total area of the lesion, size of classic CNV and the area of atrophy were selected by the model. Increasing lesion size was associated with worse DVA (t=3.65; p<0.001). When regressed against DVA at the final visit, the model which incorporated the total area of the lesion, size of occult, extent of blood and the presence of drusen was retained, with total lesion area emerging as highly significant (t=3.40, p<0.001). When change in DVA was used as the dependent variable, the presence of blood defining the border was the most important predictor of worse outcome. In the 50 eyes that had less than 25% of the border defined by blood the mean fall in DVA was 1.5 lines compared with the remaining 18 eyes in which the mean fall in DVA was 3.5 lines (p=0.016) and where greater than 25% of the lesion border was outlined by blood. Other parameters such as gender and age did not affect the outcome. Conclusions: This study suggests that PDT is less effective in eyes where haemorrhage is found at the border of the lesion signifying a highly active CNV.
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