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I. Mantel, T. Delarive, L. Zografos; Evaluation of Prognostic Factors in PDT for Age Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1746.
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Purpose: Photodynamic therapy (PDT) has proven to be effective for treatment of retrofoveal choroidal neovascularisation (CNV) in age related macular degeneration (AMD). However, the decision to terminate the treatment is often difficult to make, especially in cases of apparantly poor response to the first few treatments but persistant angiographic leakage. The aim of this study is to evaluate a variety of clinical features of the initial assessment and their evolution through the first 3 PDT sessions for their potential predictive value regarding visual outcome. Methods: 45 patients (29 females, 16 males, average age 78 years, SD 5.5 years) were treated a minimum of three times with photodynamic therapy for retrofoveal CNV in AMD according to TAP and VIP guidelines. Average follow-up was 18 months (range 9-31 months). Functional (visual acuity), morphologic (haemorrhage, hard exudates), and angiographic features (type of membrane, lesion size, serous exudation) of the initial assessment and their evolution through the first 3 PDT sessions were analysed for their potential predictive value regarding final visual loss. Results: Initial visual acuity showed a statistically significant correlation with the change in lines of visual acuity (Correlation coefficient r=0.59, p<0.0001). Further visual loss between the 1st and 2nd PDT and between the 1st and 3rd PDT showed a statistically significant correlation (r=0.32, p=0.03 for PDT2 and r=0.58,p<0.0001 for PDT 3). Morphologic and angiographic features (type of membrane, lesion size, lesion growth, serous exudation, haemorrhage, hard exudates and their evolution) did not show any clear statistical significance if compared with visual outcome. Conclusions: Our preliminary results suggest that the functional evolution between the early PDT sessions has a predictive value for the final visual outcome. No comparable evidence was found for morphologic and angiographic features. However there is a need for larger prospective studies in order to give treatment recommendations.
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