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S.M. Greenbaum, F.M. Recchia, C. Carvalho-Recchia, T.S. Hassan, A.J. Ruby; Vision Loss Following Photodynamic Therapy for Age-Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1752.
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Purpose: To evaluate the incidence of self-reported vision loss within seven days of PDT for age-related macular degeneration and to describe the anatomic and clinical course of patients with documented significant visual loss. Methods: Consecutive records of all patients with AMD treated with PDT between 5/2000 and 11/2001 at a community-based retina referral practice were reviewed for instances of self-reported visual change within seven days of treatment. All patients with documented significant visual decline (defined as loss of two or more Snellen lines of vision) were included for further study. The following data were recorded: patient demographics, ocular history, lesion characteristics, visual acuity before and immediately following PDT, anatomic findings, fluorescein angiographic findings, visual acuity (6 weeks, 3 months, 6 months, 9 months, and 12 months following PDT, and most recently), subsequent treatment, and anatomic outcome. Results: Of 396 PDT treatments performed, there were 17 instances (among 15 patients) of self-reported visual change within 7 days of PDT. Significant visual decline was documented in 8 patients (2.0%) and occurred within 3 days of PDT (median, 1 day). The average patient age was 83 years (range 76 to 95 yrs), and all but one were female. Median pre-PDT vision was 20/60 (range 20/50 to 20/200). Median lesion size was 11 mm2 (range 6.4 to 17 mm2). Six CNV were predominantly classic, one was minimally classic, and one was occult. Vision immediately following PDT was 20/200 or worse in all 8 cases and CF or worse in three. Massive subretinal and sub-retinal pigment epithelial hemorrhage occurred in 2 patients. Fluorescein angiography (FA) was performed within one week of PDT in 5 of 8 patients and showed a new circular area of choroidal hypoperfusion (corresponding to the PDT spot) in all 5. Four patients underwent additional PDT; one underwent pars plana vitrectomy and additional PDT; three patients received no further treatment. With a median follow-up of 15 months (range, 5 to 24 months), most recent visual acuity was worse than pre-PDT levels in 7 patients and the same in one patient (20/50). Visual improvement following the initial acute decline occurred in only one patient, at nine months following PDT. Conclusions: Acute visual decline following PDT for AMD is uncommon. In the current small series, visual improvement, even with additional treatment, was unlikely. Vision loss may be related to choroidal vascular damage associated with PDT.
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