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R.M. Feist, J.O. Mason, M.F. White, M.L. Thomley, T.L. Emond; Subjective Loss of Vision Immediately After Transpupillary Thermotherapy for Occult Subfoveal Choroidal Neovascularization . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4988.
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Purpose: To evaluate vision loss following transpupillary thermotherapy (TTT) for occult subfoveal choroidal neovascularization (SFCNV). Methods: Retrospective chart review of 35 eyes (29 patients) with occult SFCNV treated with TTT between February 2000 to October 2002. All eyes were treated with a diode infrared laser using at least one 3mm treatment spot size for a duration of 1 minute. Analysis of systemic conditions, ocular history, duration of symptoms and SFCNV, visual acuity, intraocular pressure (IOP), incidence of glaucoma and retinal pigment epithelial detachment (RPED), post-TTT subjective patient findings, and power levels and number of spots placed. Results: Of 35 eyes (29 patients), the age range was 37 to 91 (mean 77). Pre-TTT vision ranged from 20/50 to count fingers. One eye had angioid streaks and the other 34 eyes had wet aging macular degeneration. Nine post-TTT eyes (26%) subjectively had a significant worsening of vision from the day of treatment to 3 days after TTT. Measurement of the visual acuity from 1 day to 2 weeks post-TTT confirmed a greater than or equal to 3 lines of vision loss. There was vision loss in 5 (14%) additional eyes, 7 (20%) had increased visual acuity, and14 (40%) had stable vision. No patients reported post-TTT pain. Three eyes (8%) had primary open angle glaucoma and 1 had an increase in IOP from 19 pre-TTT to 24 at five weeks, 28 at three months, and 32 at five months post-TTT. This patient reported a subjective vision decrease the day of TTT, but her vision was objectively improved. No other patients experienced an IOP increase of more than 5mm Hg and all other patient's post-TTT IOP measurements were 19 or less. No correlation between eyes with RPED pre-TTT and patient's with subjective loss of vision was found. Of the 9 eyes with subjective loss of vision, 78% had hypertension (HTN), 44% had significant cardiovascular (CV) disease, and 56% were on anticoagulant therapy. Of the other 5 eyes with loss of vision, 80% had HTN, 40% had CV disease, and 14% were on anticoagulant therapy. Of the 21 patients with improved or stable vision, 19% had HTN, 30% had CV disease, and none were on anticoagulant therapy. Conclusions: Although there was a 26% incidence of subjective decreased vision and another 14% of measured loss of vision, 60% of eyes achieved stabilized or improved visual acuity following TTT for SFCNV. Factors possibly associated with acute visual loss following TTT will be examined in detail in this report.
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