Abstract
Purpose: :
Verteporfin photodynamic Therapy (PDT) and full macular translocation with 360 degree retinotomy (FMT) are treatment modalities in selected cases of neovascular age–related macular degeneration (AMD). The aim of this study was to report on the functional and morphological outcome of cases with neovascular AMD treated by the combination of PDT prior to (PDT–FMT) or after FMT (FMT–PDT).
Methods: :
In this retrospective study, 24 eyes of 24 consecutive patients with predominantly classic and occult choroidal neovascularization (CNV) were included who underwent FMT and PDT between May 2002 and June 2005. PDT was performed either as primary therapy or following the FMT. All patients had a complete ocular examination including visual acuity measurement with ETDRS chart, fundus photography and fluorescein angiography at baseline and at follow–up examinations in three months intervals. Visual acuity equivalents were converted into logMAR units for statistical analysis.
Results: :
16 patients were treated by FMT after having undergone PDT. 8 patients underwent PDT because of recurrent CNV after FMT. Mean follow–up of the PDT–FMT and FMT–PDT group was 17 and 30 months, respectively. Mean baseline visual acuity was 20/200 (range: 20/1000 – 20/80) in the PDT–FMT group and 20/125 (range: 20/1000 – 20/80) in the FMT–PDT group. Mean visual acuity at the last follow–up examination was 20/160 (range: 20/1000 – 20/63) in the PDT–FMT group and 20/200 (range: 20/320 – 20/80) in the FMT–PDT group. The mean visual acuity improved of one ETDRS line in the PDT–FMT group and decreased of two ETDRS lines in the FMT–PDT group. 2 eyes of the PDT–FMT group with recurrent CNV were treated by laser photocoagulation. In 2 cases of this group, a chronic cystoid macular edema developed. One patient complained about intermittent diplopia. 2 eyes of the FMT–PDT group with extrafoveal recurrent CNV were treated by laser photocoagulation before PDT of the subfoveal recurrence. One eye in this group had a subretinal massive hemorrhage after PDT requiring further surgery.
Conclusions: :
In the presented retrospective small–case series, FMT after PDT achieved stabilization or improvement of visual acuity in the majority of the eyes in a follow–up period of 1.5 year. If PDT after FMT was performed, a worsening of the vision was seen in the majority of the cases. Combination of PDT and FMT is a therapeutical option in cases who are non responder to the PDT or who developed subfoveal recurrent CNV following FMT in neovascular AMD.
Keywords: choroid: neovascularization • vitreoretinal surgery • retina