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G.J. Coscas, F. Coscas, A. Zourdani, G. Soubrane; Evaluation of the Risk of RPE Detachment Tears in AMD: Comparison Between Natural History and Post–PDT Tearing . Invest. Ophthalmol. Vis. Sci. 2005;46(13):196.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To analyse and compare natural history versus post–treatment evolution of Vascularized RPE detachment in AMD and to recognize the pre–tear symptoms. Methods: Observational series of 30 consecutive patients with exudative AMD and Vascularized PED with occult CNV, who were classified as "at the border" or "in the notch" and more or less extensive in the area of the PED. Cases with chorio–retinal anastomosis were excluded. All examinations (ETDRS visual acuity, FA and SLO–ICG–A and OCT) were performed at baseline and at each 3 month follow up period. Diagnosis of CNV and of RPE tears was based on the confrontation of the three imaging systems. Treatment group of patients (N= 12) received photodynamic therapy with verteporfin after informed consent. Follow up range was 6 to 48 months. Results: Out of the 30 patients, the occurrence of tears was observed in 14 cases ; the extension of CNV (more than one third of the PED area) was documented in 14 cases (5 in the PDT group and 9 in the observation group). In the treated group, RPE tears were observed for 8 eyes (66%), including 2 cases with extensive haemorrhages. In this group, 7 patients (58%) had initially an extensive area of CNV ( more than one third of the entire lesion) : 5 of them experienced tearing of the PED. In the observed group, RPE tears were observed in 6 eyes (33%) including 3 cases with extensive haemorrhages. Five (5) of them had initially an extensive CNV membrane. Mean initial visual acuity was 20/100 for both groups. Mean final visual acuity was 20/200 for treated group versus 20/160 for the observation group. Conclusions: The follow up of this series of patients with Vascularized PED showed that PDT treatment did not achieve better visual result that the observation group, in relation to the incidence of RPE tears in natural history and after treatment. Nevertheless, the analysis of cases with late lesions with extensive CNV seems to show worse evolution than early lesions with relatively small areas of CNV.
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