Abstract
Abstract: :
Purpose:To report a group of patients who developed late macular scar contraction and visual loss following successful Photodynamic Therapy (PDT). Methods:Four patients who experienced severe late visual loss following PDT for subfoveal choroidal neovascularization (CNV) were included. None developed recurrent leakage or new CNV growth. LogMar visual acuity testing and angiograms were performed every three months. Results:Three cases were due to age related macular degeneration (AMD), and one was idiopathic. The number of PDT applications ranged from one to three (mean two). All four developed significant visual loss three to six months after the last PDT application (six to nine months since baseline treatment). The reduction in visual acuity ranged from 16 to 34 letters (mean 20). Fundus fluorescein angiogram indicated contraction of a fibrotic lesion as a probable cause of the visual loss. They also developed superficial retinal hemorrhages along the borders of the scar with no associated CNV leakage. There had been no improvement in visual acuities six months later. Conclusions:This case series suggests that contraction of fibrotic lesions, resulting in severe visual loss, can occur after successful closure of CNV. The occurrence of sub–retinal hemorrhages does not necessarily imply lesion growth in these cases. Thorough evaluation is necessary to avoid over–treatment. Patient with significant fibrosis should be informed of the possibility of late visual loss.
Keywords: photodynamic therapy • age–related macular degeneration • retinal neovascularization