Prospective Evaluation of Photodynamic Therapy Treatment in AMD Using Fluorescein Angiography and Optical Coherence Tomography

Abstract

Abstract: : Purpose: To investigate optical coherence tomography (OCT) and angiographic findings of photodynamic therapy (PDT) in AMD and to compare with.visual outcome Methods: 23 patients (23 eyes) presenting with predominantly classic lesion of AMD were treated with PDT using the TAP guidelines and prospectively followed up with standardized ETDRS visual acuity (VA), OCT and fluorescein angiography (FA) until the complete stabilization of the lesion Results: At baseline, OCT demonstrated macular thickening in all 23 eyes, due to microcystic edema in 17, serous detachment in 3 and both in 3. During the follow up (mean: 14.9 months), VA tends to continually worsen: -0.3 lines at 1 month, -1.8 lines at 3 months and –2.6 lines at last examination. In 17 eyes (74%), the best VA was observed at 1 month. OCT findings were fairly well correlated with VA and FA at 1 month, showing in most cases, decrease of the retinal thickening, but not at 3 and 6 months. At 3 months indeed, in 8 eyes (35%), improvement of the macular profile was observed on OCT whereas VA decreased and FA showed an increase of leakage. At the end of the follow up, VA increased in 2 eyes, was stable in 8 and decreased in 13. FA and OCT demonstrated the presence of sub retinal fibrosis in 15 eyes and a central area of RPE atrophy in 8 eyes. The presence of RPE atrophy was associated with a better outcome (mean –1.5 lines) than subretinal fibrosis (mean –3.1 lines). In 16 eyes (70%), OCT demonstrated macular retinal thinning (macular thickness inferior to 140 microns). 13 of these 16 eyes had a final VA less than 20/200, whereas 5 out of 7 eyes presenting a normal retinal thickness had a final VA better than 20/100. Conclusions: Improvement observed in both VA, FA and OCT by the first month was transient in most cases. During the follow up, improvement of the macular appearance in OCT can be observed despite increase of the size of the membrane and decreased in VA. Evolution to sub retinal fibrosis or/and retinal thinning explain probably the poor visual outcome after PDT treatment

Keywords: age-related macular degeneration • imaging methods (CT, FA, ICG, MRI, OCT, RTA, S • retina