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F Hamon, P Goeminne; Photodynamic Therapy (PDT) with Verteporfin Following Transpupillary Thermotherapy (TTT) in Patients with Initial Occult Converted in Predominantly Classic Choroidal Neovascularization (CNV) from Age-related Macular Degeneration (ARMD) . Invest. Ophthalmol. Vis. Sci. 2002;43(13):584.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate PDT in management of initial occult CNV from ARMD secondary converted in classic CNV after a treatment by TTT Methods: One hundred and fifty-four eyes of 130 patients with symptomatic occult CNV were treated between June 2000 and August 2001. We have analized data from patients treated by PDT because of a conversion (occult to classic) after TTT. All patients were informed and gave written consent.Visual acuity, contrast threshold results, fundus with evaluation of the macula and angiographic features were analized. Results: Twenty eyes of 19 consecutive patients were treated. Twenty-four (15,6%) of the 154 eyes (20 included in this study) developed a predominantly classic CNV.The mean follow-up time was 10 months (range 6-14 mos).The mean delay for retreatement (Ten eyes received two TTT) by TTT was 3 months.Three eyes initially presented a pure occult CNV, 15 a minimally classic CNV, one an occult CNV with pigment epithelial detachment , and one a large macular subretinal hemorrhage and a subfoveal focal hot spot. The average of the classic component noticed before TTT was 20%. Recurrence with a classic CNV was noted in the first three months for 14 eyes. Five eyes (25%) improved visual acuity (VA) by 2 or more lines, and two (10%) by 1 line. Four (20%) of 20 eyes had stabilization of visual acuity (no change in VA). Seven eyes (35%) had a visual acuity decline of 2 or more lines. Two eyes (10%) lost one line. Ten eyes had contrast threshold and visual acuity stabilized . Three eyes had contrast threshold improved and VA declined. One eye had contrast threshold declined and no change in VA . Six eyes had contrast threshold and VA declined. All patients had reduction of metamorphopsia and reduction of exsudation.Six eyes had still more a little leakage in the late phase of the angiogram. Conclusion: It seems important to perform a careful follow-up of patients treated with TTT for CNV from ARMD, within the first three months, and especially if CNV is a minimally classic form. Association of TTT and PDT appears to be safe and may help practicians to manage some difficult cases. Moreover, this study seems to confirm the great efficiency of PDT in CNV with recent activity. Further research (TTT4CNV, VIM Studies) is still needed to improve visual outcome of such patients, and to explain clearly what is now a mere hypothesis.
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