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I Musicco, C Veronese, P Salvetti, F Viola, G Staurenghi; Transpupillary Thermotherapy for "Classic" Extrafoveal Choroidal Neovascular Membrane: A Randomised Pilot Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4416.
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Purpose: To evaluate transpupillary thermotherapy (TTT) in the treatment of "classic" extrafoveal choroidal neovascular membranes (C-CNV) and verify the possibility of minimising collateral damage to normal retina. Methods: Twenty consecutive patients with C-CNV were randomly assigned to treatment with direct photocoagulation using the Macular Photocoagulation Study (MPS) parameters (Macular Photocoagulation Study Group Arch Ophthalmol 1982; 100: 912-918) or TTT with the laser setting suggested by Reichel for occult lesions (Reichel E et al. Ophthalmology 1999; 106: 1908-14). The follow-up visits were scheduled after 7, 15 and 30 days, with recurrency being as the appearance of a new CNV after 30 days. The patients were re-treated using the same parameters if the lesion maintained its pretreatment fluorescein characteristics after one week. The main endpoints were stabilisation of visual acuity (VA) (3 ETDRS lines) and C-CNV obliteration. Alternative treatment was given after three retreatments or if the lesion grew. Results: MPS group: Immediate C-CNV obliteration in 9/10 patients; VA was stable in three, increased in one and worsened in six. Seven patients experienced a recurrence. TTT group: Immediate obliteration in 7/10 patients; VA was stable in four, increased in three and worsened in three. An average of one retreatment was necessary during the first three weeks, and three patients experienced a recurrence. Even in the case of stable or increased VA, the angiographic appearance was different: in the MPS group, the anatomical result was always an area of atrophy; in the TTT group, the lesion decrease in size and showed "granular" fluorescence. No chorioretinal atrophy was visible at the treatment site. Conclusion: TTT obliterated C-CNV even after multiple treatments in the first weeks, with functional results comparable with those after MPS. However, the anatomical results were characterised by the persistence of angiographically silent C-CNV. These preliminary data suggest the need for further research.
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