Feucht M., Fuisting B., Richard G.

Universitäts-Augenklinik Hamburg, Martinistr. 52, D-20246 Hamburg

Introduction: New laser-techniques are increasingly used for the treatment of occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
Methods: Transpupillary thermotherapy was used in 100 patients with unior bilateral predominantly occult CNV. Laser light delivered from a infrared diode laser at 810 nm was used to apply laser spots for about 60 seconds duration. Laser energy was due to the spot size 509 mW (spot: 2000µm) resp. 800 mW (spot: 3000µm). A complete ophthalmologic examination including visual acuity, slit-lamp biomicroscopy, funduscopy, fluorecein angiography and optical coherence tomography (OCT) was performed prior to and 3, 6 and 9 months after the treatment.
Results: After 9 months, in 69% of the patients visual acuity remained stable (+/- 1 line), visual acuity improved in 14% of these patients ( >/= 2 lines). In 31 % of patients TTT could not prevent further visual loss. Retinal edema formation, assessed by OCT, stabilized in 57% of the treated patients. In eyes with persistent CNV activity, an additional treatment was performed. Patients with small subretinal membranes, which could be fully covered by the laser spot size had a better prognosis regarding visual acuity and decline of the edema. Bigger membranes (up to 3900µm) now can be treated with the Mainster wide field laser lens. Even in patients with additional visual loss after TTT, there was in some cases a significant relief of metamorphopsia. Rare complications were retinal artery occlusion (4%) and subretinal hemorrhage (2%).
Discussion: In March 2001 a multicenter trial has started in Germany to evaluate the indication and possible side-effects of TTT.

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