Fuisting B., Richard G.

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

Introduction: New laser-techniques such as photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) gain increasing importance for the treatment of choroidal neovascularization (CNV) in AMD.
Methods: 100 patients with uni- or bilateral predominantly occult CNV in AMD were treated with TTT. Laser light delivered from a infrared diode laser at 810 nm was used. Treatment was initiated with one spot for a 60 seconds duration and a power setting of 509mW when using a 2000 mm spot size resp. 800 mW for a spot size of 3000 mm to raise the temperature in the CNV for about 10° C. A complete ophthalmologic examination including visual acuity, slit-lamp biomicroscopy, funduscopy, fluorescein angiography and optical coherence tomography (OCT) was performed prior to and 3, 6 and 9 months after the treatment.
Results: After 9 months of follow-up, 16% of the patients showed a change of the morphologic characteristics of the choroidal neovascular membrane such as an increase of the "classical" part of the CNV. The presence of a "classical" part correlated with a better prognosis regarding visual stabilisation (64,7%; +/- 1 line) and visual improvement (17,6%; ³ 2 lines). In 17.6% of these patients TTT-laser treatment could not prevent further visual loss. In eyes with persistent CNV activity, a re-treatment was performed after 3 months.
Discussion: After TTT in some patients a change in the characteristics of the CNV from predominantly "occult" to more "classical" could be observed. These patients meet now the inclusion criteria for PDT. Shall we re-treat these patients with PDT or is a sole TTT also sufficient for patients with predominantly "classical" membranes?

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