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Impressum
Chorioretinal anastomosis as unfavourable prognostic factor during photodynamic therapy
Kusserow C., Michels S., Schmidt-Erfurth U.
Klinik für Augenheilkunde, Universitätsklinikum Lübeck, Ratzeburger Allee 160, 23538 Lübeck
Purpose: Documentation of chorioretinal anastomosis in neovascular
agerelated macular degeneration (AMD) and correlation of the finding with
functional and angiographic results following photodynamic therapy (PDT).
Method: 212 patients presenting with neovascular AMD and indication
for PDT due to predominantly classic choroidal neovascularization (CNV)
underwent ophthalmoscopic and angiographic screening of chorioretinal
anastomosis. Conventional PDT using verteporfin according to the recommended
standard procedure was performed. The pre- and posttreatment status at
3 and 6 months post PDT in all and at 1 week in selected patients was
documented in respect to central visual acuity test (ETDRS), ophthalmoscopy
as well as fluorescein (FA) and indocyaninegreen angiography (ICGA).
Results: A primary chorioretinal anastomosis was found in 6% (n=12)
of all eyes with CNV and classic PDT indication. Mean visual loss within
the first 6 months after therapy was 3 lines indicating lack of visual
stabilization according to PDT study criteria. Furthermore, an increase
in visual acuity could not be documented in any case. The angiographic
size of the CNV demonstrated continuous progression although PDT had been
uneventful. The characteristic initial occlusion of the CNV with homogenous
hypofluorescence at one week was absent. The anastomosis was detected
by ICGA in all eyes, by ophthalmoscopy or optical coherence tomography
(OCT) in several eyes.
Discussion: Chorioretinal anastomosis is not a rare finding associated
with predominantly classic CNV. The presence of an anastomosis appears
to be an unfavourable factor during PDT. The course of visual acuity recovery
and angiographic progression are less benign than expected based on study
results. If a chorioretinal shunt is suspected an ICGA and / or OCT should
be performed and the indication for PDT should be rediscussed.