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Treatment of CNV Secondary to Chronic Idiopathic Central Serous Chorioretinopathy (ICCS) and Posterior Uveitis with PDT
1Wabbels B. K., 2Becker M., 3Holz F. G.,
1Universität Regensburg, Klinik und Poliklinik für Augenheilkunde (Heidelberg)
2Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik, Interdisziplinäres Uveitis-Zentrum (Heidelberg)
3Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)
Background: Choroidal neovascularization (CNV) represents the final pathogenetic pathway shared by various choroidal and retinal diseases. However, growth pattern, permeability, fibrotic tendency and, therefore prognosis, are dependent on the primary disease. If certain, mostly angiographic criteria are met, CNV caused by age-related macular degeneration (AMD) or high myopia can be successfully treated by photodynamic therapy (PDT), whereas CNV e.g. due to angioid streaks appears to respond poorly to PDT. Efficacy of PDT in secondary CNV associated with chronic ICCS or posterior uveitis is unclear.
Patients: Six patients with predominantly classic subfoveal CNV due to chronic ICCS or posterior uveitis were treated. Three patients with chronic ICCS (age 53-69 years) received 1-3 PDT treatments. In 2 of these patients the CNV regressed with reduced leakage and improvement in visual acuity. In 1 patient the CNV persisted with resulting fibrosis and poor vision. Two patients with multifocal choroiditis (age 22 and 32 years) received 2 to 4 PDT treatments resulting in stable vision at 1,0 and improvement from 0,125 to 1,0, respectively. One patient with CNV secondary to serpiginous choroiditis (age 27 years) received 3 PDT treatments with consecutive leakage reduction and unchanged vision.
Discussion: These preliminary observations indicate that PDT represents an option in the treatment for CNV due to chronic ICCS as well as posterior uveitis. However, the clinical course appears highly variable. There is a definitive tendency for better outcome in younger patients and in patients with less wide spread retinal pathology. Prospective randomised clinical trials appear difficult to perform because of the rarity of these diseases.