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Transpupillary Thermotherapy (TTT) in Patients with Age-related Macular Degeneration - A Follow-up after 12 Months
Fuisting B., Feucht M., Schwartz R., Hassenstein A., Richard G.,
Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Augenheilkunde (Hamburg)
Purpose: New laser techniques such as Transpupillary Thermotherapy (TTT) and Photodynamic Therapy (PDT) are increasingly used for the treatment of occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
Methods: 60 patients with uni- or bilateral choroidal neovascularization (CNV) were treated with Transpupillary Thermotherapy. Infrared diode laser at a wavelength at 810 nm was used. A complete ophthalmologic examination also including fluoresceinangiography and optical coherence tomography (OCT) was performed prior to and 3, 6, 9 and 12 months after the treatment.
Results: After 12 months, in 43.33% of the patients visual acuity remained stable (± 1 line) and visual acuity improved in 10% of the patients (³ 2 lines). In 46.67% of patients TTT could not prevent further visual loss. Retinal edema formation, assessed by fluorescein angiography and OCT, decreased or stabilized in 51.67% of the treated patients. In eyes with persistent CNV activity, an additional treatment was performed. Patients with small subretinal membranes (<2500mm) had a better prognosis regarding visual acuity and decline of the edema. 8 (13.33%) of the treated patients showed a change of the morphologic characteristics of the choroidal neovascular membrane from predominantly occult to predominantly classic. Therefore 5 of these patients were additional treated with PDT. TTT of large subretinal membranes (>4500mm), which could not be completely covered by the laser spot size, could not prevent progression.
Conclusions: To verify the indication and possible side-effects of TTT, a multicenter trial has started in Germany. In addition, the results after PDT will be discussed.