gms | German Medical Science

Classic choroidal neovascularisation (CNV) is a visual threatening complication of chorioretinal inflammatory diseases. The effectiveness of PDT in such cases was recently demonstrated by some short-time-follow-up studies. The authors now studied the longterm efficacy of PDT treatment in these younger patients with classic CNV of inflammatory or idiopathic origin.

The study included 52 eyes of 48 patients (32 female, 16 male, mean age 38,5y, follow-up 12-48 mo) with angiographic diagnosis of subfoveal or iuxtafoveal classic CNV. These secondary CNV were associated with multifocal choroiditis (20 eyes), punctate inner choroidopathy (9 eyes), POHS (12 eyes) or of idiopathic origin (11 eyes). The PDT treatment was performed following the treatment criteria of TAP study. If after three months persistent leakage of the CNV was visible, PDT was repeated.

After PDT (Follow-up of Ø 22 mo) 41 of 52 eyes showed visual improvement or visual stabilisation (max. 2 lines of visual loss), 5 of 52 eyes showed a moderate visual loss (≥3 lines ETDRS) und 6 eyes had a severe visual loss (≥6 lines ETDRS). Visual improvement or stabilisation was achieved after a mean of 1.8 PDT-treatments, while in case of progressive visual impairment even 3-7 PDT-treatments failed to inactivate the CNV. Eyes with PIC showed the best visual results compared to CNV associated with other inflammatory conditions and this could be achieved by a small number of PDT-treatments.

PDT can improve or stabilize the long-term visual outcome in 80% of the patients with classic CNV of inflammatory or idiopathic origin. Patients who can be successfully treated most often achieve this result after 1 or 2 PDT treatments, while patients with further growth of the CNV after the first PDT treatment often did also not response to further PDT applications. New therapeutic approches like combined therapies (e.g. combined PDT and triamcinolon application) should be investigated for such `non responders`.