gms | German Medical Science

Choroidal neovascularisation (CNV) represents a severe complication of patients with angioid streaks. The majority of these cases are characterised by an aggressive course, whereby there is loss of the central visual acuity. Following the success of photodynamic therapy (PDT) for CNV due to other causes, this therapy modality was applied to patients with CNV and angioid streaks.

Retrospective analysis of 16 eyes (14 patients: 11 males, 3 females) with CNV and angioid streaks, who were treated with PDT using standard parameters during the period between October 1999 and March 2004. In 3 eyes, a CNV recurrence following laser coagulation was present. The patients' age ranged from 39 to 72 years (median 53 years); the follow-up period between 2 and 44 months (median 12 months). Repeated PDT occurred in those patients where membranes persisted or recurrences occurred on the basis of the fluoroscein angiographic and clinical findings.

The visual acuity (VA) before therapy ranged between 0.1 and 0.8 (median 0.3). The localisation of the CNV before treatment was subfoveal in 9/16 eyes, juxtafoveal in 4/16 and extrafoveal in 3/16. In total, between 1 and 7 repeat sessions (average 3.4) per eye were performed. These were conducted between 6 and 24 weeks after the initial therapy; in over 75% of cases this was performed 8 weeks after therapy. In 6/16 (38%) of patients the VA post-therapy was ±2 lines compared to the pre-treatment value. A decrease in vision of 3 or more lines occurred in 10/16 (62%) of the treated eyes. The average change of VA was -4.1 lines. The last recorded VA were between finger counting and 0.5 (median 0.1).

A fibrosis of CNV in patients with angioid streaks can be produced using PDT. This appears to produce a higher rate of stabilisation of VA and/or a decreased loss of central VA when compared to other currently applied therapies. However, the PDT-treated patients with CNV and angioid streaks had a high rate of recurrence and a more aggressive clinical course, when compared to CNV due to other aetiology. Our results suggest that regular controls and short periods between treatment sessions are necessary.