Comparison of foveal-sparing with foveal-involving photodynamic therapy for myopic choroidal neovascularization

Abstract

Purpose To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia in eyes treated with photodynamic therapy (PDT), and to determine the effect of lesion location and foveal involvement on visual prognosis. Methods Interventional case series of 24 consecutive patients with myopic CNV treated with PDT. The main outcome measure was final LogMAR visual acuity (VA). Results Of 24 eyes, the CNV lesion was subfoveal in 11 and extrafoveal in 13. Overall, the mean LogMAR VA at 24 months was 0.72. Extrafoveal CNV lesions achieved significantly better final VA compared with subfoveal CNV (LogMAR 0.45 vs 1.05, P ¼ 0.012). Eyes with extrafoveal CNV lesions were subdivided into foveal-sparing PDT (where the PDT laser spot did not involve the foveal center) and foveal-involved PDT (where the PDT laser covered the fovea). At all time points, the group with fovealsparing PDT had significantly better VA compared with the foveal-involved group. The final LogMAR VA for the foveal-sparing PDT group was 0.26 compared with 1.00 for the foveal-involved PDT group (P ¼ 0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of Z20/40, compared with 25% of foveal-involved PDT cases and 9.1% of subfoveal CNV lesions (P ¼ 0.006). Conclusion For patients with myopic CNV, foveal-sparing PDT results in significantly better long-term visual outcomes compared with those with foveal-involved PDT. Fovealsparing PDT may be of value for treatment of myopic CNV patients who are not suitable for treatment with anti-vascular endothelial growth factor injections.

Response to the letter to the editor entitled "Forty-two-month outcome of intravitreal bevacizumab in myopic choroidal neovascularization"

“…With regard to extrafoveal myopic choroidal neovascularization (mCNV), we agree with Chew and Tan about a continuing role for photodynamic therapy in this patient category [2]. Our population was composed of subfoveal and juxtafoveal mCNV.…”

Letter to the editor: Forty-two-month outcome of intravitreal bevacizumab in myopic choroidal neovascularization

“…al. [3] recently demonstrated that if the PDT laser spot does not involve the center of the fovea in extrafoveal mCNV, the visual outcomes are comparable to longterm studies using anti-VEGF therapy. In that series, mean LogMAR VA of 0.26 was achieved at 24 months [3].…”

“…[3] recently demonstrated that if the PDT laser spot does not involve the center of the fovea in extrafoveal mCNV, the visual outcomes are comparable to longterm studies using anti-VEGF therapy. In that series, mean LogMAR VA of 0.26 was achieved at 24 months [3]. Furthermore, while anti-VEGF therapy has been shown to be effective [1], it is also associated with both ocular and systemic risks [4] such as endophthalmitis and cerebrovascular accidents.…”

“…Furthermore, while anti-VEGF therapy has been shown to be effective [1], it is also associated with both ocular and systemic risks [4] such as endophthalmitis and cerebrovascular accidents. For patients who are unwilling to accept the risk of anti-VEGF therapy, we believe that PDT is a viable alternative to consider [3].…”

“…However, we would like to highlight that the VIP study evaluated only patients with subfoveal mCNV. We believe that PDT still has a role in the management of extrafoveal mCNV, which may occur in between 18.5% to 32% of myopic CNV patients [3]. Tan et.…”