Large–Spot Size Transpupillary Thermotherapy for the Treatment of Occult Choroidal Neovascularization Associated With Age-Related Macular Degeneration

Abstract

To describe the outcome of patients with occult choroidal neovascularization in age-related macular degeneration treated with transpupillary thermotherapy. Design: Prospective, nonrandomized, nonmasked case series. Methods: All patients with age-related macular degeneration with a predominantly occult choroidal neovascular membrane and an initial visual acuity of 20/400 or better were offered treatment using transpupillary thermotherapy. The treatment consisted of using a diode laser, a spot size of about 3000 to 6000 µm delivered over 60 seconds, and a power of 600 to 1000 mW. Main Outcome Measures: A stable, improved, or worsened visual acuity and the need for additional treatment. Results: Sixty-nine patients were treated. All patients have been followed up for at least 6 months. At the 6-, 9-, and 12-month follow-up visits, 71% of patients have stable or improved visual acuity and 29% have lost 2 or more lines of visual acuity on the Snellen letter chart. Conclusion: Large-spot size transpupillary thermotherapy is effective in stabilizing the visual acuity in those patients who have occult choroidal neovascularization due to age-related macular degeneration.

Transpupillary thermotherapy for the treatment of choroidal neovascularization in age-related macular degeneration in Taiwan

“…In eyes with occult CNV, the best-corrected visual acuity was improved or remained unchanged in 45.4%. Compared with results from other studies in which visual acuity in 71-82% eyes was stable or improved, 8,11,12 the result in our study was less favourable. This difference may be partly attributed to the different baseline visual acuities and the longer average follow-up period in our series.…”

“…Our complication rate was higher compared to other series. 8,10,11 An even higher complication rate (16%) was noted in a series of Japanese patients using an energy level half of that used in Caucasians. 12 We may conclude that for light-browncoloured fundus, energy should be adjusted to a lower level to avoid complications.…”

“…This difference may be partly attributed to the different baseline visual acuities and the longer average follow-up period in our series. 8,11,12 In AMD, a gradual visual deterioration over time is expected. Although over half of our patients had decreased vision, the CNV closed in about 80%, and none had increased exudates.…”

“…9 Several studies show encouraging results of TTT in the stabilization or improvement of visual acuity, as well as its effectiveness in CNV closure. 8,10,11 However, most of the study participants were Caucasian, and the recurrence rate of CNV after TTT has not been well studied.…”

Low power vs standard power transpupillary thermotherapy in patients with age-related macular degeneration and subfoveal choroidal neovascularization ineligible for photodynamic therapy

“…Recent interest has focused on the potential therapeutic effect of TTT on subfoveal CNV secondary to AMD following observations by Reichel et al 12 in 1999 and more recent publications. [13][14][15] TTT has been shown to stabilize vision and reduce overlying exudation in both classic and occult subfoveal CNV. [12][13][14][15][16] The exact treatment parameters have not yet been elucidated.…”