Magnification requirement after photodynamic therapy with verteporfin for subfoveal predominantly classic choroidal neovascularization due to age-related macular degeneration.

PURPOSE: To prospectively assess the magnification requirement after repeat photodynamic therapy (PDT) with verteporfin in patients with predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). METHODS: A total of 103 patients were treated for the first time with PDT between November 1999 and September 2002. These patients were followed up at 3-month intervals for a minimum of 12 months. In addition to the usual investigations undertaken during PDT therapy, the magnification requirement was determined, under standardized conditions, using the SZB test developed by the Swiss Central Association for Blindness. RESULTS: A stable lesion with a stable magnification requirement was achieved in 86 (83.5%) patients; these patients were followed up for 24.8 months (range 12 to 36 months). At the time of the last follow-up examination, the magnification requirement compared with baseline was < 3 log units higher in 46 patients (53.5%) and > or = 3 log units higher in the remaining 40 patients (46.5%). Seventy-four (86%) of these 86 patients had a magnification requirement of < or = 8x. Stability was not achieved in 17 (16.5%) patients; up to the last examination these patients had been followed up for 12 to 30 months (mean 20.8). At the time of the most recent examination, 7 (41.2%) patients had a higher magnification requirement of < 3 log units while 10 (58.8%) had changed by > or = 3 log units. Sixteen patients (94%) had a magnification requirement of < or = 8x. CONCLUSIONS: PDT with verteporfin helps achieve stability without severe impairment in reading ability in most patients with predominantly classic subfoveal CNV due to AMD.

[Reading ability after photodynamic therapy (PDT) for age-related macular degeneration (AMD) and for high myopia]. / Lesefähigkeit nach photodynamischer Therapie (PDT) für altersabhängige Makuladegeneration (AMD) und für hohe Myopie.

BACKGROUND: A prospective uncontrolled follow-up of changes in reading ability after PDT with Verteporfin in patients with predominantly classic subfoveal choroidal neovascularization (CNV) due to AMD or high myopia was carried out. PATIENTS AND METHODS: A follow-up time of at least 6 months is documented for 48 patients with AMD and for 22 patients with high myopia. In addition to the usual clinical parameters the need for magnification was measured using standardized reading charts provided by the SZB.A need for magnification higher than 3.2-fold was defined as a severe loss in reading ability.PDT's were repeated every 3 months according to the usual guidelines. RESULTS: Before treatment, the mean reading acuity for patients with AMD was between 20/200 and 20/100. The average need for magnification was between 2.5-fold and 3.2-fold.Reading acuity, need for magnification and the percentage of patients with a need for magnification of 3.2-fold or less remained stable over a 6-12 months follow-up period. High myopic patients initially had a mean reading acuity of 20/200 and a need for magnification of 2.5-fold. After 9 months follow-up, reading acuity showed a mean improvement from 0.2 up to 0.3 ( p<0.05). There was also a trend towards improvement in the need for magnification and the percentage of patients with a need for magnification of 3.2-fold or less improved significantly from 68% to 78% ( p<0.05). CONCLUSION: Reading ability could be stabilized with PDT for predominantly classic subfoveal CNV in patients with high myopia or AMD for at least 9-12 months. The risk of developing a severe loss in reading ability (need for magnification >3.2-fold) was significantly reduced in high myopia and was stable over time in AMD.

[Radiotherapy for choroidal neovascularization (CNV) in age-related macular degeneration (AMD)]. / Radiotherapie von choroidalen Neovaskularisationen (CNV) bei altersabhängiger Makuladegeneration (AMD).

AIM OF THE STUDY: Several pilot studies have indicated, that radiation therapy might have a beneficial effect on the course of CNV in AMD. This controlled study was aimed at the question, whether such treatment might halt progression of neovascular AMD and whether a low or a high radiation dose should be applied. METHODS AND PATIENTS: Enclosed were patients aged > or = 60 and < or = 85 and eyes with a VA of > or = 0.1 and < or = 0.6, revealing a juxta/subfoveal CNV either of the occult or the classic type. Treatment was performed with a linear accelerator at fractions of 2 Gy up to a total dose of 10 Gy or 36 Gy. 95 eyes had completed follow-up of > or = 12 < or = 24 months. RESULTS: Among eyes with occult CNV 8 received 36 Gy, 16 were treated with 10 Gy and 21 were in the control group. Mean visual loss was 3.5 lines after 12 months and 5 lines after 24 months with no difference between irradiated eyes and those in the control group. In the groups with classic CNV 8 eyes were treated with 36 Gy, 27 eyes received 10 Gy and 15 eyes were in the control group. Mean visual loss after 6 months was 2.2 lines in eyes of both groups treated with radiation and 5.7 lines in the control group. This was statistically significant (p < 0.05). VA was < 0.1 after 12 (24) months of follow-up in 50 (75)% of the cases with 36 Gy, in 48 (83)% with 10 Gy and in 60 (83)% of the controls. These results were statistically significant after 12 months only. DISCUSSION AND CONCLUSIONS: The natural course of occult CNV could not be improved by irradiation with 10 or 36 Gy. In eyes with classic CNV a VA of > or = 0.1 was maintained significantly more often in irradiated eyes than in those of the control group. Treatment with 36 Gy however was associated with an unacceptable incidence of radiation retinopathy.

[Radiotherapy for choroidal neovascularization in age-related macular degeneration. A pilot study using low- versus high-dose photon bean radiation]. / Radiotherapie von subretinalen Neovaskularisationsmembranen bei altersabhängiger Makuladegeneration (AMD). Niedrig- versus hochdosierte Photonenbestrahlung.

PURPOSE: Several pilot studies have indicated that low-dose radiation therapy might have a beneficial effect on the course of choroidal neovascularization (CNV) in age-related macular degeneration (AMD). This study aimed to ascertain whether such treatment might halt the progression of neovascular AMD and whether a low or a high radiation dose should be applied. PATIENTS: The patients comprised some randomized to 0 vs 10 vs 36 Gy of radiation and (after a change of the study protocol became necessary) others who participated in a prospective, controlled non-randomized pilot study. Enclosed were eyes with visual acuity of > or = 0.1 and < or = 0.6 revealing a juxta-subfoveal CNV either of the occult type (type 1) or the classic type (isolated or as part of a predominantly occult lesion). RESULTS: Eyes treated with 10 Gy for occult CNV (n = 12) were subject to severe visual loss in 41.6% of the cases compared to 38.5% in the control group (n = 13) at 12 months of follow-up. For eyes treated with 10 Gy because of classic CNV, the corresponding figures were 33% (n = 18) and 57% (n = 14) respectively. At 18 months of follow-up, the percentages were 63% and 75% respectively. Fluorescein angiographic growth of classic and occult CNV could not be halted by 10 Gy, while a temporary growth retardation was observed in cases irradiated with 36 Gy. CONCLUSION: In the study presented, the natural course of occult CNV could not be improved by irradiation with 10 or 36 Gy. In cases of classic CNV, low-dose irradiation with 10 Gy postponed severe visual loss by a maximum of 18 months. A positive treatment effect was also observed in cases irradiated with 36 Gy; however, a 25% incidence of radiation retinopathy seems unacceptable.