Photodynamic therapy vs limited macular translocation in the management of subfoveal choroidal neovascularization in pathologic myopia: a two-year study.

PURPOSE: To compare the results of limited macular translocation and photodynamic therapy (PDT) in subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia with a 24-month follow-up. DESIGN: Retrospective analysis of nonrandomized interventional clinical study. METHODS: Retrospective review of 66 consecutive patients: 34 myopic eyes with subfoveal neovascularization treated by PDT and 32 operated on with the translocation technique. Translocation was considered principally when the lesion size was adequate (nasal inferior margin of the membrane less than half a disk diameter away from the center of the fovea) with duration of symptoms of less than four months. Main outcome measure was the postoperative change in visual acuity. RESULTS: In the translocation group, mean gain in visual acuity was greater than in the PDT group (+2.8 lines and -1.8 line, respectively, P = .001). In the translocation group, 55% of eyes gained 3 lines or more at two years compared with 10% in the PDT group. Sixty percent of eyes in the translocation group vs 40% in the PDT group had an improvement of at least five letters. Mean foveal displacement after translocation was 906 mum; postoperative complications included retinal detachment (three eyes), macular fold (one eye), and transient diplopia (four eyes). In young patients, the postoperative gain was better in both groups. In the translocation group, mean survival time for choroidal neovascularization recurrence was 40 months for patients younger than 40 years and 20 months for older patients. CONCLUSIONS: Translocation showed better results than PDT at two years. Further studies are required to confirm these findings.

[Age-related macular degeneration]. / La dégénérescence maculaire liée à l'âge.

Age-related macular degeneration (AMD) is the commonest overall cause of irreversible blindness in patients aged 50 or over in the western world. It is a spectrum of related diseases that have in common the progressive decline of vision as a consequence of dysfunction of the central retina and its underlying supporting elements, principally the retinal pigment epithelium and choroid in older adults. The disease has been traditionally classified into early and late stages with its dry and wet forms. Patients with age-related maculopathy should consider taking a dietary supplement such as that used in AREDS. There is no effective treatment for geographic atrophy. The exudative AMD is approached depending on the type and localisation of choroidal new vessels. Laser photocoagulation has only been shown to be beneficial for extra and juxtafoveal well defined lesions. PDT with verteporfin is effective in the management of patients with subfoveal predominantly classic lesions. A variety of molecules such as bevacizumab, pegaptanib sodium and ranibizumab, specifically targeted to different pathologic pathways in AMD, have been identified to their therapeutic potential. Research is actively being pursued in preclinical models both in academic laboratories and in the pharmaceutical industry, including multiple early stage clinical trials. There is no strong evidence to support benefits of submacular surgery in the management of neovascular AMD.