Comparison of foveal-sparing with foveal-involving photodynamic therapy for myopic choroidal neovascularization.
OBJECTIVE
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=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 foveal-sparing 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=0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of ≥ 20/40, compared with 25% of foveal-involved PDT cases and 9.1% of subfoveal CNV lesions (P=0.006).


CONCLUSIONS
For patients with myopic CNV, foveal-sparing PDT results in significantly better long-term visual outcomes compared with those with foveal-involved PDT. Foveal-sparing PDT may be of value for treatment of myopic CNV patients who are not suitable for treatment with anti-vascular endothelial growth factor injections.
1] Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore [2] Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore.
C S
CS
Tan
Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
M C
MC
Chew
1] Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore [2] Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore.
T H
TH
Lim
D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000503:physiopathology; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000188:drug therapy* / Q000503:physiopathology; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology
D004396:Coloring Agents; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D007208:Indocyanine Green