Fotodynamische Therapie bei retinaler angiomatöser Proliferation

Abstract

In age-related macular degeneration (ARMD) angiomatous proliferation can progress from the retina into the subretinal space. Retinal angiomatous proliferation (RAP) can be diagnosed by angiographic findings and optical coherence tomography (OCT). We investigated the outcome of photodynamic therapy in patients with RAP.14 patients with ARMD and RAP were retrospectively analysed using a standardised protocol. The protocol included best corrected visual acuity (BCVA), ophthalmoscopy, OCT examination, fundus photography and fluorescein angiography (FAG). In a masked fashion the OCT and angiographic findings were independently graded in 3 stages (RAP I: intraretinal neovascularisation, RAP II: subretinal neovascularisation with a retinal-retinal anastomosis or subretinal neovascularisation with a serous pigment epithelial detachment, RAP III: choroidal neovascularisation with vascularised pigment epithelial detachment and retinal-choroidal anastomosis). 15 eyes of these 14 patients were evaluated pre- and post-PDT with the standardised protocol and the data statistically analysed.The age ranged from 58 to 90 years (median 76 years). In 15 eyes of 14 patients with RAP a PDT was performed. 6 of these 15 PDT cases were successfully treated and gained >or= 2 lines (dry macula), 3 eyes with RAP I and 3 with RAP II. 4 eyes stablilised with +/-1 line (persistent macular oedema) under PDT with 2 RAP I, 1 RAP II and 1 RAP III. 5 eyes showed a deterioration with loss of >or= 2 lines (increasing macula oedema) with 2 RAP I and 3 RAP III. The median BCVA was pre-PDT in the successful cases 0.3, post-PDT 0.6, in the stable cases pre-PDT 0.2, post-PDT 0.2 and in the deterioration group pre-PDT 0.4 and post-PDT 0.01.According to our study PDT might be helpful in the treatment of RAP stages I and II in selected cases in ARMD patients. Further prospective studies are required to investigate the outcome of PDT in RAP.