Laser treatment in eyes with drusen

PHOTODYNAMIC THERAPY AND VITELLIFORM LESIONS

PURPOSE

To investigate the effect of photodynamic therapy (PDT) with verteporfin on patients with vitelliform lesions caused by cuticular drusen or adult-onset foveomacular vitelliform dystrophy (AOFVD).

DESIGN

Observational case series.

PATIENTS AND METHODS

Eight eyes of seven patients from two centers were examined prospectively. Each patient received PDT with verteporfin applied to the vitelliform lesions.

RESULTS

Photodynamic therapy did not significantly affect the median visual acuity outcome (20/50 before PDT and 20/66 after PDT) in all seven treated patients. Of note, however, were four eyes of four patients who experienced a severe decrease in visual acuity after PDT with verteporfin. The temporary relationship of the vision loss to the treatment suggests that this may represent an adverse effect from therapy. The fluorescein angiographic appearance was virtually unchanged in all treated patients, whereas indocyanine green angiography showed typical PDT-associated reduction of choroidal perfusion in the treatment area.

CONCLUSION

Photodynamic therapy does not have a positive influence on the visual outcome in patients with vitelliform lesions and may have a negative impact on vision in some treated patients. It is important for physicians using PDT to exercise caution in distinguishing between choroidal neovascular membranes and vitelliform lesions because the outcome in this latter group may be worse with application of PDT than with the natural course.

Macular atrophy after photocoagulation of soft drusen

PURPOSE

To analyze the appearance and characteristics of macular atrophy after photocoagulation of soft drusen.

PATIENTS AND METHODS

The authors studied the development of macular atrophy in 52 consecutive eyes (52 patients) that underwent green argon laser photocoagulation for the treatment of soft drusen. The mean age was 71.4 +/- 5.1 years (range, 61-85 years). Twelve eyes (23%) were in men and 40 (77%) were in women. Follow-up averaged 50.1 +/- 21.3 months (range, 6-96 months).

RESULTS

Macular atrophy occurred in nine eyes (17.7%), including five (56%) women and four (44%) men. The time interval between photocoagulation and macular atrophy averaged 37.2 +/- 21.2 months (range, 7-75 months). The mean age of patients with macular atrophy was 68.1 +/- 4.6 years (range, 61-75 years). Mean best-corrected visual acuity (BCVA) after soft drusen photocoagulation and before macular atrophy development was 20/55 (range, 20/28-20/200). After the appearance of macular atrophy, mean BCVA was 20/126 (range, 20/50-20/900). Differences between BCVA before and after macular atrophy were statistically significant (P = 0.02, student's paired t-test).

CONCLUSIONS

Macular atrophy can occur after photocoagulation of soft drusen, as applied according to our treatment protocol. The development of macular atrophy was associated with a significant decrease in BCVA.