Yasa bağlı makula dejenerasyonunda subfoveal/ juxtafoveal koroid neovaskülarizasyonunun optikal koherens tomografi rehberliğinde fotodinamik tedavisi
Özet
Age related macular degeneration (ARMD), encompasses changes insensorial retina, retina pigment epithelium and choriocapillaris related to age and it isthe leading cause of severe central visual loss in people older 55 years. Although theexudative form occurs in only 10% of the ARMD population, it is responsible for 90%of cases of severe vision loss due to ARMD.The probability of non-exudative form turning into exudative form, smallnumber of patients who were appropriate for laser photocoagulation, high recurrensratio after laser photocoagulation and because of the thermal damage caused insubfoveal region, different treatment modalities other than thermal laserphotocoagülation have been continuously researched to treat subfoveal/juxtafovealchoroidal neovascular membranes. In clinical studies, photodynamic therapy (PDT)with verteporfin has become well established for the treatment of choroidalneovascularisations secondary to ARMD.In Ankara University School of Medicine Departmant of Ophthalmolgy, 88 eyesof 77 patients who were exposed to PDT because of subfoveal/jukstafoveal CNVbetween March 2003 and May 2007 were included in this study and they allcompleted at least one year of follow up.Subfoveal/juxtafoveal choroidal neovascular membranes , which occur in agerelated macular degeneration, were treated by PDT under the guidance of OpticalCoherence Tomography (OCT) in accordance with standard TAP treatment protocol.At the end of one year follow-up; frequency of treatment, visual results andcomplication ratios were analysed and compared to TAP and VIP treatment results.Retreament was applied to Phase IIIa patients with the presence of leakage inFluorescein Angiography and with greater retinal fluid than fibrosis according tophasing system developed by Rogers and his colleagues for the post-PDT OCTchanges.In our study series, the ratio of loss of less than 3 lines in visual aquity was67.1% (59/88) compared to baseline at the end of one year. The ratio of preventingloss of six or more lines was found to be 87.6%.Regarding the lesion groups, loss of less than 3 lines in visual aquity was 66%in predominantly classic lesion group, 71.3% in minimally classic lesion group and66.7% in occult lesion group. At the end of the first year, on average visual aquityloss was observed to be 1.16 lines in predominantly classic lesion group, 2 lines inminimally classic lesion group and 1.04 lines in occult lesion group compared tobaseline.Regarding all groups before the treatment, while average visual aquity was0.89 LogMAR at the beginning, it was 1.05 LogMAR at the end of the first year. Lossin visual aquity was observed to be 1.26 on average at the end of the first year.At the end of the first year, patients who were below age of 75, who did nothave systemic hypertension, who had lower visual aquity in the baseline, who did notsmoke, whose lesions were subfoeval located and whose lesion size was smallerthan 3 MPS DA in predominantly and minimally classic lesion groups exhibited bettertreatment results. However, there were no statistically significant differences in theseresults.In our study group, treatment frequency was 1.66 at the end of the first year.Most of re-treatment applications (73%) were needed in the first six month follow upperiod.Macular thickness and activation sign were evaluated with OCT in each visit.Before treatment, all patients had CNV with intra/subretinal fluid and/or cystoidmacular edema. Regarding all treatment groups, macular thickness which was 314?m in baseline, decreased to 264 ?m at the end of the first year.During the first year, in our study series we detected one eye (%1.15) who hasvisual aquity loss of more than 4 lines (acute severe visual loss) in the first week ofpost treatment period. None of the patients seemed to have fotosensitivity reactionduring the treatment. Two of the patients (2.3%) experienced temporary back painduring infusion. Three patients (3.4%) developed post-treatment subretinalhemorrhage.At the end of the first year, compared to results of TAP and VIP study group,although our treatment frequency was lower in our study group, our visual resultswere better and severe complication ratios were found to be similar.The treatment of subfoveal choroidal neovascular membranes, which issecondary to age related macular degeneration, with photodynamic therapyimplemented under the guidance of optic coherence tomography makes it possible todecrease the number of retreatment which may lead to a decline in cost of treatmentand probability of complications.