PERSISTENT AND RECURRENT NEOVASCULARIZATION AFTER LASER PHOTOCOAGULATION FOR SUBFOVEAL CHOROIDAL NEOVASCULARIZATION OF AGE-RELATED MACULAR DEGENERATION

Objective: To determine the incidence and visual impact of and risk fa ctors for persistent and recurrent neovascularization after laser phot ocoagulation of subfoveal choroidal neovascularization (CNV) in patien ts with age-related macular degeneration. Design, Patients, and Method s: The records of 189 eyes in the Subfoveal New CNV Study and 100 eyes in the Subfoveal Recurrent CNV Study assigned to laser photocoagulati on were examined. Persistent CNV (detected within 6 weeks of treatment ) and recurrent CNV (detected after 6 weeks) were defined angiographic ally by fluorescein leakage from the periphery of the treatment scar. Incidence was estimated using survival analysis methods. Results: In b oth studies, persistent CNV was observed in approximately 13% of the e yes, and recurrent CNV was estimated to have developed by 3 years in a n additional 35% of the eyes. In the New CNV Study, by 3 years, 36% of the eyes with persistent CNV had lost 6 or more lines of visual acuit y as had 19% of the eyes with recurrent CNV and 27% of the eyes withou t persistence or recurrence. The presence of neovascular maculopathy i n the fellow eye was associated with an increased risk for persistence or recurrence in the study eye. In the New CNV Study, partial coverag e of the lesion with heavy laser treatment and/or runoff was associate d with increased risk for persistence; less extensive natural scarring of the lesion at study entry was associated with increased risk for r ecurrence. Conclusions: Close to half of the eyes treated for subfovea l CNV have persistent or recurrent CNV within 3 years. There is a stro ng association between neovascular maculopathy in the fellow eye and t he inability of laser photocoagulation to permanently obliterate signs of CNV from the study eye. Within these two studies, there was little additional damage to visual function resulting from persistent or rec urrent neovascularization. There appears to be no reason to deviate fr om the protocol goal of covering the entire neovascular complex when t reating eyes with subfoveal CNV.