LASER PHOTOCOAGULATION FOR JUXTAFOVEAL CHOROIDAL NEOVASCULARIZATION -5-YEAR RESULTS FROM RANDOMIZED CLINICAL-TRIALS

Objective: To summarize findings from three randomized clinical trials of krypton laser treatment of juxtafoveal neovascular lesions regardi ng changes in visual acuity during 5 years of follow-up, rates of pers istent and recurrent choroidal neovascularization, and status of macul ar lesions 5 years after enrollment. Design, Patients, and Primary Out come Measures: Follow-up of patients enrolled in three randomized tria ls of choroidal neovascularization secondary to age-related macular de generation (AMD), ocular histoplasmosis, or idiopathic causes ended in March 1991. All patients were eligible to complete at least 3 years o f follow-up examinations. Data on visual acuity, reading vision, and a natomic outcomes during 5 years of follow-up were available for 276 (9 2%) of 300 patients with AMD, 236 (92%) of 256 patients with ocular hi stoplasmosis, and 38 (97%) of 39 patients with idiopathic choroidal ne ovascularization enrolled 5 or more years earlier who were still livin g. Results: Among eyes with AMD, the estimated relative risk (RR) of a loss of 6 or more lines of visual acuity from baseline to any examina tion from 6 months through 5 years after enrollment for untreated eyes in comparison with treated eyes was 1.20 (P=.04). Normotensive patien ts with AMD realized the greatest benefit from laser treatment (RR, 1. 82) and hypertensive patients experienced little or no benefit (RR, 0. 93). Untreated eyes with ocular histoplasmosis were at much greater ri sk of a 6-line decrease in visual acuity from the 1-year through the 5 -year examination than were treated eyes (unadjusted RR, 2.60; RR, 4.2 6 after adjustment for visual acuity and hypertension at baseline; P<. 001 for both). The treatment effect for eyes with idiopathic choroidal neovascularization was between the effects for eyes with AMD and eyes with ocular histoplasmosis. Conclusions: The early beneficial effects of laser treatment on visual acuity persisted for at least 5 years in eyes with all three underlying conditions. Laser treatment of similar eyes with choroidal neovascularization in a juxtafoveal location is r ecommended for patients with these conditions, with the caveat that hy pertensive patients with AMD may fare no better with laser treatment t han with out treatment.