Transpupillary thermotherapy of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration

Objective: To evaluate the efficacy of transpupillary thermotherapy for the treatment of occult subfoveal choroidal neovascularization (CNV) in patien ts with age-related macular degeneration. Design: A retrospective, noncomparative case series. Participants: Sixteen eyes of 15 consecutive patients who presented with oc cult subfoveal choroidal neovascularization secondary to age-related macula r degeneration. Intervention: After informed consent was obtained, 16 eyes of 15 patients w ere treated with transpupillary thermotherapy. All patients underwent pretr eatment fluorescein angiography and were deemed untreatable by the Macular Photocoagulation Study standard. Transpupillary thermotherapy was delivered using a diode laser at 810 nm. A variable spot size of 1.2 mm, 2.0 mm, or 3.0 mm was used depending on the size of CNV. The diode laser was delivered through a contact lens, and treatment was initiated in one spot for 60 sec onds' duration at a power range between 360 and 1000 mW. The end point was an area of no visible color change to a light-gray appearance. Main Outcome Measures: In all eyes, outcome was assessed by Snellen chart v isual acuity and clinical examination. In 10 of 16 eyes, preoperative and p ostoperative fluorescein angiography and optical coherence tomography were available. In the remaining 6 of 16 eyes, exudation was measured by postope rative clinical examination alone. Results: Three eyes (19%) showed a two-or-more-line improvement in visual a cuity over a period of 6 to 25 months. Mean follow-up was 13 months. Visual acuity remained stable (no change or one-line improvement) in nine treated eyes (56%). The remaining four eyes (25%) showed a decline (equal to one-l ine worsening or greater) in visual acuity. Fifteen eyes (94%) demonstrated decreased exudation on fluorescein angiography, optical coherence tomograp hy, and/or clinical examination. Conclusions: Transpupillary thermotherapy shows no deleterious side effects in treating occult subfoveal choroidal neovascularization. A randomized, p rospective study is necessary to evaluate treatment efficacy.