First Author: C.Tan SINGAPORE
Co Author(s): T. Lim
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PDT has been shown to be useful in patients with subfoveal choroidal neovascularisation CNV) secondary to pathological myopia. We aim to evaluate the visual outcome of patients with myopic CNV and to determine the role of lesion location and foveal involvement by the PDT laser spot in determining the visual prognosis.
This was an interventional case series of patients with pathologic myopia treated for myopic CNV at the Ophthalmology Clinic at Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore
Twenty-four consecutive patients with pathological myopia and spherical equivalent of ≤-6D treated for myopic CNV were recruited. Patients with co-existing ocular pathology were excluded. Confocal scanning laser ophthalmoscopy fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed. The CNV lesions were classified according to their location n FA: subfoveal, juxta-foveal, or extra-foveal. PDT as divided into foveal sparing or foveal involved if the CNV lesion was subfoveal. All patients received PDT and were followed up for 2 years. The main outcome measure was LogMAR VA.
In 11 patients (45.8%), the CNV lesion was subfoveal. Of the remaining 13 (54.2%) with extrafoveal CNV lesions, 4 had foveal involvement by PDT laser whereas the remaining 9 were foveal-sparing cases. Overall, the mean LogMAR VA at 24 months was 0.72. Extrafoveal CNV lesions achieved signiﬁcantly better ﬁnal VA compared with subfoveal CNV (LogMAR 0.45 vs 1.05, P=0.012). At all time points, the group with foveal sparing PDT had signiﬁcantly better VA compared with the foveal-involved group. The ﬁnal LogMAR VA for the foveal-sparing PDT group was 0.26 compared with 1.00 for the foveal-involved PDT group (P=0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of ≥20/40, compared with 25% of foveal-involved PDT cases and 9.1% of subfoveal CNV lesions (P=0.006).
For patients with myopic CNV, foveal-sparing PDT results in signiﬁcantly better long-term visual outcomes compared with those with foveal-involved PDT. This is relevant in myopic CNV patients who require PDT.