Transpupilární termoterapie u exsudativní věkem podmíněné makulární degenerace Výsledky po 2 letech a nálezy na druhém oku

Transpupillary Thermotherapy in Exsudative Age-related Macular Degeneration. Two-Years Results and Findings on the Other Eye

The purpose of the prospective randomized study was to analyze long-term results of transpupillary thermotherapy (TTT) in exsudative age-related macular degeneration (ARMD) after 24 months of follow-up and to compare them with findings on the other, not treated eye.

Material and methods:
Seventy-two patients aged 50-93 years (average age 70.6 years) with one eye treated by means of TTT and the other considered as control were in the study. Occult choroidal neovascularization (CNV) was treated in 33 eyes (45.8 %), serous ablation of the pigment epithelium (SAPE) in 21 eyes (29.2 %), and classical CNV in 18 eyes (25.0 %). In all patients, the central visual acuity (VA) on EDTRS chart was specified, the macular findings were observed by means of indirect binocular ophthalmoscope and biomicroscopically with the contact lens on the slit lamp, and fluorescence angiography and optical coherence tomography (OCT) examinations were performed before and 3, 6, 12, 18, and 24 months after the TTT treatment.

Results:
The final VA improved or remained unchanged in 27 eyes (37.5 %), and worsened in 45 eyes (62.5 %), by 5 or more lines the VA worsened in 19 eyes (26.4 %). The average VA decreased from initial 0.24 to final 0.13, but the decrease in different forms of ARMD varied. In SAPE the highest initial as well as final average VA was found, in occult and classical CNV the initial and final average VA was almost identical. Exsudative changes observed by means of biomicroscopical, fluoroangiographical, and OCT examinations totally disappeared in 59.7 %, 63.9 %, and 59.7 % respectively. At the end of the followup period we observed chorioretinal atrophy of different stage in the macula in all eyes (100 %) and subretinal fibrosis in 44 eyes (61.7 %). Both these findings represented final stages of natural course of exsudative ARMD. On the contrary, differently pronounced areas of chorioretinal atrophy corresponding with applied laser burns represented scars after the coagulation. It developed in 31 eyes (43.0 %) and pointed to the possible destructive consequence of the TTT. In 33 patients (45.8 %), late stages of exsudative ARMD, mostly disciform scars with chorioretinal atrophy were found on the other not treated eye. In these eyes the final average VA was 0.05, e.g. more than one half worse than final average VA in treated eyes.

Conclusions:
Results of TTT treatment after 24 month of follow-up demonstrated full regression of exsudative changes in the macula in 60 % of eyes and improved or stable VA in 37.5 % of eyes. Results in SAPE and classical CNV confirmed the efficacy of TTT treatment in those forms of ARMD. The TTT did not prevent the appearance and progress of the chorioretinal atrophy and subretinal fibrosis, causing the main obstacle of better functional results. Extremely unfavorable course of exsudative ARMD in the other (not treated) eye could indirectly confirm the positive influence of the TTT in the ARMD treatment. Despite all positives are the possibilities of the TTT limited and determined by the basis and natural course of exsudative ARMD.

Key words:
transpupillary termotherapy, age-related macular degeneration, choroidal neovascularization, serous ablation of the retinal pigment epithelium