Transpupillary Thermotherapy in Age Related Serous Detachment of the Pigment
Epithelium
Karel I.1, Záhlava J.1, Boguszaková J.2, Dubská Z.3, Lešták J.1
1Oční klinika JL, Praha, primář MUDr. J. Lešták, CSc. 2Katedra oftalmologie IPVZ, Praha, přednosta prof. MUDr. J. Boguszaková, DrSc. 3Oční klinika VFN a 1. LF UK, Praha, přednosta doc. MUDr. M. Filipec, CSc. |
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Summary:
The goal of this prospective study was to evaluate results of the transpupillary
thermotherapy (TTT) in the age relatedmacular degeneration (ARMD) where the
serous detachment of the pigment epithelium (SDPE) was the dominant sign.
Material and methods: Thirty eyes of 29 patients were treated by TTT. All patients
were examined before and 3, 6, 9, 12, 18, and 24 months after TTT in terms of visual
acuity (VA), indirect binocular ophthalmoscopy, and indirect slitlamp biomicroscopy,
fluorescein angiography, and optic coherent tomography (OCT) of the macular
region. In 25 eyes (83,3 %) signs of choroidal neovascularization (CNV) were
present (vascular SDPE). TTT was performed with a standard technique by diode
laser (wavelength 810 nm). In 14 eyes (46.7 %) the TTT procedure was repeated
after 3 to 38 weeks. The follow-up period was 7 to 28 month (mean 15.2 months). Results: AfterTTT,VAimprovedin6 eyes (20.0 %),remained stable in 8 eyes (26.7 %),
and deteriorated in 16 eyes (53.3 %). Indirect slitlampbiomicroscopy revealed, that
the SDPE re-attached in 13 eyes (43.3 %), decreased in size in 12 eyes (40.0 %);
fluorescein leakage disappeared in 16 eyes (53.3 %) and was reduced in 10 eyes
(33.3 %). By OCT, the re-attachment of SDPE was confirmed in 14 eyes (46.7 %) and
it’s reduction in 13 eyes (43.3 %). The leading cause of the same or worse VA after
diminishing of SDPE was chorioretinal atrophy, with or without subretinal fibrosis.
Conclusion: In the long term, the TTT led to the decline of SDPE in the majority
of eyes and improved or stabilized VA in nearly one half of eyes. In most cases,
signs of neovascularization were present. After the SDPE regression, the chorioretinal
atrophy prevented the better functional results. TTT is not economically
expensive and widens treatment possibilities in exsudative form of ARMD including
SDPE.
Key words:
Transpupillary thermotherapy (TTT), age related macular degeneration
(ARMD), serous detachment of the pigment epithelium (SDPE)
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