Sequential combined therapy for treatment of choroidal neovascularization in age-related macular degeneration: photodynamic therapy and thermal laser photocoagulation

PURPOSE: To analyze the results achieved after treating extrafoveal choroidal neovascularization (CNV) recurrences with thermal laser photocoagulation (TLP) in patients who had previously undergone photodynamic therapy (PDT). PATIENTS AND METHODS: Seven eyes (seven patients: four women and three men) that had been initially treated by PDT for CNV associated with age-related macular degeneration (ARMD) and then developed extrafoveal recurrences were treated with green argon TLP. All patients underwent a complete ophthalmologic evaluation and fluorescein angiography. Mean age was 74.4 +/- 4.4 years (range, 69 to 81 years). Five right eyes and two left eyes were treated. Mean follow-up after the beginning of the treatment with PDT was 18.0 +/- 3.5 months (range, 11 to 22 months). Follow-up after TLP was 6.8 +/- 1.0 months (range, 6 to 8 months). RESULTS: Mean best-corrected visual acuity (BCVA) before treatment was 20/150 (range 20/400 to 20/40). After PDT it was 20/281 (range, 20/400 to 20/80), with a mean of 3.1 +/- 0.8 treatments (range, 2 to 4). After TLP, BCVA was 20/233 (range, 20/400 to 20/80), with no statistically significant difference from BCVA after PDT (p = 0.06, Student's t-test paired data). In all cases total closure of CNV was achieved after only one session of TLP. CONCLUSIONS: TLP could be helpful in association with multiple sessions of PDT in order to achieve a complete closure of subfoveal CNV secondary to ARMD. Further studies are required to confirm our findings.