Comparison of Foveal-Sparing and Foveal-Involving Photodynamic Therapy for Myopic Choroidal Neovascularization
Purpose
To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia in eyes treated with photodynamic therapy (PDT), and determine the effect of lesion location and foveal involvement on visual prognosis.
Methods
Interventional case series of 24 consecutive patients with myopic CNV treated with PDT. The main outcome measure was final LogMAR visual acuity (VA).
Results
Of 24 eyes, the CNV lesion was subfoveal in 11 and extrafoveal in 13. Overall, mean LogMAR VA at 24 months was 0.72. Extrafoveal CNV lesions achieved significantly better final VA compared to subfoveal CNV (LogMAR 0.45 vs. 1.05, p=0.012). Eyes with extrafoveal CNV lesions were subdivided into foveal-sparing PDT (where the PDT laser spot did not involve the foveal center) and foveal-involved PDT (the PDT laser covered the fovea). At all visits, 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 to 1.00 for foveal-involved PDT (p=0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of ≥20/40, compared to 25% of foveal-involved PDT and 9.1% of subfoveal CNV lesions (p=0.006).
Conclusion
For patients with myopic CNV, foveal-sparing PDT results in significantly better long-term visual outcomes compared to those with foveal-involved PDT. Foveal-sparing PDT may be of value in treating myopic CNV patients who are not suitable for treatment with anti-vascular endothelial growth factor injections.