Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Chorioretinal Atrophy and Visual Loss as Complication after Treatment of an Occult Subfoveal Choroidal Neovascularization by Transpupillary Thermotherapy (TTT)

Schmack I., Holz F. G., Dithmar S.
Department of Ophthalmology Heidelberg

Purpose: In the last years transpupillary thermotherapy (TTT) has also been used in treatment neovascular age-related macular degeneration. Clinical case series revealed therapeutic effects (increase or stabilization of visual acuity, decrease of retinal edema) especially in occult choroidal neovascularization (CNV). Up to know no randomized, prospective studies are available which have proved the efficiency of this therapy. Complications have been observed by application of recommended energy levels. Case reports are very rare in literature.
Method: A 74-year-old phacic patient with an occult subfoveal CNV was treated by TTT. The diameter of the membrane measured 4.1 mm; preoperative visual acuity was 0.4. Hyperpigmentation of the fundus was absent. We used a Mainster Wide Field Laser Lens with a spot size of 3.0 mm and a total energy of 1080 mW (Magnification: 0.68; retinal spot size: 4.41).
Results: TTT was finished precocious after 33 sec. because of whitening of the treated retinal area. During follow-up time regression of the CNV and development of a retinal scar tissue was observed. Visual acuity was 0.05.
Conclusions: Despite using recommended energy levels and treatment criteria overdose with irreversible retinal functional loss could be observed (800 mW / 3.0 mm spot). Causing factors are still unknown. It should

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