PHOTODYNAMIC THERAPY COMBINED WITH SURGICAL MEMBRANE REMOVAL

Jörg Schmidt, P. Kroll (Marburg)

Background: Since introduction of photodynamic therapy (PDT) it is implicated to patients that exsudative age related macular degeneration (EAMD) can be well treated. However, results in the clinical practice are sobering.

Patients and Methods: Since 1,5 years we observe 22 Patients with EAMD after treatment with PDT. In 3 younger patients we initiated surgical membrane removal 2 to 6 weeks after PDT due to progressive growth of the CNV membrane. No consecutive PDT was carried out in these 3 patients an follow-up of this group is now 4 to 18 weeks.

Results: All patients who had received PDT show a decrease in visual function and were treated in cases of a remaining CNV membrane with more PDT cycles. In those 3 patients who received a vitrectomy, membrane extraction was easily carried out via retinotomy. It is important to note that membrane extraction is easier in cases with previous PDT since adhesion of the PDT-treated membrane to retinal pigment epithelium (RPE) is decreased. Thus, RPE loss in PDT treated patients undergoing surgical membrane extraction is less. Visual acuity was preoperative between 0.2 and 0.3 and postoperative between 0.3 and 0.6. Two patients gained reading vision.

Conclusions: Since PDT reduces membrane size after one treatment only temporarily, a number of approaches are necessary. Final vision is in these only-PDT treated patients between 0.05 and 0.1 These results are close to the natural course of the disease. Surgical membrane extraction 2 to 6 weeks after PDT appears indicated and preferable since the whole membrane can be removed an RPE losses than in patients who were not treated with PDT before.


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