Ghazi et al progression of and reduce ﬂuorescein leakage from CNV lesions. Our study exclusively discusses the beneﬁcial effect of PDT on the progression and size of the CNV lesion, and on the evolution of the disciform scar (DS) in patients with predominantly classic SFCNV. We also comment on why this effect may be desirable even when PDT fails to reduce the risk of vision loss. Methods Following Institute Review Board approval, we performed a retrospective chart review of all patients who received verteporﬁn-mediated PDT for SFCNV at the Department of Ophthalmology at the University of Virginia Health System during a 2-year period. All patients were treated by two of us (JST and BPC). Patients with AMD and non-AMD-related predominantly classic (SFCNV) (area of classic CNV occupies 50% or more of the area of the entire lesion) were included. All cases that demonstrated ophthalmoscopic and ﬂuorescein angiographic evidence of “retinal angiomatous proliferation” (RAP) (Yannuzzi 2001) were excluded. To be included in this study, each treated eye had to complete at least 6 months of follow-up after the first PDT treatment. In addition, the CNV lesion had to meet the eligibility criteria set in the TAP and VIP trials (TAP 1999; VIP 2001a). Also, the treatment, re-treatment and follow-up methods had to adhere to the standard protocol of verteproﬁn-mediated PDT used in these trials. Only two minor deviations were allowed. First, eyes with initial best-corrected visual acuity worse than 20/200 for AMD and 20/100 for myopia were included. Second, only rarely eyes whose follow up did not precisely adhere to the TAP (1999) and VIP (2001a) follow-up protocol were included. The breach to the protocol in such eyes was that ﬂuorescein angiography (FA) was not necessarily performed on all follow-up visits. These were stable eyes that had dramatic and sustained improvement in symptoms with visual stabilization following PDT, in which the treating physician found no funduscopic evidence of active CNV on later follow up visits. In each case, the etiology of the neovascular lesion, the indication for PDT, the number of treatment sessions, and the range of follow up were noted. Also, the size of the neovascular lesion, estimated by the greatest linear dimension (GLD) of the lesion (TAP 1999), was measured before treatment and at the last follow up following treatment. Then, the percentage change in lesion size; the percentage of eyes with stable, reduced, or progressed neovascular lesion (according to TAP grading criteria of ﬂuorescein angiographic assessment at follow up); and the percentage 774 of eyes that developed disciform scarring following PDT were calculated. A subgroup of 14 cases that received PDT to one eye only (study eye) and already had a DS in the fellow eye at presentation was analyzed. None of the latter eyes received PDT prior to scar development. The size of the DS, as estimated by its GLD, was measured in each case from funduscopic and angiographic data. The average size of these scars was calculated and compared to that of the DS that developed following PDT in some eyes. Also it was compared to the average size of the DS that could have potentially developed following PDT in the study eyes of the same 14 patients, and in the study eyes of the rest of the patients. In each of these comparisons, a double-tailed student’s t-test was performed to assess signiﬁcance. The size of the DS that could have potentially developed in the study eyes over the follow-up period after PDT was calculated based on the following. In eyes that had no progression or less CNV leakage by TAP criteria (TAP 1999), the size of the potential DS was approximated by the size of the pre-treatment neovascular lesion. We believe this is appropriate because PDT is believed to cause occlusion of the vascular component of the neovascular lesion without affecting the ﬁbrous component (Ghazi et al 2001). So although by TAP criteria (TAP 1999) the size (GLD) of the entire lesion and CNV leakage might angiographically decrease following PDT, the neovascular membrane, with its occluded vessels and ﬁbrous matrix, anatomically persists with no regression. In eyes with progression following PDT, the size of the potential DS was approximated by the size of the post-treatment neovascular lesion at the last follow up visit. Results One hundred and forty eight eyes of 137 patients were treated with verteporﬁn-mediated PDT for SFCNV at the Department of Ophthalmology at the University of Virginia Health System over a period of 2 years. Careful review of the charts of these patients disclosed that 62 eyes of 60 patients satisﬁed the inclusion criteria of this study. The major reasons for exclusion included less than 6 months follow-up after the ﬁrst PDT session, nonpredominantly classic SFCNV, and/or evidence of “RAP” (Yannuzzi et al 2001). The following is a report of the results obtained from analysis of the 62 eyes. Sixty patients received PDT to only one eye and two patients had PDT performed to both eyes. Ninety-ﬁve percent (59/62) of the eyes had predominantly classic SFCNV secondary to AMD. The remaining 3 (5%) were due to pathologic myopia (2 cases) and POHS (1 case). Twelve eyes (19%) had recurrent SFCNV Clinical Ophthalmology 2008:2(4)