O R I G I N A L R E S E A R C H Is reduction in the risk of vision loss the only beneﬁt of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization? Nicola G Ghazi Brian P Conway James S Tiedeman Steven J Yoon University of Virginia Health System, Department of Ophthalmology, Charlottesville, VA, USA Correspondence: Nicola G Ghazi University of Virginia Health System, Department of Ophthalmology, P.O. Box 800715, Charlottesville,VA 22908, USA Tel +1 434 924 5189 Email nghazi@eyeweb.org/ ngg6f@virginia.edu Purpose: To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV). Methods: A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT. Results: After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of ﬂuorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was signiﬁcantly larger than that post-PDT (p = 0.044). It was also signiﬁcantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001). Conclusion: This study demonstrates a beneﬁcial effect for PDT on the size of the NL and DS in SFCNV, which might be of great signiﬁcance, particularly when PDT fails to prevent severe vision loss. Keywords: age-related macular degeneration, choroidal neovascularization, classic choroidal neovascularization, disciform scarring, ﬂuorescein angiography, photodynamic therapy Introduction Age-related macular degeneration (AMD) is the leading cause of legal blindness in the elderly (Klein et al 1995). The main reason for visual loss in these patients is the development of choroidal neovascularization (CNV) in the macular area, mainly in the subfoveal region (Ferris et al 1984; MPSG 1993). Subfoveal choroidal neovascularization (SFCNV) is also a common cause of vision loss in pathologic myopia (Soubrane and Coscas 2001) and the presumed ocular histoplasmosis syndrome (POHS) (Olk et al 1984). Since its introduction, PDT has had a great impact on the management of SFCNV (Bressler and Bressler 2000; Margherio 2000) and its beneﬁt in reducing the risk of vision loss has been documented in large multicenter clinical trials in the case of AMD (TAP 1999; Bressler 2001, 2002; VIP 2001b) and myopia (VIP 2001a). Some evidence for its beneﬁt in other causes of SFCNV is also available (Sickenberg et al 2000; Saperstein et al 2002; Busquets et al 2003). Although these trials included data regarding the ﬂuorescein angiographic outcomes and progression of the CNV lesion following PDT, the main emphasis was on visual outcome and the reduction in the risk of vision loss. However, these studies, and data from other studies (Schmidt-Erfurth 1999; Michels et al 2000), suggest that PDT could limit Clinical Ophthalmology 2008:2(4) 773–780 © 2008 Ghazi et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 773