Complications of Transpupillary Thermotherapy in Exudative Age-Related Macular Degeneration

To evaluate the visual outcomes and complications of low power transpupillary thermotherapy (TTT) in patients with neovascular age-related macular degeneration (AMD). The study included 20 eyes of 17 patients. Diagnosis of exudative AMD was established on the basis of fundus examination and fluorescein angiography (FA). TTT was performed using a diode laser at 810 nm wavelength, spot size of 2.5 to 4 mm and duration of 60 seconds for each spot with power settings between 300-600 mw (20% reduction). Follow-up visits were scheduled 1 and 6 weeks and 1, 3 and 6 months after the procedure and yearly thereafter. Patients were followed for at least 6 months. Cases with persistent leakage from CNV in late frames of FA were referred for another treatment option. Patients included 10 men (12 eyes) and 7 women (8 eyes) with mean age of 70.71±9.8 (range 50-84) years. Baseline best-corrected visual acuity (BCVA) ranged from 20/50 to 20/1300. Post-TTT regression of leakage (clinically and angiographically), and improvement or stabilization of visual acuity, was not statistically significant (P=0.14). Post-TTT complications included subretinal prepapillary hemorrhages in 2 eyes, vitreous hemorrhage in 2 eyes and macular infarction in one eye. At final follow-up, fibrosis of the CNV was detected in 7 (35%) eyes and flat chorioretinal atrophy with hypopigmentation was seen in 11 (55%) eyes. There was no significant difference between cases with flat atrophy and those with fibrous scars in terms of BCVA (P=0.91). Subgroup analysis showed that patients with better visual acuity (≥20/60) had poorer visual outcomes after TTT (P=0.03). Overall, in spite of the low threshold, visual acuity remained unchanged or decreased. Although TTT can occlude choroidal neovascularization, it could not prevent retinal complications and occurrence or progression of chorioretinal atrophy or subretinal fibrosis.