97th DOG Annual Meeting 1999



H. Elsner, I. Barbazetto, U. Schmidt-Erfurth

Purpose: Age related macular degeneration (AMD) is the leading course of blindness among people over the age of 50. Classic subfoveal choroidal neovasculari-zation (CNV) are known for poor prognostic outcome. Several treatments are currently under investigation. But the evaluation of the treatment success remains difficult without a matching control group. The aim of this study is the precise documentation of the functional and angiographic spontanous course of classic subfoveal CNV.

Patients and method: 19 patients (19 eyes) were followed over a period of 2 years in a prospective, randomized study. All patients presented with subfoveal CNV secondary to AMD with angiographic evidence of classic CNV. In follow ups at three months intervals a standardized visual acuity examination (ETDRS), contrast sensitivity (Pelli Robson Charts), ophthalmoscopy, microperimetry (Rodenstock SLO) and fluorescein angiography were performed.

Results: Mean visual acuity dropped from 20/126 (Snellen Equivalent) to 20/250 over a period of 24 month, 9 patients showed significant visual loss > 3 lines, 4 patients presented with moderate visual loss >= 3 lines while 6 patients could stabilize or improve their visual acuity. In group I with a visual acuity >= 20/100 at baseline, 4/7 patients could stabilize or improve their visual aquity score (which was related to a reduction of leakage from CNV in angiography) compared to only 2/12 patients in group II with baseline visual acuity of < 20/100. Contrast sensitivity dropped from 23 to 19 letters. Again group I showed improved contrast sensitivity in 5/7 patients. In microperimetry an increase of absolute and relative scotoma size was found in 16/19 patients.

Conclusion: In spite of the poor prognosis of classic subfoveal CNV in general, this study showes, that depending on baseline visual acuity a stabilization of angiographic and functional features occurs in some patients. When evaluating treatment results of non-placebo controlled studies these outcomes should be considered.

Department of Ophthalmology, Medical University Luebeck