[Treatment of choroidal neovascular membranes].

Purpose: The purpose is to present our experience in diagnosis and treatment of choroidal neovascular membranes of various etiology.

Material And Methods: This is a retrospective study consisting of 165 patients that were diagnosed with choroidal neovascular membranes (CNM). From this patients, 62 were treated between 2001-2005 for CMN of different etiology: age-related macular degeneration (AMD), myopia, presumed ocular histoplasmosis syndrome, angioid streaks, viteliform dystrophy. The diagnosis was based on the clinical examination (direct and indirect ophthalmoscopy, direct and indirect biomicroscopy) and angiofluorography. The treatment was either PDT for sub-foveolar membranes, or laser coagulation with YAG532 laser for juxta and para-foveolar well defined membranes, or combined treatment for large minimal classic membranes with a well defined juxta para-foveolar component or a component on the feeder vessels. PDT was done with verteporfin (Visudyne, Novartis Pharma AG) activated with a diode laser of 689 nm (Activis, Quantel medical) and the laser coagulation was done with a Visulas YAG 532 Carl Zeiss laser.

Results: Results can be evaluated from two points of view: changes in the neovascular membrane (enlargement and activity signs) and the changes in VA. Last researches are based not only on AV but also on the quality life. The membranes are closed with PDT in 90% of the cases in the first week but there are rebounds in almost 100% of the cases at 3 months. This calls for multiple treatments. After two or three treatments the signs of activity (hemorrhage and exudation) drop and 60% of the membranes will close. After laser coagulation the CMN is closed completely in 70% of the patients and in 20% of the cases there is a rebound in the first month and in 30% of the cases the rebound appears in the next 2 years. The visual acuity has improved at 33% of cases, remained the same in 33% of cases and worsened in the rest of the treated eyes. The results are compatible with TAP and VIP results where after 24 months the average VA of those treated with verteporfirin was lower than at the beginning but twice as good compared with placebo.

Conclusions: For four year we had at our disposal methods with which we can improve (33%) the VA in patients with CMN, at some of them we could maintain (33%) the visual acuity and at the rest of the patients, even though the visual acuity is lower, it will be still higher then the one during the natural course of the disease.