TRANSPUPILLARY THERMOTHERAPY (TTT): A novel approach in the treatment of occult subfoveal choroidal neovascularization in age-related macular degeneration

Dr. Ashish Vaidya Vitreo-retinal Consultant, Bombay City Eye Institute. Dr. Jigisha Shah Fellow, Bombay City Eye Institute INTRODUCTION: ARMD is a leading cause of central vision loss in patients older than 50 years of age. The majority of eyes suffer severe vision loss as a result of choroidal neovascularization, the only proven effective treatment for which is laser photocoagulation. The Macular Photocoagulation Study1 demonstrated that treatment of well-defined subfoveal choroidal neovascularization was beneficial, but most patients experienced an immediate decline in vision because of damage to the overlying neurosensory retina. Freud et al2 demonstrated that only 13% of patients with choroidal neovascularization from ARMD are eligible for treatment by the MPS criteria, as the majority of patients present with occult choroidal neovascularization. TTT represents an emerging new treatment for ARMD patients presenting with subfoveal occult choroidal neovascularization, who are currently untreatable with conventional techniques. First described by Oosterhuis et al3 in 1995, in the treatment of choroidal melanomas, transpupillary thermotherapy is a technique in which heat is delivered to the choroid and retinal pigment epithelium through the pupil using a modified diode laser. This laser technique has been successfully used in the treatment of small choroidal melanomas. It is now being studied as a treatment modality for occult sub foveal choroidal neovascularization. Preliminary results show that TTT shows no side effects and may be effective in treating occult choroidal neovascularization, in ARMD.