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The use of systemic steroids and photodynamic treatment for choroidal neovascularisation in young patients
  1. C J Flaxel
  1. Correspondence to: C J Flaxel Oregon Health and Science University Institution, 3375 SW Terwilliger Blvd, Portland, OR 97239, USA; flaxelc{at}ohsu.edu

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Advantages of adjunctive corticosteroid treatment in combination with photodynamic treatment (PDT) as against PDT alone in eyes with subfoveal idiopathic choroidal neovascularisation

Idiopathic choroidal neovascularisation (ICNV) is a relatively rare cause of vision loss due to choroidal neovascularisation (CNV). However, it affects young patients (aged <50 years) and thus may have a significant impact on lifestyle and visual acuity over the patient’s lifetime. To date, the only randomised clinical trial specifically and prospectively to evaluate treatment for ICNV was the Macular Photocoagulation Study (MPS).1 In this trial, patients with extrafoveally located ICNV were randomised to either no treatment or standard argon blue–green laser photocoagulation. The sample size (67 eyes) in the idiopathic portion of the MPS was too small to yield definitive conclusions; however, the pattern of response was towards stabilisation and/or improvement in visual acuity with laser treatment. These results were similar to the results of the MPS 1 and 2 studies (for age-related macular degeneration (ARMD) and presumed ocular histoplasmosis syndrome (POHS), respectively). Thus, the MPS group concluded that eyes with ICNV would also benefit from laser treatment.1–3 Since the MPS study, there have been no randomised, controlled clinical trials to evaluate other treatment options for ICNV, primarily due to the small number of eyes with this condition.

Photodynamic treatment (PDT) using verteporfin (Visudyne, Novartis Ophthalmics, East Hanover, New Jersey, USA) has been proven safe and effective for the treatment of predominantly classic CNV due to ARMD and pathologic myopia (PM); however, it has not been prospectively evaluated in other conditions such as ICNV, again owing to the relatively small numbers of eyes with this condition.4,5 It should be noted, however, that the benefits of verteporfin for the treatment of subfoveal CNV in PM seemed to wane in the second year, as reported …

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