Photodynamic Therapy

I experienced a dark spot and wavy lines in my left eye a couple of months ago, went to a retina specialist who diagnosed it as a neovascular membrane due to severe myopia and treated it with PDT.  Since then I've noticed the spot growing, went back today and learned the blood leakage has stopped and the larger spot is due to scar tissue.  I'm confused because I thought scarring was not an outcome of PDT and in fact that PDT was to avoid the scarring that occurred when conventional laser treatment is used for this condition.  I'm also confused because I thought PDT required 4-5 visits and don't understand why leakage stopped after only one visit.

So my questions are, (1) is scarring an outcome of PDT, and (2) can someone recommend a specialist who is premier in this area - I'm in the northeast but will go anywhere.  I want to make sure I'm getting proper treatment, and I'm very worried that the scarring will continue as I feel this spot is growing weekly.

[John C Hagan]

PDT (photo dynamic therapy) does not cause scarring. However it is used for web macular degeneration and choroidal neovascular membranes (CNV) that does cause scaring.  There is bleeding with CNV that will vary from very little to massive amounts. Like scarring on the skin, scarring in the eye takes several weeks to months to develop. So its likely that the scars are from coagulation, fibrosis and scarring from the blood.

Most CNV are not destroyed with one visit and close ongoing observation and fluorescein angiograms (FA) are necessary to determine reoccurence or new CNV. You should be scheduled for a repeat exam and FA in the very near future. If not I would schedule an appointment.

Avastin and Lucentis are used also to treat CNV but you probably know that they are injected directly into the eye through a stab wound in the white part of the eye.

You should have an Amsler Grid at home to monitor your 'spot" on a daily basis. You also need to test the other eye as there is a very big problem with CNV developing in both eyes.

Any retina specialist ophthalmologist will be able to treat your CNV and/or give you a second opinion. This is there bread and butter and most do many treatments daily.

Your general ophthalmologist may be able to recommend a retina specialist or you can go to www.aao.org and find one near you. You do not need to travel far to get good expertise.

In fact you need to see a Retina ophthalmologist that is easy to get to because there will be many, many trips in the coming months/years.

JCH III MD