[Diagnosis, treatment and monitoring of diabetic eye disease (Update 2023)]. / Diagnostik, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung (Update 2023).

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these disorders correlates with disease duration and quality of metabolic control. Regular ophthalmological examinations are needed to prevent sight-threatening advanced stages of diabetic eye diseases.

Detection rate of diabetic macular microaneurysms comparing dye-based angiography and optical coherence tomography angiography.

Diabetic maculopathy (DM) is a microvascular dysfunction clinically characterized by microaneurysms (MA) leading to edema and central visual deprivation. This prospective explorative study investigated 27 eyes of 17 patients with DM by fluorescein/indocyanine green angiography (FA/ICGA; SPECTRALIS HRA-OCT, Heidelberg Engineering) and by swept source-optical coherence tomography angiography (SS-OCTA; DRI-OCT Triton Plus, Topcon) to identify clinically relevant MAs. The SS-OCTA cubes were split into the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) according to the automated segmentation. The images of all modalities were superimposed for alignment by an Early Treatment Diabetic Retinopathy Study grid overlay and compared to each other. In total, the mean number of MAs in FA was 33.4 ± 22 (standard deviation) (median 27.5 [q1:21.75;q3:38.25]), in ICGA 24.9 ± 16.9 (17.5 [14;35]), in the SCP 6.5 ± 3.7 (5.5 [3.75;9.25]) and in the DCP 18.1 ± 10.5 (18.5 [10.75;23.5]). Mixed effects models between ICGA and the DCP were borderline significant (p = 0.048; 95% confidence interval 0.21 to 13.49), whereas all other imaging methods differed significantly. Quantitative analysis of MAs in DM showed a plausible agreement between ICGA and the DCP in SS-OCTA. These findings contribute to the imaging methodology in DM.

[Diagnosis, treatment and monitoring of diabetic eye disease (Update 2019)]. / Diagnose, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung (Update 2019).

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow-up depending on stage of diabetic eye disease are summarized.

[Diagnosis, treatment and monitoring of diabetic eye control]. / Diagnose, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow up depending on stage of diabetic eye disease are summarized.

[Diagnosis, therapy and follow up of diabetic eye disease]. / Diagnose, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung.

Diabetes mellitus causes diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of the metabolic control. The recommendations of the Austrian Diabetes Association for the diagnosis, the therapeutic procedures and requirements for adequate follow up depending on the stages of the different forms of diabetic eye disease are summarized.

Safety and feasibility of a novel intravitreal tamponade using a silicone oil/acetyl-salicylic acid suspension for proliferative vitreoretinopathy: first results of the Austrian Clinical Multicenter Study.

BACKGROUND: The safety and efficacy of a new surgical method of intravitreal tamponade using silicone oil suspended with aspirin (acetylsalicylic acid) was investigated for the treatment of proliferative vitreoretinopathy. METHODS: The study was designed as a prospective, randomized, controlled, double-blind multicenter study. A total of 29 patients were included; 15 patients were treated with the silicone oil suspended with aspirin, and 14 patients represented the control group receiving only silicone oil. A standard three-port pars plana vitrectomy was performed in 29 eyes of 29 patients. In cases in which the natural lens was present, simultaneous phacoemulsification was required. The control group received as standard therapy a vitreous tamponade with pure 5000 mPas silicone oil and the treatment group received silicone oil containing 0.2 mg/ml aspirin (AS SiO). At 6 months after surgery, the tamponade was removed from all eyes. The main outcome measure was the incidence of retinal redetachment requiring reoperation. Secondary outcome measures were visual acuity and ophthalmic examination results. RESULTS: The rate of redetachment, defined as the primary outcome parameter, was the same for both groups. The AS SiO was well tolerated and remained clear during the 6-month study period. Clinical examination revealed no signs of local or systemic adverse effects. The visual acuities were well matched before inclusion in the study and there were no significant differences during the follow-up period and in the final visual outcome between the two groups. CONCLUSIONS: Aspirin delivery by intravitreal silicone oil in the human eye is safe and also may provide a delivery vehicle for other antiproliferative agents to the posterior pole.

Comparison of macular function and visual fields after membrane blue or infracyanine green staining in vitreoretinal surgery.

BACKGROUND: To compare possible toxic effects of membrane blue and infracyanine green used as vital stains in macular surgery. Vital stains are used in vitreoretinal surgery to perform peeling of the internal limiting membrane and idiopathic epiretinal membrane. There are many controversial studies about their toxicity, safety, and their effects on the retinal pigment epithelium and the neuroretinal elements. To compare possible toxicities of the two vital stains membrane blue and infracyanine green in vivo, we conducted a prospective, randomized, clinical trial. METHODS: A prospective, randomized clinical trial including 30 eyes of 30 patients with either full-thickness macular hole or idiopathic epiretinal membrane were included and randomized 1:1 to receive either membrane blue or infracyanine green during vitreoretinal surgery. Complete ophthalmic examinations, including optical coherence tomography and peripheral visual field were performed preoperatively, and 1, 3, and 6 months postoperatively in our clinic. The main outcome measure was the peripheral visual field. Data was analysed with Student's t-test and Pearson's correlation coefficient. RESULTS: Three months after surgery there was a significant difference in increase in visual field in the superior region in favor of the membrane blue group (p = 0.021). Eight eyes (53%) of the infracyanine group had a decrease in temporal visual fields of at least 5 degrees . CONCLUSION: Although there was a significant difference in visual fields between the groups after 3 months in the superior region, there were no more significant differences between the two groups after 6 months. However, due to the decrease in the temporal visual field in some eyes, we conclude that membrane blue is less toxic.

Efficacy of intravitreal bevacizumab (Avastin) therapy for early and advanced neovascular age-related macular degeneration.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age-related macular degeneration (ARMD). METHODS: A consecutive series of eyes with neovascular ARMD treated with monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml) as long as there was evidence of activity on fluorescein angiography (FA) and optical coherence tomography (OCT) was included and observed for 6 months. For further analysis they were assigned to either an early (untreated/newly diagnosed) or an advanced (predominantly fibrotic/pre-treated) ARMD group. We examined distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central retinal thickness with OCT, as well as lesion size and safety aspects. RESULTS: Forty-four patients (44 eyes) were enrolled (21 early lesions, 23 advanced lesions). Mean VA changed from 0.74 logMAR at baseline to 0.68 logMAR at month 6 (P = 0.01). Improvement in VA was statistically significant only in eyes with early lesions (n = 21) from month 1 (P = 0.015) up to month 6 (P = 0.03). The changes in central retinal thickness (CRT) (P < 0.001) and total lesion size (P < 0.001) were significant in both groups (early and advanced) at all time-points during follow-up. No significant ocular or systemic adverse effects were observed. CONCLUSION: Intravitreal bevacizumab was tolerated well by our patients and we did not identify any apparent short-term safety concerns. We observed stabilization in VA overall, with significant improvement in the early lesion group.

Subretinal surgery and transplantation of autologous pigment epithelial cells in retinal angiomatous proliferation.

PURPOSE: The aim of this study was to examine whether the presence of retinal angiomatous proliferation (RAP) is a prognostic factor in subretinal surgery with transplantation of a suspension of autologous retinal pigment epithelial (RPE) cells. METHODS: Eyes that had been followed for at least 12 months after subretinal surgery were reviewed retrospectively and assigned to group 1 (presence of RAP) or group 2 (lesions without RAP). Main outcome measures were logMAR distance acuity and lesion size at 12 months. RESULTS: A total of 68 eyes of 68 patients were included; 28 were assigned to group 1 and 40 to group 2. A total of 43% of patients were male and 57% were female. Their mean age was 77.8 years. Mean distance acuity was 1.02 logMAR at baseline and 1.06 logMAR at month 12. Mean lesion size was 27.9 mm(2) at baseline and 29.9 mm2 at month 12. The differences between the groups were not significant. CONCLUSIONS: The presence of RAP did not significantly influence the outcome after subretinal surgery with transplantation of autologous RPE cells. Other than age, preoperative lesion size and distance acuity were the only predictive factors for postoperative results.

Retinal angiomatous proliferation: combined therapy of intravitreal triamcinolone acetonide and PDT versus PDT alone.

BACKGROUND: The objective of the study was to investigate whether combined treatment with photodynamic therapy (PDT) and triamcinolone acetonide intravitreally applied is superior to PDT alone in eyes with retinal angiomatous proliferation (RAP). METHODS: Between July 2004 and June 2005 eyes with RAP in age-related macular degeneration were included in a prospective study and were treated with 4 mg of triamcinolone acetonide followed by PDT (group 1). Eyes with RAP treated with PDT alone before June 2004 were retrospectively reviewed (group 2). Distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, greatest diameter of the lesion (measured by fluorescein angiography), and retinal thickness (measured by optical coherence tomography) were performed at baseline and at 6 weeks, 3 months, 6 months and 12 months thereafter. RESULTS: Fifty-eight eyes in 58 patients were included: 27 eyes in the combined treatment group and 31 eyes in the PDT monotherapy group. The groups were comparable with regard to age, gender and RAP stage. VA decreased from 65.6 to 52.0 and from 60.7 to 44.0 letters, and lesion size increased from 3.2 mm to 3.5 mm and from 3.3 mm to 3.5 mm in the combined and monotherapy groups respectively. There was a trend towards a better outcome in the combined group. Significantly (p = 0.01) fewer complications occurred in the combined group (22.2%) than in the monotherapy group (54.8%). CONCLUSION: No significant differences could be found in the time course of distance VA, retinal thickness, and lesion size between the PDT monotherapy group and the combined PDT and IVTA group. However, significantly fewer complications occurred in the combined treatment group. New therapeutic strategies might be required in RAP lesions, probably including therapy with anti-angiogenic agents.

25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial.

AIM: To compare 25-gauge vs 20-gauge system for pars plana vitrectomy in a prospective, randomised, controlled clinical trial. METHODS: Three-port pars plana vitrectomy was performed in 60 patients belonging to 2 groups. Evaluations were performed preoperatively, intraoperatively, during the first three postoperative days, at 1 week, and at 1 and 3 months. The main outcome measure was time for surgery, divided into duration of wound opening, vitrectomy, retinal manipulation and wound closure. RESULTS: The total duration of surgery showed no significant difference between the groups (p = 0.67). The 25-gauge group showed significantly shorter duration of wound opening (p<0.001) and wound closure (p<0.001). In contrast, the vitrectomy duration was significantly longer in the 25-gauge group (p<0.001). Conjunctival injection and subjective postoperative pain showed significantly lower irritation in the 25-gauge group (p<0.001 for both). CONCLUSION: The 25-gauge vitrectomy system offered significantly improved patient comfort during the first postoperative week. The smaller surgical openings facilitated wound healing and minimised pain. Duration of surgery was comparable between the two systems-the shorter time needed for wound opening and closure in the 25-gauge group being equalised by the longer vitrectomy duration. Intraoperative as well as retinal manipulation and illumination caused more surgical difficulties using the 25-gauge system.

Prognosis of untreated occult choroidal neovascularization.

PURPOSE: The aim of this investigation was to evaluate prognostic factors influencing the short-term prognosis of occult choroidal neovascularization (CNV). METHODS: A consecutive series of 107 untreated occult CNV in 101 patients were evaluated in terms of the effect of their initial lesion characteristics, as determined with fluorescein angiography (FA), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT), on the change in distance acuity, lesion size and retinal thickness over 1-3 months. Descriptive statistics, the Pearson Correlation Coefficient and a multiple linear regression analysis were applied to treat the data. RESULTS: A total of 107 eyes (101 patients) were examined. The study cohort consisted of 35 males and 66 females, with a mean age of 77.6 years. During the 3-month study period the mean distance acuity decreased from 67.0 to 63.2 letters; the mean size of the lesion increased from 16.1 to 18.4 mm(2); the mean maximum retinal thickness increased from 374.5 to 387.5 mum. Of the lesions, 59.8% included pigment epithelial detachments (serous or fibrovascular) and 29.9% retinal angiomatous proliferation. A better distance acuity at both visits for the entire study population correlated significantly with smaller lesions, as determined by FA and ICG-A (p < 0.0001), and a lower maximum retinal thickness, as determined by the OCT (p < 0.0001). CONCLUSIONS: A small and statistically insignificant change in distance acuity, lesion size and retinal thickness occurred over the 3 months of the study period. This reduced the ability of the study to examine the effect of baseline findings on outcome. Only two factors - the presence of a RAP lesion or the presence of CNV in the other eye - significantly and adversely affected the distance visual acuity at follow-up.

Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c).

BACKGROUND: Glycosylated haemoglobin (HbA1c) correlates with the amount of hyperglycemia in diabetic patients. High HbA1c levels often predict clinically significant macular edema (CSME), which then needs to be treated with grid laser photocoagulation. The question asked in this study was whether there is a correlation between the effect grid laser photocoagulation in diffuse diabetic macular edema and HbA1c, using an optical coherence tomography (OCT) for the evaluation of the retinal thickness. METHODS: A prospective, non-comparative case series was performed to find a correlation between the effect of grid laser photocoagulation in diffuse diabetic macular edema and HbA1c. Thirty eyes with CSME of diabetic patients were included in the study. Complete ophthalmic examinations and OCT were performed at baseline, 1 month, 3, and 6 months after grid laser photocoagulation therapy. HbA1c was measured at the end of study. RESULTS: Significance level was set at P<0.05. A significant difference in the foveal (P=0.02) and superior (P=0.021) retinal thickness 6 months after laser therapy, no correlation between HbA1c and retinal thickness after photocoagulation, and an insignificant decrease in visual acuity (P=0.9) were found. The correlation between foveal retinal thickness and visual acuity was P=0.24 6 months after treatment. CONCLUSION: There was no significant correlation between HbA1c and the effect of grid laser photocoagulation therapy in diffuse diabetic macular edema. The retinal thickness decreased significantly in the foveal and superior area 6 months after therapy. No correlation between the foveal retinal thickness and the visual acuity was found. The visual acuity did not increase after treatment. There are many factors influencing the retinal thickness, such as the blood pressure and the attached posterior hyaloid.

Endophthalmitis with retinal necrosis following intravitreal triamcinolone acetonide injection.

A 69-year-old man with heterozygote factor V Leiden mutation and a history of central retinal vein occlusion in his left eye complained of decreased visual acuity in his right eye. Macular edema and ischemic CRVO were diagnosed. Following an intravitreal injection of 4 mg triamcinolone acetonide, endophthalmitis and necrotizing retinopathy developed, clinically resembling necrotizing herpetic retinopathies as have been described in immuno-compromised patients. An endogenous viral infection due to a steroid-induced immune suppression may be another complication of intravitreal injections of corticosteroids.

A new treatment regimen in combined intravitreal injection of triamcinolone acetonide and photodynamic therapy.

BACKGROUND: Combined photodynamic therapy (PDT) and intravitreal injection of triamcinolone acetonide is a new option in the treatment of the neovascular form of age-related macular degeneration. With the aim of increasing safety and efficacy we examined whether it is possible to administer the intravitreal injection prior to PDT. METHODS: Patients with retinal angiomatous proliferation, who have an unfavourable prognosis when treated with PDT alone, were recruited to this study. Intravitreal injection of triamcinolone acetonide was applied 1 day before PDT. Distance acuity testing, retinal thickness measurement and fluorescein angiography were performed before treatment and 6 weeks and 3 months thereafter. RESULTS: Twenty-five patients were included: 18 were female, 7 male. Their mean age was 79 years. The distance acuity was 68 letters before treatment and at the follow-up examinations. The retinal thickness decreased significantly from mean 470.8 microm to 335.4 microm at week 6 and 360.8 microm at month 3. At month 3, 48% showed signs of activity in the fluorescein angiography needing retreatment. Visualisation of the fundus was not reduced by the triamcinolone crystals. DISCUSSION: PDT was possible without difficulty after intravitreal injection of triamcinolone acetonide. Stabilisation of the visual acuity was possible, although only eyes with retinal angiomatous proliferation were included.

Choroidal neovascularization in pathologic myopia: three-year results after photodynamic therapy.

PURPOSE: To examine whether the encouraging functional results one year after photodynamic therapy (PDT) can be maintained up to three years. DESIGN: Prospective interventional case series. METHODS: Highly myopic eyes that had been treated with PDT for subfoveal choroidal neovascularization and had been observed at least 36 months were included. Distance acuity (Early Treatment of Diabetic Retinopathy charts), reading acuity (Jaeger charts), 10-degree static threshold perimetry, fluorescein angiography, and optical coherence tomography were performed. The main outcome measures were the differences of the values among the baseline and the month 12 and the month 36 examinations. RESULTS: Twenty eyes of 18 patients were included: 15 patients were female, and 3 patients were male. The average age was 64 years (range, 36 to 85 years). The mean distance acuity was 43 letters at baseline and 53 letters after 12 months and after 36 months. The mean reading acuity changed from mean J10.8 to mean J8.1 after 12 months and to mean J9.85 after 3 years. The mean defect decreased from mean 13.5 dB at baseline to mean 12.5 dB after 12 months and mean 11.2 dB after 36 months. The maximum retinal thickness decreased from mean 360 mum at baseline to mean 259 mum after one year and mean 238 mum after 36 months. CONCLUSION: Distance acuity and central visual field showed stabilization after the month 12 examination up to the month 36 examination. The reading acuity decreased between the month 12 and the month 36 examinations, which might be related to an increase of retinal atrophy.

Vitrectomy for persistent diffuse diabetic macular edema.

PURPOSE: To evaluate the potential benefit of vitrectomy in eyes with persistent diffuse macular edema. DESIGN: Prospective randomized comparative clinical trial. METHODS: Eyes with diffuse diabetic macular edema for 6 to 18 months, an attached posterior hyaloid, and grid laser photocoagulation performed at least 4 months before were included. Patients were randomized either to a vitrectomy group or to a control group. MAIN OUTCOME MEASURES: Evaluations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, reading vision, and retinal thickness were carried out at baseline and 1, 3, and 6 months after enrollment. RESULTS: Fifty-six eyes (100%) were enrolled in this study. Twenty-five eyes (44.6%) were randomized into Gr I (vitrectomy group) and 31 eyes (55.4%) into Gr II (controls). Both groups were comparable in mean age (62.7 years and 63.9 years) and distribution of gender (one third male, two thirds female). ETDRS visual acuity showed a statistical significance in favor of Gr I at all time points (P = .035 to .005 Fisher's exact test). With Jaeger charts a significance for Gr I was found only at the 6-month examination (P = .01). With optical coherence tomography, the different behavior of retinal thickness changes in both groups during follow-up was statistically significant; P values were <.0001 for month 1, 3, and 6, preferring Gr I. CONCLUSIONS: We provide evidence that vitrectomy with internal limiting membrane peeling is superior to observation alone in eyes with persistent diffuse diabetic macular edema for 6 to 18 months. Longer follow-up periods and larger series might be needed to confirm these results and gain additional information.

Outcome of transplantation of autologous retinal pigment epithelium in age-related macular degeneration: a prospective trial.

PURPOSE: To present the outcome of a consecutive series of patients who had foveal choroidal neovascularization (fCNV) in age-related macular degeneration (AMD) and were treated with subretinal surgery combined with simultaneous transplantation of autologous retinal pigment epithelial (RPE) cells. METHODS: Patients with fCNV who were not eligible for laser or photodynamic therapy were included in the study. They underwent subretinal membrane excision with simultaneous transplantation of autologous RPE cells. Eyes with membrane excision alone served as the control. Tests included best corrected visual acuity for far and near with Early Treatment Diabetic Retinopathy Study (ETDRS) and Jaeger charts, multifocal (mf)ERG, central visual field analysis, optical coherence tomography (OCT), and angiography, before surgery, and 1 month and 3 months after treatment, and at 3-month intervals thereafter. RESULTS: The results of final examinations of 53 eyes are presented. In 39 eyes, RPE transplantation was performed (group 1); 14 eyes had membrane excision alone (group 2). In group 1, visual acuity improved significantly, two or more lines in 21 (53.8%) patients; remained stable in 12 patients (30.8%); and decreased two or more lines in 6 patients (15.4%; P=0.0062). In group 2, the corresponding values were 21.1%, 57.8%, and 21.1% (P=0.5377 NS). Statistical analysis of results in the two groups showed a trend in favor of group 1 (P=0.9714). The difference in reading acuity was significant between the two groups (mean change in group 1: 1.85 +/- 0.42 vs. 0.43 +/- 0.47 in group 2; P=0.0001). mfERG response density changes were significantly different between groups 1 and 2 (P=0.0094). No significant decreases in central visual field defects were detected. OCT showed the postoperative median retinal thickness in the lesion area in group 1 to be higher (242.31 +/- 12.30 microm) than in group 2 (202.07 +/- 10.68 microm), showing a trend (P=0.0682). CONCLUSIONS: Patients undergoing fCNV removal with autologous transplantation of RPE reached significantly better reading acuity and higher mfERG-response density than control subjects. The results provide evidence that autologous transplantation of RPE is a beneficial supplement to membrane excision alone in patients with fCNV in AMD and may be regarded as a reasonable treatment option.

The effect of specific gravity of perfluorocarbon liquid on the retina after experimental vitreous substitution.

PURPOSE: To evaluate the histological changes in the retina after experimental vitreous substitution with various amounts of perfluorophenanthrene (PFPH). METHODS: Thirty-two rabbit eyes were mechanically vitrectomized and filled up with 0.8 cc or 0.2 cc highly purified PFPH. The substance remained for 1 week (4 eyes), 2 weeks (8 eyes), 4 weeks (10 eyes) or 8 weeks (10 eyes). Eight eyes underwent the same surgical procedure without PFPH exchange to serve as a control group. A histological comparison of corresponding areas in the center and in the periphery of the inferior retina ensued. RESULTS: After 2 weeks, nuclear drop-downs and irregularities of the outer plexiform layer and of both nuclear layers were observed centrally in the eyes with a 0.8 cc substitution. The changes proceeded to irregularities and cell loss of all retinal layers with focal areas of complete destruction of the retinal architecture after 8 weeks. In contrast, single nuclear drop-downs, wrinkling of the outer nuclear layer and cell loss in the photoreceptor layer were observed in the peripheral retina at the end of the observation period. In those eyes where 0.2 cc PFPH was exchanged nuclear drop-downs were found after 2 weeks, leading to focal thinning of the outer plexiform layer and irregularities of the outer nuclear layer after 4 weeks with an insignificant increase after 8 weeks. At this time these histological alterations were comparable with those that we observed after 2 weeks in the eyes with a 0.8 cc tamponade in a corresponding area. CONCLUSIONS: Even high purification of PFPH does not prevent retinal damage. The different results in different areas after vitreous substitution with 0.2 cc and with 0.8 cc demonstrate that the high specific gravity of the substance may also play a role in the development of histological changes after extended tamponade.

Reading ability and central visual field after photodynamic therapy.

PURPOSE: We examined whether photodynamic therapy (PDT) can prevent severe loss of reading acuity and further depression of the visual field in cases of predominantly classic subfoveal neovascularization due to age-related macular degeneration. PATIENTS AND METHODS: Sixty eyes of 52 patients underwent biomicroscopy, assessment of reading and distance acuity, 10 degrees static threshold perimetry, distance acuity, and fluorescein angiography at baseline, after 6 weeks, 3 months and then every 3 months after therapy. RESULTS: After 18 months only 16.7% had lost more than 3 levels of reading acuity, 23.3% had lost less than 3 levels, 6.7% had remained unchanged and 53.3% had gained reading acuity, 18.7% of these more than 3 levels. 81.7% of the eyes lost less than 3 lines of distance acuity. 78.3% did not show any increase of the mean defect in the central visual field. CONCLUSION: PDT can prevent severe loss of distance and reading acuity and further deterioration of the central visual field in about 80% of the eyes. The baseline reading acuity was poor and the patients should be aware of the fact that loss of reading acuity cannot be regained even after successful PDT.