Subfoveal choroidal neovascularization: radiotherapy or perifoveal photocoagulation? A fellow eye study

Perifoveolar photocoagulation is advised for subfoveal choroidal neovascularization responding to the MPS eligibility criteria. Recently, radiation therapy has been proposed but has not yet proved its efficacy. We compared these two treatments. We retrospectively reviewed 27 patients with age related macular degeneration and subfoveal choroidal neovascularization in both eyes. The first eye was treated with perifoveolar photocoagulation and the second eye with radiotherapy. In case of simultaneous diagnosis, radiotherapy was performed in the eye with the best visual acuity. Although the follow up is two times longer and the initial visual acuity is lower in the group of the photocoagulated eyes, both groups have similar results at the end of their respective follow up. However, in the eyes treated with radiotherapy the lesions are still active and edematous while in the eyes treated with perifoveolar photocoagulation, the lesions are stable and dry. The percentage of patients who subjectively prefer the photocoagulated eye has increased progressively from 0% to 71.5% along the 20 months of follow-up post radiotherapy. The perifoveolar photocoagulation of the subfoveal choroidal neovascularization seems, at median term, to give better objective and subjective results than the radiation therapy.