Transpupillary thermotherapy (TTT) – Review of the clinical indication spectrum

Abstract

Transpupillary thermotherapy (TTT) is a non-invasive treatment option for malignant choroidal melanoma and choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). It can be considered as a cost-saving treatment, preventing surgical intervention. Up to now the energy level for TTT in CNV has not been clearly defined. Therefore over-treatment (inducing a retinal scar) as well as undertreatment (persistence of CNV) is possible. This may be the main cause for not using TTT as a preferred treatment for wet ARMD. Over the last 2 years the use of TTT for CNV has experienced a slight revival. In some studies a sub-threshold or low-dose TTT has been applied alone or in combination with intravitreal triamcinolone acetonide (iVTA) or vascular endothelial growth factor (VEGF) inhibitors. In several studies TTT for the treatment of malignant choroidal melanoma has been shown to be safe as a unique treatment for small choroidal tumors or as an adjuvant treatment for larger choroidal tumors (‘sandwich technique’).