This document discusses transpupillary thermotherapy (TTT), a technique that uses low-level heat delivered through the pupil to treat conditions like choroidal neovascularization (CNV), choroidal melanoma, and retinoblastoma. TTT works by inducing tumor necrosis or occlusion of neovascular vessels via localized hyperthermia above 42°C. The document outlines the laser parameters used to treat CNV via TTT, noting that a pilot study found 19% of patients experienced improved vision, 56% had no change, and 25% had declining vision, while 94% saw reduced exudation. TTT is currently being used and studied as a treatment for several ocular diseases.

1. METASTASIS
CNVM
CHOROIDAL MELANOMA
OSTEOMA

2. Transpupillary
Thermotherapy of
Choroidal
Neovascularization
Mark Rivellese & Elias Reichel
Chapter 71 Peymann
Presentor: Dr.Pushkar Dhir

3. • Oosterhuis et all started this 1995.
• Transpupillary thermotherapy (TTT) is a technique in which low-level heat is
delivered through the pupil to the CHOROID AND RETINAL PIGMENT
EPITHELIUM using a modified diode laser.
• TTT currently being used in retinoblastoma, choroidal melanoma, classic and
occult choroidal neovascularization, which is a common cause of adult onset
blindness or age-related macular degeneration.

4. BASICS
• TTT based on Hyperthermia principle.
• 3 range can be used for tumour destruction.
– Low Range = 42-44 C (Helps potentiate radiotherapy)
– Intermediate Range = 45-60 C (Induces tumour necrosis , no coagulative
effect.)
– High Range = >60 C (Results in coaglative necrosis.
• Hyperthermia Systemic Heating
Localized Heating
– The success in TTT for CNV requires only occlusion of neovascular
vessel.

8. CNV TREATMENT
• Heat energy is delivered slowly to choroid & retinal pigment epithelium
(RPE) using 810 nm diode laser.
• Laser spot size 1.2 , 2.0 , 3.0 mm.
• Laser Parameters used are
• Duration = 60-70 sec
• Power = 250-1000 mW
• (In general 3mm spot with 800 mW & appropriately reduced to smaller
spot size, Power density 10W/cm2).
• No Visible colour changes at end of treatment.
• Large diameter of radiation beam allows homogenous treatment of large
lesion.

9. • In pilot study of 16 eyes of 15 patient with subfoveal occult CNV
were treated with TTT.
• Of 16 eyes
– 19% (3) experienced improved VA by 2 or more lines.
– 56% (9) had no change in visual acuity
– 25% (4) had decline in VA.
– 94%(15) eyes had improvement in exudation.
– 1 eye showed persistant subretinal exudation.

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