Transpupillary thermotherapy (TTT) is currently being evaluated in clinical trials for the treatment of choroidal neovascularization (CNV). Preliminary results show that TTT achieves closure of CNV and reduction in subretinal exudation while preserving visual acuity. Fluorescein and indocyanine green angiography reveal increased leakage activity from CNV and collateral choroid within 1 hour after TTT and absence of dye leakage from CNV at 1 week after treatment. Optical coherence tomography confirms the angiographic findings. The early vascular changes after TTT of CNV are similar to those observed after PDT of CNV. Transpupillary thermotherapy and PDT might share common mechanisms of action. A placebo-controlled, multi-center trial (TTT4CNV) evaluating the long-term efficacy and visual implications of TTT in occult CNV is underway.