Occult with no classic choroidal neovascularization secondary to age-related macular degeneration treated by intravitreal triamcinolone and photodynamic therapy with verteporfin

PURPOSE: To examine combined treatment with intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) for occult with no classic choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS: In this prospective, interventional case series, 11 eyes of 10 consecutive patients with occult with no classic CNV underwent a single injection (25 mg) of IVT followed 1 month later by PDT. Best-corrected visual acuity was measured by Early Treatment Diabetic Retinopathy Study (ETDRS) protocol refraction. RESULTS: Median best-corrected visual acuity was 20/160, 20/80, 20/80, 20/50, and 20/80 at baseline and 1, 3, 6, and 12 months, respectively. Best-corrected visual acuity at baseline was statistically different (P < 0.05) than best-corrected visual acuity at 1, 3, and 6 months. Of 11 eyes, 5 (45.5%), 7 (63.6%), 7 (63.6%), and 4 (36.3%) had improved best-corrected visual acuity of at least 3 ETDRS lines at 1, 3, 6, and 12 months, respectively, while 6 (54.5%), 9 (81.8%), 10 (91%), and 8 (73%) had improved best-corrected visual acuity of at least 2 ETDRS lines at 1, 3, 6, and 12 months, respectively. Two eyes (18%) lost >3 lines at 12 months. One eye had intraocular hypertension at 3 months and was treated with a combination of topical antiglaucomatous drugs. One eye developed a dense cataract at the last follow-up visit. No endophthalmitis, retinal detachment, or vitreous hemorrhage developed. Fluorescein leakage and retinal thickness reduced significantly after treatment. CONCLUSIONS: Improvement of best-corrected visual acuity and lack of fluorescein leakage suggest combination treatment with IVT and PDT for occult with no classic CNV merits further investigation.     

Laser photocoagulation and photodynamic therapy (PDT) with verteporfin for retinal angiomatous proliferation (RAP) in age-related macular degeneration (AMD)

BACKGROUND: Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (AMD) with particularly bad prognosis. Diverse treatment modalities are performed. PATIENTS AND METHODS: This is a retrospective review on the treatment results of 41 consecutive patients from 1/2003 to 12/2005 with RAP stage 1-3 (Yannuzzi classification), who were treated with laser photocoagulation, photodynamic therapy (PDT) and intravitreal injection of triamcinolone acetonide (IVT). Follow-up was 12 months minimally. RESULTS: In RAP stage I complete closure of the vascular lesion in 14 / 22 eyes was achieved by 1.2 +/- 0.5 sessions of laser photocoagulation (4 x combined with IVT) and in 3/14 eyes with photodynamic therapy (2 +/- 0.5 sessions). In RAP stage II closure of the lesion was achieved by 3.2 +/- 0.6 sessions of photodynamic therapy in 6/14 eyes (4 x combined with IVT). In RAP stage III closure of the lesion was achieved by 3.2 +/- 0.4 sessions of photodynamic therapy in 0 / 5 eyes (3 x combined with IVT). A rip of the retinal pigment epithelium was observed in 2/14 eyes of RAP stage II and 2/5 eyes of RAP stage III. Visual acuity improved in 9/17 eyes with occlusion of RAP stage I. Without closure of the vascular lesion all eyes got legally blind (visual acuity 1/50 or less). CONCLUSIONS: Early detection and subsequent direct treatment of RAP stage I in AMD is recommended. In advanced stages anatomical closure of the vascular complex is rarely achieved and the risk is improved for development of tears in the retinal pigment epithelium and getting legally blind.     

Photodynamic therapy for retinal angiomatous proliferations and pigment epithelium detachment

PURPOSE: To evaluate results of photodynamic therapy (PDT) with verteporfin for subfoveal neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) and pigment epithelial detachment (PED). DESIGN: Interventional case series. METHODS: Thirteen eyes (11 stage 2 and 2 stage 3 RAP) underwent PDT. Best-corrected visual acuity (BCVA), fluorescein and indocyanine-green angiography were performed to evaluate the outcome. RESULTS: After 13.5 +/- 2.5 months and 1.7 +/- 0.4 treatments, mean BCVA decreased from 20/73 to 20/174 (P = .04). Occlusion of RAP and flattening of PED was observed in three eyes, and persistence of PED in six. Two eyes deteriorated to disciform lesions, one developed hemorrhagic PED, and one evolved toward stage 3 RAP. Three eyes, with PED exceeding 50% of the entire lesion, developed retinal pigment epithelium tear. CONCLUSIONS: PDT might prove effective for neovascular ARMD with RAP and small PED, whereas it might cause acute retinal pigment epithelium tear for RAP with PED exceeding 50% of the lesion.     

Full macular translocation following photodynamic therapy in neovascular age-related macular degeneration

PURPOSE: To report the long-term functional and anatomical outcome of full macular translocation (FMT) in eyes with neovascular age-related macular degeneration (AMD) following photodynamic therapy (PDT). METHODS: Twelve eyes of 12 consecutive patients with neovascular AMD who were PDT-nonresponders and underwent FMT were analysed. Best-corrected visual acuity (BCVA) measurement, fundus photography, and fluorescein angiography at baseline and at follow-up examinations in 3 months intervals were performed. Primary end point was change of BCVA from baseline to last visit. RESULTS: Totally 12 eyes of 12 patients were analysed. Mean time interval between the last PDT and FMT was 3.7 months (range 1-10 months). Mean follow-up after FMT was 25.6 months. BCVA ranged at baseline from 20/1000 to 20/80 (mean 20/230). At the last visit, mean BCVA was by 20/185. BCVA improved in 50% (6/12) of eyes by more than 1 line. Twenty five per cent (3/12) of eyes had final BCVA within +/-1 line from baseline. In 25% (3/12) of eyes the BCVA decreased by more than 1 line. One eye had recurrent CNV. In four eyes a cystoid macular oedema developed. No retinal detachment or disturbing diplopia was noted. CONCLUSIONS: In the present study, FMT in PDT-nonresponders stabilised or improved visual acuity in the majority of the eyes in a mean follow-up period of nearly 2 years. FMT can be considered as a therapeutical option in eyes who are nonresponders to the PDT in neovascular AMD.     

Intravitreal bevacizumab (avastin) treatment of retinal angiomatous proliferation

PURPOSE: To report our short-term experience with intravitreal bevacizumab treatment of retinal angiomatous proliferation (RAP) in neovascular age-related macular degeneration (AMD). METHODS: A retrospective, interventional case series was performed that included 13 patients who received intravitreal injection of bevacizumab (1.25 mg) for treatment of RAP and completed 12 weeks of follow-up. Ophthalmic assessment included determination of best-corrected Snellen visual acuity (BCVA), complete ocular examination, fluorescein angiography, and optical coherence tomography (OCT). Injections were repeated if no further improvement or worsening was observed after an initial favorable functional and/or anatomical response. Main outcome measures were BCVA and central macular thickness (CMT) measured by OCT. RESULTS: Twelve eyes (92.3%) had stable or improved BCVA, and 8 eyes (61.5%) had at least 2 lines of vision improvement. The average BCVA improved from 20/203 at baseline to 20/113 at 12 weeks (P = 0.001). Average CMT improved from 369 mum at baseline to 216 microm (P = 0.016) and 315 microm (P = 0.020) at 8 weeks and 12 weeks, respectively. Six eyes underwent fluorescein angiography at the 12-week follow-up visit; 3 (50%) of these eyes had decreased leakage compared with baseline. Both stabilization of vision and improved CMT were maintained for at least 8 weeks after a single injection in almost all eyes. No significant side effects were observed. CONCLUSION: These short-term data suggest that bevacizumab is a viable treatment option for RAP in AMD. The initial treatment effect appears to be maintained for at least 8 weeks.     

Two-year results of combined intravitreal anti-VEGF agents and photodynamic therapy for retinal angiomatous proliferation

Purpose

To clarify the efficacy of a combination of intravitreal anti-vascular endothelial growth factor (VEGF) injections and photodynamic therapy (PDT), over 24 months, for patients with symptomatic retinal angiomatous proliferation (RAP).

Methods

We retrospectively reviewed 13 treatment-naïve eyes of 12 patients (7 men, 5 women; age range (mean), 63–92 (77) years) treated with intravitreal bevacizumab (IVB) plus PDT as initial treatment. Retreatment was performed with IVB plus PDT until February 2009 or intravitreal ranibizumab and PDT from March 2009.

Results

Mean best-corrected visual acuity (BCVA) significantly improved from 0.26 at baseline to 0.40 at 24 months (P = 0.013). The mean improvement in BCVA at 24 months from baseline was 1.79 lines. The central retinal thickness decreased significantly from 431 to 142 microns at 24 months (P < 0.0001). Complete occlusion of the retinal–retinal anastomosis was achieved in seven of the 10 eyes at 24 months. The mean number of PDT treatments during 24 months was 2.8 and the mean number of injections was 3.4. Geographic atrophy was seen in four eyes without significant decline of VA at 24 months.

Conclusion

Combined anti-VEGF and PDT for RAP patients effectively maintained or improved VA and reduced exudation, without severe adverse events, over 24 months.     

光动力疗法治疗渗出型老年性黄斑变性四年临床观察总结

目的 总结4年来光动力疗法（PDT）治疗渗出型老年性黄斑变性(AMD)的临床疗效，以评价PDT的长期治疗效果。 方法 回顾73例经双目间接检眼镜、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查确诊的渗出型AMD患者的95只患眼行PDT治疗前后的临床资料，对比分析其视力、眼底像、FFA、ICGA和光相干断层扫描(OCT)检查结果的变化。73例患者平均年龄67.8岁，就诊时最佳矫正视力数指/10 cm～1.0。95只眼PDT平均治疗次数为1.5次，治疗后随访时间为3个月～4年。 结果 PDT治疗后末次随访时，39只眼视力提高≥2行，占41.1％；51只眼视力波动在1行以内，占53.7％；5只眼视力下降≥2行，占5.3％ 。所有患眼眼底出血和渗出均减轻。FFA或FFA联合ICGA检查显示：58只眼脉络膜新生血管（CNV）渗漏完全停止，转为瘢痕期，占61.05％；6只眼CNV部分闭合， 占6.32％；22只眼CNV小部分闭合，占23.16％；9只眼CNV复发，占9.47％。早期AMD患者12只眼经过1次PDT治疗后，最佳矫正视力0.6～1.5，CNV完全闭合，OCT检查显示黄斑区水肿及神经上皮脱离消失。随访时间最长达4年，未见有复发，视力保持稳定。 结论 单次和重复PDT治疗渗出型AMD长期疗效较好，安全性较高。对于早期渗出型AMD患者微小典型性CNV，单次PDT治疗可以使其完全封闭，使患者视力保持在较好的水平。 （中华眼底病杂志，2004，20：275-279）     

Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study

PURPOSE: To evaluate the efficacy of a safety enhanced photodynamic therapy (PDT) protocol with half-dose verteporfin for treating chronic central serous chorioretinopathy (CSC). METHODS: Forty-eight eyes of 48 patients with symptomatic chronic CSC underwent indocyanine green angiography guided PDT with half dose (3 mg/m) verteporfin. Outcome measures included logMAR best-corrected visual acuity (BCVA), central retinal thickness, and angiographic changes during the 12-month study period. RESULTS: The mean CSC duration was 8.2 months (range, 3-40 months). At 12 months after PDT, the mean logMAR BCVA improved from 0.31 to 0.15 (P < 0.001). The mean improvement was 1.6 lines and 45 (95.8%) eyes had stable or improved vision. Eyes without pigment epithelial detachment (PED) had significantly greater visual improvement compared with eyes with PED (P = 0.031). Patients with CSC of 6 months or less or younger than 45 years were more likely to gain vision by two or more lines after treatment (P = 0.007 and P = 0.018, respectively). Forty (83.3%) eyes had complete resolution of serous detachment at 3 months, with 43 (89.6%) eyes at 12 months. CONCLUSIONS: The safety enhanced PDT protocol appeared to be beneficial for patients with chronic CSC. Further controlled study is warranted to evaluate the safety and efficacy of this treatment option.     

Photodynamic therapy with verteporfin for retinal angiomatous proliferation

Purpose The aim of this study was to evaluate the results of photodynamic therapy (PDT), using verteporfin, for subfoveal neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) with pigment epithelial detachment (PED) and/or choroidal neovascularization (CNV).Methods In this non-comparative, consecutive, interventional, case series, the data on 21 eyes (19 with stage 2 and two with stage 3 RAP) of 20 patients were reviewed. Serous PED occupied more than 50% of the lesion in 19 eyes. PDT was performed as per TAP protocol. Biomicroscopy and fluorescein and indocyanine-green angiography were performed to evaluate anatomical results and need for retreatment. Changes from baseline in best-corrected visual acuity (BCVA), and complications, were assessed.Results A mean of 3.5±0.9 treatments was performed. After 13.7±2.2 months, mean BCVA decreased from 20/80 to 20/174 (P=0.0063). In six eyes (28.6%) BCVA remained stable, whereas in 15 eyes (71.5%) it decreased. Occlusion of RAP and flattening of PED was observed in three (14.2%) eyes, conversion to disciform lesion in one (4.7%), and persistence of PED in 11 eyes (52.3%). One eye (4.7%) evolved to haemorrhagic PED, and one (4.7%) toward stage 3 RAP. A tear in the retinal pigment epithelium (RPE) was observed in four eyes (19%). Eleven (52.3%) showed progression of leakage, six moderate leakage (28.6%), and three (14.2%) absence of leakage.Conclusions Timely PDT with verteporfin in the early stages in eyes with smaller lesions has the potential for a beneficial effect on vision, whereas it might worsen the natural course of larger lesions, with most eyes undergoing enlargement, disciform transformation or RPE tear.Presented in part as a paper at the American Academy of Ophthalmology Annual Meeting, Anaheim, California, 15–18 November 2003The authors have no financial interest in this study     

光动力疗法治疗息肉状脉络膜血管病变随访三年效果观察

目的 观察光动力疗法（PDT）治疗息肉状脉络膜血管病变（PCV）随访3年的治疗效果。方法 回顾性、非对照性病例系列研究。临床确诊为PCV的29例患者32只眼纳入研究。所有患者首次均行常规PDT治疗。对治疗后6个月有活动性息肉状病灶、病灶残留及渗出性改变者,行PDT联合玻璃体腔注射抗血管内皮生长因子（VEGF）制剂治疗或单纯玻璃体腔注射抗VEGF制剂治疗。所有患者均随访3年以上,平均随访时间（43.64±10.84）个月。观察统计患者首次PDT治疗后1、3、6、12、24、36个月的最佳矫正视力（BCVA）以及随访期间的PCV复发率和治疗次数。BCVA转换为最小分辨角对数(logMAR)视力记录和分析。结果 首次PDT治疗后1、3、6、12个月,患者平均BCVA均较治疗前明显提高,差异均有统计学意义（t=2.27、4.57、3.77、2.37,P＜0.05）。首次PDT治疗后24、36个月,患者平均logMAR BCVA较治疗前有所下降,但差异无统计学意义（t=-1.29、-0.81,P＞0.05）。首次PDT治疗后36个月,视力提高6只眼,占所有患眼的18.75%;视力稳定14只眼,占所有患眼的43.75%;视力下降12只眼,占所有患眼的37.50%。随访期间,PCV复发24只眼,占所有患眼的75.00%;未复发8只眼,占所有患眼的25.00%。PCV复发的24只眼中,1次复发12只眼,占复发患眼的50.00%;2次复发9只眼,占复发患眼的37.50%;3次复发3只眼,占复发患眼的12.50%。首次PDT治疗后12个月内复发4只眼,占复发患眼的16.67%;治疗后13~24个月复发11只眼,占复发患眼的45.83%;治疗后25~36个月复发9只眼,占复发患眼的37.50%。所有患者PDT治疗、抗VEGF治疗平均次数分别为（1.86±1.04）、（4.95±3.92）次。结论 PDT治疗PCV随访3年的治疗效果较差,其视力提高率较低,PCV复发率较高。