Intravitreal bevacizumab for retinal capillary hemangioblastoma: A case series and literature review

ObjectiveTo evaluate the long-term outcomes of intravitreal bevacizumab for peripheral and juxtapapillary retinal capillary hemangioblastoma (RCH).DesignWe conducted a retrospective noncomparative interventional case series.ParticipantsThere were 4 patients (5 eyes) presenting with RCH.MethodsFive eyes with RCH presented with exudative changes and visual loss. Three eyes of 2 patients with peripheral RCH were treated with cryotherapy and 2 intravitreal injections of bevacizumab (0.5 mg). Two eyes with juxtapapillary RCH were treated with 3 intravitreal injections of bevacizumab. The main outcome measures were changes in best-corrected visual acuity (BCVA), lesion size, exudation, and retinal thickness.ResultsIn peripheral RCH, improvement of BCVA from counting fingers to 20/400 was obtained in 1 eye. One patient with bilateral RCH maintained a vision of 20/20 in 1 eye with complete anatomic regression of the 3 small peripheral RCH lesions. The fellow eye with fibrotic bands from the RCH to the optic nerve head developed a tractional retinal detachment after the first injection and was treated with pars plana vitrectomy. In patients with juxtapapillary RCH, bevacizumab injections resulted in an improvement of BCVA from 20/80 to 20/20 in 1 eye, whereas the second eye did not show an improvement of BCVA despite a regression of the tumour.ConclusionsIntravitreal anti–vascular endothelial growth factor agents, alone or in combination with other treatment modalities, may improve visual acuity. Further trials evaluating the dose, the number of injections, and the route of administration will be important in advancing antiangiogenic therapies for RCH.     

应用1/3剂量光动力学疗法治疗急性CSC

观察1/3剂量光动力学疗法（photodynamic therapy, PDT）治疗急性中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy, CSC）的短期疗效。 方法：选取急性CSC患者26例26眼,行单次1/3量维替泊芬（2mg/m2）进行PDT治疗,术前和术后1,4,12wk进行最佳矫正视力和OCT的检测,且于术前、术后4wk和12wk进行眼底荧光素血管造影（FFA）,吲哚青绿血管造影（ICG）检查,观察治疗的有效性和安全性。 结果：术后1wk,26眼中有20眼（77%）视网膜下积液吸收,其余6眼（23%）视网膜下液部分吸收;术后4wk,26眼视网膜下积液全部吸收,22眼荧光渗漏完全消失,脉络膜血管高渗透性消失;术后12wk,26眼均病情平稳,无复发。治疗后1wk,最佳矫正视力从术前平均0.41升高至0.80。随访期间26眼均未见任何不良反应。 结论：1/3剂量PDT治疗急性 CSC短期内安全有效     

Subretinal fibrosis after photodynamic therapy in subfoveal choroidal neovascularisation in highly myopic eyes

AIMS: To analyse the occurrence of subretinal fibrosis (SRF) after photodynamic therapy (PDT) with verteporfin in highly myopic eyes with subfoveal choroidal neovascularisation (CNV). METHODS: PDT with verteporfin was performed on 33 eyes of 32 highly myopic patients with subfoveal CNV. Patients were followed for 14-24 months and best corrected visual acuity (BCVA) and angiographic and funduscopic findings were recorded. RESULTS: Two patients (two eyes) were lost to follow up. SRF appeared in 14 of 31 eyes. SRF appeared more frequently in eyes with a spherical equivalent (SE) of less than -10 D, in patients of age equal to or less than 55 years, and when CNVs were larger than 1500 micro m in diameter. SRF appeared more frequently in the group of patients with worse final BCVA. CONCLUSIONS: The appearance of SRF after treatment is correlated with size of the CNV and SE. The results of this study indicate that highly myopic eyes with CNV treated with PDT do not show a decrease in BCVA, even though they develop SRF. The appearance of SRF after PDT in highly myopic CNV does not always imply a loss of BCVA from baseline, though its presence is more frequent in eyes with lower BCVA.     

Photodynamic therapy for retinal capillary hemangioma

Purpose

To describe the results of photodynamic therapy (PDT) for juxtapapillary and peripheral retinal capillary hemangioma (RCH).

Patients and methods

Interventional case series of four eyes (four patients) with juxtapapillary RCH and one eye (one patient) with peripheral RCH. Two eyes with juxtapapillary RCH had received two sessions of full-fluence, double-duration PDT; whereas other two eyes had received single session of half-fluence, single-duration PDT. The peripheral RCH was treated with a single session of full-fluence, single-duration PDT.

Results

Two patients had von Hippel–Lindau disease. Follow-up duration ranged from 4 months to 1 year. Pre-PDT visual acuity (VA) ranged from 20/200 to HM (juxtapapillary RCH) and 20/100 (peripheral RCH). Among the eyes with juxtapapillary RCH, tumor regression with partial resolution of macular edema was noted in two eyes (one eye each with half-fluence and full-fluence PDT), whereas two eyes had no change in tumor size with persistent macular edema. VA remained stable in three eyes and declined in one eye. In an eye with peripheral RCH, regression of tumor and macular edema with VA improvement was noted. Post-PDT complications included epiretinal membrane (one eye) and transient exudative retinal detachment (one eye).

Conclusion

PDT can be effective in reducing macular edema associated with RCH but this does not always correspond with an improvement in VA especially for juxtapapillary tumors.     

Combined intravitreal anti‐vascular endothelial growth factor (Avastin®) and photodynamic therapy to treat retinal juxtapapillary capillary haemangioma

Objective: Retinal capillary haemangioma complications are characterized by progressive exudation with consecutive intraretinal and subretinal leakage. A successful therapy without side‐effects has not been found. We report a case of retinal juxtapapillary capillary haemangioma causing consecutive leakage with macular involvement. The tumour was treated with a combination of anti‐vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) and was followed for 1 year. Methods: A 44‐year‐old woman with retinal juxtapapillary capillary haemangioma in the right eye experienced a decrease of visual acuity from 20/20 to 20/60 because of a severe leakage from the tumour involving the macula with lipid depositions. Two sessions of PDT (sparing the part of the haemangioma located within the optic disc) and five injections of bevacizumab were applied in a period of 5 months. Visual acuity, visual field testing, retinal thickness measurements, fundus photography and fluorescein angiography were performed to evaluate the treatment effect. Results: One year after the last injection, visual acuity increased to 20/40. All lipid exudates at the posterior pole resolved. Retinal thickness decreased from 490 to 150 μm with the restoration of normal central macular architecture. Leakage in fluorescence angiography reduced significantly, but hyperfluorescence of the tumour was still evident. Visual field testing and angiography did not show any treatment‐related vaso‐occlusive side‐effects. Conclusion: In this single case, the combination of anti‐VEGF and PDT appeared to be an effective strategy for the treatment of retinal juxtapapillary capillary haemangioma without side‐effects. Further studies with a greater number of eyes and adequate follow‐up are necessary to support these first clinical results.     

半量维替泊芬光动力学疗法治疗急性中心性浆液性脉络膜视网膜病变

目的:观察半量维替泊芬光动力学疗法(photodynamic therapy,PDT)治疗急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的短期疗效。方法:2009-04/2009-09确诊为急性CSC患者12例12眼,行单次半量维替泊芬(3mg/m2)光动力学治疗,术前和术后1,4,12wk进行三维光学相干断层扫描(3D-OCT)的检测,且于术前、术后4wk和12wk进行视网膜荧光造影(FFA)、脉络膜血管造影(ICG)和眼底自发荧光(FAF)检查,观察治疗的有效性和安全性。结果:术前3D-OCT均显示浆液性神经上皮脱离,造影中均存在墨迹样或炊烟样的渗漏及脉络膜血管扭曲扩张弥漫荧光渗漏;术后1wk,3D-OCT有6眼的视网膜下积液吸收;术后4wk时有9眼在OCT中显示渗液完全吸收,7眼在FFA中显示荧光渗漏消失、3眼渗漏减轻,9眼在ICG中显示扭曲扩张的脉络膜血管管径恢复正常、3眼管径略改善,且9眼在术前渗漏点处的异常自发荧光基本恢复正常;术后12wk,仅有1例视网膜下积液仍未完全吸收,余11眼渗液均完全吸收,12眼在造影中均未显示异常荧光渗漏,在FAF上显示在原有浆液性脱离区域内出现点片状散在强自发荧光点。治疗后12wk,视力从术前平均0·43升高至0.8,其中2眼视力术后无明显变化。随访期间12眼均未见任何不良反应。结论:半量维替泊芬PDT治疗急性CSC短期内安全有效。     

低剂量PDT治疗中心性浆液性脉络膜视网膜病变

目的：观察低剂量光动力学疗法(photodynamic therapy, PDT)治疗中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy, CSC)的短期疗效。

方法：选取急性CSC患者36例36眼,进行单次1/2量维替泊芬(3mg/m²)进行PDT治疗,分别于术前和术后1,4,12,24wk进行最佳矫正视力和OCT的检查,术前、术后4,24wk进行FFA和ICG检查。

结果：术后1wk,36眼中有27眼(75%)OCT显示视网膜下积液完全吸收,其余9眼(25%)视网膜下液部分吸收; 术后4wk,36眼视网膜下积液全部吸收,FFA+ICG示36眼荧光渗漏完全消失,脉络膜血管高渗透性消失; 术后12～24wk,36眼无复发。治疗后4wk,最佳矫正视力从术前平均0.52提高至0.80。随访期间36眼未见任何不良反应。

结论：低剂量PDT治疗CSC短期内安全有效,能缩短病程,显著提高视力。     

半剂量维替泊芬与半能量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变

目的 比较半剂量维替泊芬光动力与半能量光动力疗法(photodynamic therapy,PDT)对慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)治疗的有效性和安全性.方法 回顾性队列病例研究.将我院门诊确诊为慢性CSC患者42例(42眼)纳入研究.根据患者PDT治疗过程中所接受的药物剂量和激光参数的不同分为半剂量和半能量组.半剂量组22例(22眼)接受半剂量维替泊芬(3 mg· m-2)和标准能量PDT(83 s,50 J·cm-2)治疗.半能量组20例(20眼)接受全剂量维替泊芬(6 mg·m-2)和半能量PDT (42 s,25 J·cm-2)治疗.PDT治疗后1、3、6个月随访,观察两组患者视网膜下液(subretinal fluid,SRF)完全吸收的比例,最佳矫正视力(best corrected visual acuity,BCVA)变化和黄斑部视网膜厚度(central macular thickness,CMT)的变化.结果 治疗后6个月,半剂量组患者22眼(100％) SRF完全吸收,半能量患者19例(95％)SRF完全吸收,两组间治愈率比较差异无统计学意义(P＞0.05);治疗后6个月,半剂量组BCVA提高7.2字母,半能量组BCVA提高6.7个字母,BCVA提高字母数两组间比较差异无统计学意义(P＞0.05).治疗前半剂量组CMT为(351±90) μm,治疗后6个月降至(178±55) μm,治疗前后比较差异有统计学意义(P＜0.05),半能量组CMT治疗前为(322±96) μm,治疗后6个月降至(181±47) μm,治疗前后比较差异有统计学意义(P＜0.05).所有患者均未出现视网膜色素上皮萎缩、脉络膜新生血管形成等并发症.结论 半剂量维替泊芬光动力和PDT治疗慢性CSC同样安全有效.     

Subretinal hemorrhage after photodynamic therapy for juxtapapillary retinal capillary hemangioma

A 75-year-old Japanese woman presented with a juxtapapillary retinal capillary hemangioma (RCH) in her left eye. Twelve months after the initial examination, the size of the hemangioma had increased and the exudation from the RCH involved the macula. Her best-corrected visual acuity (BCVA) had decreased from 0.8 to 0.3. A total of five intravitreal injections of bevacizumab (IVB; 1.25 mg) was given but the RCH did not respond. A photodynamic therapy (PDT) was done using multiple laser spots to avoid damaging the optic nerve head. After the first PDT, the subfoveal fluid was reduced but not completely gone. One week after the second PDT, a massive subretinal hemorrhage developed. The subretinal hemorrhage was successfully displaced by injecting intraocular sulfur hexafluoride (SF(6)) gas. At the 3-year follow-up examination, no subretinal hemorrhage or fluid was observed at the macula and the BCVA remained at 0.05. Our case was resistant to the combination of anti-vascular endothelial growth factor (VEGF) and PDT and had a rare massive subretinal hemorrhage. A further collection of RCH cases treated with anti-VEGF and PDT that would justify this treatment is necessary.     

PDT联合AVASTIN玻璃体腔注射治疗高度近视性黄斑区CNV观察

目的 观察光动力疗法(PDT)联合AVASTIN玻璃体腔注射治疗高度近视性黄斑区脉络膜新生血管(CNV)的临床效果.方法 经眼底荧光血管造影(FFA)和吲哚青绿(ICGA)检查确诊为高度近视性黄斑区CNV患者26例26只眼,非随机选取12例12只眼仅行光动力疗法,14例14只眼先行AVASTIN 1.25mg玻璃体腔注射,1周后行光动力治疗,治疗后1、3、6个月复诊,记录最佳矫正视力、症状变化、FFA及黄斑区的情况,对治疗前1天和治疗后6个月的最佳矫正视力、自觉症状进行比较分析.结果 6个月后,Amsler方格表检查PDT组4只眼症状消失,6只眼减轻或不变,2只眼加重;联合治疗组7只眼症状消失,6只眼减轻或不变,1只眼加重.最佳矫正视力,PDT组6只眼视力提高1行以上,4只眼视力不变,2只眼视力下降1行以上;联合治疗组10只眼视力提高1行以上,3只眼视力不变,1只眼视力下降1行以上.2组患者在消除或减轻症状、提高或稳定视力等方面进行组间Fisher精确检验,P＞0.05,差别均无统计学意义.结论 光动力疗法联合AVASTIN玻璃体腔注射治疗治疗高度近视性黄斑区CNV,在消除或减轻患者的自觉症状、提高或稳定患者的视力方面,较单纯光动力疗法(PDT)均无明显差别.     

Photodynamic therapy with verteporfin to induce regression of aggressive retinal astrocytomas

Purpose: To evaluate the effect of photodynamic therapy (PDT) with verteporfin on symptomatic, aggressive retinal astrocytomas. Methods: A prospective, interventional study in a tertiary referral centre. Two patients were treated with a single session of PDT using the standard parameters of the Verteporfin in Photodynamic Therapy (VIP) study: a 34‐year‐old man whose previously stationary juxtapapillary retinal astrocytoma, secondary to tuberous sclerosis, progressed within 7 months to involve the foveola; and a 68‐year‐old man whose acquired retinal astrocytoma progressed over 18 months in spite of standard photocoagulation. Both tumours were vascularized and had caused secondary lipid exudation and an exudative retinal detachment. Outcome measures were visual acuity, resorption of subretinal fluid, tumour height and fluorescein angiography. Results: The progressing, vascularized part of both retinal astrocytomas regressed, with little change in the poorly vascularized, stationary part of the congenital hamartoma. Visual acuity improved in the first patient and was unchanged in the second by 3 months, with stable vision in both and no sign of recurrence at 2 years. The exudative retinal detachments resolved completely. Tumour height reduced a median of 30%. Regression was associated with obliteration of tumour vessels within the progressing part of the lesion, with closure of some of the dilated retinal capillaries over the tumour. Intraretinal microvascular abnormalities and scattered haemorrhages appeared outside the treated area in the first patient. Conclusion: PDT with verteporfin can induce regression of progressive, vascularized, aggressive retinal astrocytomas and may prevent typical progression to total retinal detachment and enucleation, whether the astrocytoma is associated with tuberous sclerosis or not. PDT may be considered a first‐line treatment for aggressive retinal astrocytomas.     

光动力疗法治疗病理性近视脉络膜新生血管的临床观察

目的 探讨光动力疗法(PDT)治疗病理性近视(PM)黄斑部脉络膜新生血管(cNV)短期的安全性和有效性.方法 回顾经临床眼底检查、FFA和/或ICGA检查及确诊的继发于PM的CNV患者19例(19只眼)行PDT治疗前后的临床资料,对比分析其最佳矫正视力、眼底像、眼底血管造影CNV渗漏、OCT及mf-ERG检查结果.光动力治疗方案参照TAP制定的标准.随访时间为3-6个月.结果 PDT治疗后全部患者视力改善或保持不变,无视力下降者.所有患眼底出血或渗出均减轻.FFA/ICGA检查显示:CNV停止渗漏11只眼,占57.89%;渗漏减少8只,占42.11%.OCT检查显示CNV明显变薄.PDT治疗后1个月mf-ERG3-5环N1、P1波波振幅密度值与治疗前均有显著提高(P＜0.05),3个月时3～4环N1、P1波振幅密度值与治疗前均有显著提高(P＜0.05).结论 病理性近视CNV经PDT治疗短期有效,安全性好,PDT治疗CNV的长期疗效有待进一步观察.     

1/3量维替泊芬光动力学疗法治疗急性中心性浆液性脉络膜视网膜病变

目的: 观察1/3量维替泊芬光动力学疗法(photodynam ic therapy,PDT)治疗中心凹下急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的疗效。方法: 我院眼科门诊2010-05/2011-05确诊为急性CSC患者22例22眼,行单次1/3量维替泊芬光动力学治疗,术前和术后1,2,4wk及3mo进行光学相干断层扫描(optical coherence tomography,OCT)的检测,且于术前、术后4wk进行视网膜荧光造影(fundus fluorescein angiography,FFA)、脉络膜血管造影(indocyanine green angiography,ICGA)检查,观察治疗的有效性和安全性。结果: 术前22眼OCT均显示视网膜浆液性神经上皮脱离,造影中均存在明显荧光渗漏及脉络膜血管扭曲扩张弥漫荧光渗漏;术后1wk,OCT显示7眼视网膜下积液部分吸收;术后2wk时11眼视网膜下渗液完全吸收,术后4wk时22眼视网膜下渗液完全吸收,22眼FFA显示荧光渗漏消失,15眼ICG显示扭曲扩张的脉络膜血管管径形态有所改变,7眼脉络膜血管形态改变不明显。视力从术前平均0.5升高至0.9,视物变形情况22眼均明显改善。随访期间22眼均未见任何不良反应。结论: 1/3量维替泊芬PDT治疗急性CSC短期内安全有效。     

Photodynamic therapy for chronic central serous chorioretinopathy

Purpose: This study aimed to evaluate the efficacy of photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). Methods: We describe a non‐randomized, multicentre, interventional case series. A total of 82 eyes of 72 patients with chronic CSC were treated by conventional PDT. LogMAR best corrected visual acuity (BCVA) (ETDRS charts) and central foveal thickness (CFT) measured by optical coherence tomography before and after PDT, number of PDT treatments and complications were used as outcome indicators. Results: Mean follow‐up was 12 ± 10 months and mean age was 46 ± 10 years. Mean logMAR BCVA changed from 0.53 (standard deviation [SD] 0.43) before PDT to 0.38 (SD 0.41) at 3 months and 0.48 (SD 0.50) at 6 months (p < 0.0001 and p = 0.007, respectively, Student’s t‐test for paired data). Mean BCVA at the end of follow‐up was 0.37 (SD 0.45; p < 0.0001 from baseline). Macular detachment was resolved and subretinal fluid (SRF) disappeared in all cases. Central foveal thickness decreased from 325 μm (SD 95), to 229 μm (SD 70) at 1 month after PDT, 206 μm (SD 68) at 3 months, and 202 μm (SD 76) at 6 months (all p < 0.0001, Student’s t‐test for paired data). No cases developed severe visual loss or complications derived from PDT. Reactive retinal pigment epithelium hypertrophy appeared in nine cases after PDT. Conclusions: Photodynamic therapy with verteporfin may be useful in chronic CSC for improving BCVA and reducing SRF and CFT. Randomized studies with longer follow‐up are needed to assess the real role of this treatment in chronic CSC.     

Treatment of choroidal neovascularization in central serous chorioretinopathy by photodynamic therapy with verteporfin

PURPOSE: To evaluate the safety and efficacy of photodynamic therapy (PDT) with verteporfin in the treatment of patients with choroidal neovascularization (CNV) secondary to central serous chorioretinopathy (CSC). DESIGN: Open-label, two-center, noncomparative, prospective interventional case series. METHODS: Consecutive patients with subfoveal or juxtafoveal CNV secondary to CSC were recruited and treated with a standard regimen of PDT with verteporfin. At regular 3-month follow-up examinations, re-treatment was considered if fluorescein angiography showed evidence of leakage. Outcome measures included the proportion of patients who had improvement (gained 2 more lines), stable, or loss (dropped in 2 or more lines) in vision at the final follow-up and the changes in best-corrected visual acuity (BCVA) from baseline. RESULTS: Ten eyes of 10 patients were recruited into the study. The mean age of the patients was 57.3 years with a mean follow-up duration of 12.6 months. At the last follow-up, six (60%) eyes gained 2 or more lines of BCVA with four (40%) patients having final BCVA of within 1 line. No patient lost 2 or more lines of BCVA. The mean logarithm of the minimal angle of resolution BCVA improvement after PDT was 2.4 lines (Wilcoxon signed-rank test, P =.013). No patient suffered serious ocular or systemic complications from PDT. CONCLUSIONS: Photodynamic therapy with verteporfin therapy is a safe and well-tolerated treatment in patients with CNV associated with CSC. A randomized, controlled trial with a longer follow-up period is warranted to further study the efficacy of PDT in the management of CNV secondary to CSC.     

Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.     

Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration

PURPOSE: To examine the 7-month results for patients treated with combined photodynamic therapy (PDT) with verteporfin and intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: This is a retrospective series of 24 eyes with juxtafoveal or subfoveal CNV secondary to AMD. Patients were treated with PDT with verteporfin and 1.25 mg of intravitreal bevacizumab. All patients were naive to treatment and had either treatment within a 14-day interval. Main outcome measures were visual acuity stabilization (defined as no change or a gain in visual acuity) and retreatment rate. RESULTS: At the 7-month follow-up, 20 (83%) of 24 patients had stabilization of visual acuity. Sixteen eyes (67%) had improvement in visual acuity. Mean improvement in visual acuity (n = 24) was 2.04 Snellen lines. Fifteen eyes (63%) required only a single combined treatment for CNV resolution. There were no complications, including endophthalmitis, uveitis, and ocular hypertension. CONCLUSION: The results of this study suggest that combined treatment of PDT with verteporfin and intravitreal bevacizumab may be useful in treating neovascular AMD by reducing retreatment rates and improving visual acuity. Further investigation with large, controlled trials is warranted to outline the appropriate treatment paradigm for combination therapy.     

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 juxtafoveal choroidal neovascularization secondary to pathologic myopia-1-year results of a prospective series

PURPOSE: To study the efficacy of photodynamic therapy (PDT) with verteporfin in the treatment of juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia. METHODS: Prospective, open label, two-centre, noncomparative, interventional case series. Consecutive patients with juxtafoveal CNV associated with pathologic myopia were recruited and treated with a standard regimen of PDT with verteporfin. Patients were being followed up every 3-monthly and retreatment was considered when there was evidence of angiographic leakage. Outcome measures included changes in the mean best-corrected visual acuity (BCVA) at the 1-year follow-up when compared with the baseline, the proportion of patients who had stable (within 1 line) and improved visions. RESULTS: A total of 11 eyes from 11 patients with juxtafoveal CNV secondary to pathologic myopia were recruited and all completed the 1-year follow-up. The mean age at presentation was 44.8 years. The refractive error ranged from -6.0 to -15.0 D (+/-SD was -9.55+/-3.04 D). The logMAR BCVA improved from 0.57 to 0.39 at the 1-year follow-up (Wilcoxon signed-ranks test, P=0.027). The mean improvement was 1.8 lines. Five eyes (45.4%) had BCVA improved by >or=3 lines. None of the treated patients had visual loss of >or=1 line. The mean number of treatments over the 12-month study period was 2.3 sessions. CONCLUSIONS: The results are encouraging, especially on considering the low retreatment rate, stable or improved BCVA in all treated eyes, and consistently good safety profile. Juxtafoveal myopic CNV may be an expanded indication for PDT with verteporfin.     

Time‐course and characteristic morphology of retinal changes following combination of verteporfin therapy and intravitreal triamcinolone in neovascular age‐related macular degeneration

Purpose: To identify characteristic morphological changes of the retina over time and the association with visual function after combined photodynamic therapy (PDT) and intravitreal triamcinolone (IVTA). Methods: In this retrospective study, 40 patients (40 eyes) were treated with PDT and same‐day IVTA. Optical coherence tomography (OCT), fluorescein angiography (FA) and evaluation of distance visual acuity (VA) were performed. The anatomical changes within intra‐ and subretinal compartments and their detailed analysis and grading were the main outcome measures. Results: Intraretinal fluid (IRF) and subretinal fluid (SRF) by OCT decreased until 3 months (p < 0.01). At month 3, intraretinal cystoid spaces (ICS) had resolved or decreased in 84% of eyes, SRF in 58% and pigment epithelial detachment (PED) in 50%. Mean best‐corrected VA (BCVA) improved significantly at month 1 (p < 0.01). Mean central retinal thickness (CRT) increased from 334 μm at baseline to 439 μm at day 1 (p = 0.03) before decreasing to 286 μm at day 7 (p = 0.06), 233 μm at month 1 (p = 0.001) and 255 μm at month 3 (p = 0.001). Conclusion: Combined verteporfin/IVTA therapy induces distinct time‐related effects on the retina within the different intra‐ and subretinal compartments.