Photodynamic therapy with verteporfin for corneal neovascularization

PURPOSE: To investigate the efficacy of photodynamic therapy with verteporfin for the treatment of patients with corneal neovascularization. DESIGN: Prospective interventional case series. METHODS: Eighteen eyes of 18 patients with stable corneal neovascularization who were refractory to conventional treatment were treated with photodynamic therapy with verteporfin (6 mg/m(2)). Five patients were treated following penetrating keratoplasty (PK), and two patients were treated before PK. Anterior segment photography was performed before and after treatment. Best-corrected visual acuity (BCVA) and area of corneal neovascularization were measured. RESULTS: At the one-year follow-up, 14 eyes (77.8%) showed a decrease in corneal neovascularization, and nine eyes (50.0%) showed complete vascular occlusion. In five patients who had corneal allograft, complete or partial occlusion was achieved in all eyes. Two patients who underwent subsequent keratoplasty did not manifest allograft rejection or revascularization. Seventeen eyes (94.4%) had stable or improved vision. The mean area of corneal neovascularization significantly decreased from 25.5 +/- 14.2 mm(2) to 14.9 +/- 14.6 mm(2) (P < .01), respectively. No significant complications associated with photodynamic therapy were observed except mild stromal haze in one eye. CONCLUSION: Photodynamic therapy with verteporfin may be effective for the treatment of corneal neovascularization.     

Photodynamic therapy with verteporfin in mallatia leventinese

OBJECTIVE: To describe a case of a patient with documented genetic mallatia leventinese who developed a classic choroidal neovascular membrane and underwent photodynamic therapy (PDT) with verteporfin (Visudyne; CIBA Vision Corp., Duluth, GA). DESIGN: Interventional case report. INTERVENTION: The patient underwent a complete ophthalmologic evaluation and fluorescein angiography. Photodynamic therapy with verteporfin was performed. MAIN OUTCOME MEASURES: Clinical and angiographic records were analyzed for evidence of changes in visual acuity, clinically evident subretinal fluid and the extent of fluorescein leakage from choroidal neovascularization (CNV). RESULTS: Three weeks after treatment, a fluorescein angiogram showed closure of the neovascular membrane, no evident subretinal fluid was seen, and visual acuity had improved from 20/60- to 20/40. Nine weeks after the application, fluorescein angiography demonstrated a microscopic hyperfluorescent spot at the site of the previously active CNV at which a small area of shallow subretinal fluid was observed, and visual acuity was 20/50. Thirty-four weeks after PDT, visual acuity was 20/60, subretinal fluid resolved, and fluorescein angiography did not show any further changes. CONCLUSIONS: Photodynamic therapy with verteporfin may be considered as a possible treatment in patients with mallatia leventinese who develop classic CNV.     

Photodynamic therapy with verteporfin for peripapillary choroidal neovascularization

PURPOSE: To evaluate the efficacy of photodynamic therapy with verteporfin in the management of symptomatic extrafoveal peripapillary choroidal neovascularization (CNV). METHODS: Seven eyes of seven patients with symptomatic peripapillary CNV underwent visual acuity testing, ophthalmic examination, color photography, and fluorescein angiography to evaluate the results of photodynamic therapy with verteporfin. Patients were offered treatment following the development of hemorrhage, subretinal fluid, or lipid if it was associated with visual symptoms. A standard nomogram was used to dose Visudyne, application was performed in three separate 30-second zones confluent over the extent of the lesion. The light dose per unit area applied to the retina was approximately 18 J/cm. RESULTS: Five of the seven had CNV limited to the peripapillary area associated with age-related macular degeneration; the remaining two eyes had presumed ocular histoplasmosis syndrome. In five of the seven eyes, two treatments were needed and in two eyes only one treatment was necessary to elicit resolution of active leakage. Retreatment was performed at an average of 76 days after initial treatment. Baseline best-corrected visual acuity (BCVA) ranged from 20/20 to 20/150. Final BCVA ranged from 20/20 to 20/80. In all eyes except for one, which had a pretreatment vision of 20/20, at least two lines of Snellen visual acuity improvement were achieved. Resolution of submacular fluid, hemorrhage, or exudates was noted in six eyes; in the remaining eye there was persistence of subretinal lipid. There were no complications including optic neuropathy in any of the treated eyes. Follow-up ranged from 6 to 13.5 months following last treatment (mean, 10 months). CONCLUSION: Photodynamic therapy with verteporfin for extrafoveal symptomatic peripapillary CNV appears to be effective in improving vision and promoting the resolution of subfoveal exudates, hemorrhage, or fluid. A randomized controlled study with longer follow-up is justified.     

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     

Photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide in the treatment of neovascular age-related macular degeneration

PURPOSE: To examine the efficacy of photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide in the treatment of neovascular age-related macular degeneration (AMD). DESIGN: Retrospective, interventional case series. METHODS: Sixty eyes of 56 patients with neovascular AMD were treated with PDT with verteporfin followed by an intravitreal injection of 4 mg triamcinolone acetonide. The main outcome measures were visual acuity (VA), retreatment frequency with PDT (and triamcinolone), and frequency of side effects. RESULTS: Mean follow-up was 15.9 months (range 12 to 30 months, median 15 months). Twenty-three (38.3%) of 60 eyes had a stable result at 12 months' follow-up (that is, loss/gain 相似文献   

Photodynamic therapy with verteporfin in laser-induced choroidal neovascularization

PURPOSE: To report a case of laser-induced choroidal neovascularization (CNV) treated with verteporfin photodynamic therapy. DESIGN: Interventional case report. METHODS: A patient developed CNV in the macular area of the left eye 2 years following grid laser for macular edema secondary to branch retinal vein occlusion. RESULTS: The CNV was controlled with one session of photodynamic therapy. Lesion decreased in size, contracting to a smaller subretinal fibrotic scar. Vision improved from 20/200 to 20/100, and there was no recurrence at 2-year follow-up. No complications were encountered. CONCLUSION: Laser-induced CNV can be safely and effectively treated by photodynamic therapy.     

Photodynamic therapy of corneal neovascularization with verteporfin

PURPOSE: To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in two patients. METHODS: Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months. RESULTS: Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases. CONCLUSIONS: PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required.     

维替泊芬介导的光动力疗法治疗兔眼角膜新生血管

目的:旨在探讨和评估光敏剂维替泊芬(vertporfin)介导的光动力疗法(PDT)对角膜新生血管(CoNV)治疗的效果。方法:新西兰白兔随机分为2组:两组采用角膜基质层缝线的方法诱导CoNV形成。Ⅰ组行vertporfin-PDT治疗CoNV,verteporfin以1.5mg/kg静注。Ⅱ组不治疗,为阳性对照。治疗后裂隙灯显微镜观察CoNV变化并记录面积,取处理组及对照组的角膜、虹膜睫状体组织,行组织病理学检查,免疫组织化学(SABC法)检测血管内皮生长因子(VEGF)在角膜组织中的表达。结果:治疗后3d;1,2wk,Ⅰ组CoNV面积均明显小于Ⅱ组(P<0.01)。组织病理学检查显示,Ⅰ组CoNV管壁破坏,形成血栓。VEGF的表达Ⅰ组明显低于Ⅱ组(P<0.01)。结论:Vertporfin-PDT对兔模型眼CoNV有明显的抑制作用,不损伤邻近的正常血管及组织。     

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in children

PURPOSE: To report the safety of photodynamic therapy with verteporfin in three children. DESIGN: Retrospective interventional noncomparative case series. METHOD: Children identified from all patients treated with verteporfin therapy at a university-based practice had records reviewed for adverse retinal or systemic events. RESULTS: Patients aged 11, 11, and 13 years, with subfoveal idiopathic choroidal neovascularization (CNV) received verteporfin therapy with no ocular complications recognized either immediately after the procedure or during the follow-up from 7 to 12 months. Treatment resulted in cessation of fluorescence leakage from CNV by the last follow-up visit in two patients and reduced leakage from the lesion in one. The visual acuity change was + 4, +7, and 0 lines. CONCLUSIONS: Verteporfin therapy in three children with subfoveal CNV was associated with stable or improved vision during short-term follow-up in the absence of serious ocular or systemic adverse events.     

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in Vogt-Koyanagi-Harada syndrome

PURPOSE: To assess the role of photodynamic therapy using verteporfin in the treatment of subfoveal choroidal neovascularization in Vogt-Koyanagi-Harada syndrome. DESIGN: Interventional case report. METHODS: A 9-year-old patient with subfoveal choroidal neovascularization received a single photodynamic therapy with verteporfin session (one eye) and was prospectively followed with fluorescein angiography. RESULTS: A complete regression of the lesion was achieved within 1 week after treatment. Visual acuity improved from 20/800 to 20/320 by 6 months of follow-up. Fluorescein angiography disclosed unexpected retinal pigment epithelium alteration within the treatment area. CONCLUSION: Although regression of the choroidal neovascularization occurred, unpredicted findings involving normal retina in the vicinity of the lesion suggest that further studies are required to assess the clinical value of this treatment for subfoveal choroidal neovascularization in Vogt-Koyanagi-Harada syndrome.     

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in best disease

PURPOSE: To describe the effects of photodynamic therapy using verteporfin for the treatment of subfoveal choroidal neovascularization (CNV) in Best vitelliform macular dystrophy. DESIGN: Interventional case report. METHODS: A 43-year-old patient with confirmed Best vitelliform macular dystrophy complicated with subfoveal CNV received a single photodynamic therapy session with verteporfin. The patient was prospectively followed with fluorescein angiography and optical coherence tomography. RESULTS: A regression of the neovascular lesion and resolution of the exudative manifestations was observed 3 weeks after treatment; at that time, visual acuity had improved from 20/60 to 20/25. Optical coherence tomography disclosed restoration of normal macular architecture due to fluid resolution and lesion contraction. Up to 2 years from this single treatment, no further change was observed. CONCLUSIONS: Regression of CNV and resolution of subretinal hemorrhage as well as exudative manifestations occurred after photodynamic therapy with verteporfin. Verteporfin therapy may be a viable treatment for subfoveal neovascular lesions in Best vitelliform macular dystrophy.     

Photodynamic therapy with verteporfin for choroidal neovascularization in patients with angioid streaks

PURPOSE: To evaluate safety and efficacy of photodynamic therapy with verteporfin for subfoveal choroidal neovascularization associated with angioid streaks. DESIGN: Prospective interventional case series. METHODS: Eight patients (eight eyes) with subfoveal choroidal neovascularization secondary to angioid streaks were reviewed. Standardized protocol refraction, visual acuity testing, ophthalmologic examinations, color photographs, fluorescein angiograms and indocyanine angiograms were used to evaluate the results of photodynamic therapy with verteporfin. Follow up ranged from 6 to 12 months with a mean (+/- SD) of 8.75 (+/- 2.37) months. RESULTS: Photodynamic therapy with verteporfin was well tolerated in patients with choroidal neovascularization related to angioid streaks. No deterioration in visual acuity was observed. Increase in median best-corrected visual acuity was 1.37 lines (SD +/- 1.59 lines, range 1-5 lines) at the last follow up. Two (25%) patients had no improvement of visual acuity. At the last follow up three (37.5%) patients showed no leakage and three (37.5%) patients had minimal leakage from choroidal neovascularization. Photodynamic therapy related ocular complications were not reported in any case. CONCLUSIONS: Photodynamic therapy with verteporfin generally achieved short-term cessation of or decrease of fluorescein leakage from subfoveal choroidal neovascularization without loss of vision in patients with angioid streaks. Further studies with longer follow up are necessary to confirm whether verteporfin therapy is beneficial for subfoveal choroidal neovascularization related to angioid streaks.     

Photodynamic therapy with verteporfin for choroidal neovascularization in patients with angioid streaks

PURPOSE: To evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks. METHODS: The authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size. RESULTS: Their mean age was 61.3+/-5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5+/-10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400+/-766.81 micrometer, and the mean GLD at the last examination was 3483+/-444.59 micrometer. CONCLUSIONS: PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.     

大节段小梁切除术治疗新生血管性青光眼

目的 评价大节段小梁切除术治疗新生血管性青光眼的临床效果。方法 对23例(23眼)新生血管性青光眼采用大节段小梁切除术，术后给予视网膜光凝或虹膜根部新生血管直接光凝。术后随访6～24月，平均18月。结果 出院时眼压：5～21mmHg者21眼(91．3％)，小于5mmHg者2眼(8．7％)。全部形成功能型滤过泡，2眼视力下降，6眼视力提高。随访眼压：5～21mmHg者19眼(82．6％)，其中5眼须局部滴用降低眼压药物。小于5mmHg者1眼(4．3％)，3眼眼压升高(13．0％)。术后早期并发症主要有前房积血(39．1％)和浅前房(47.8％)，后期主要有滤过区巩膜葡萄肿(30．4％)。结论新生血管性青光眼需要手术、激光、药物等综合治疗，大节段小梁切除术是疗效较好手术方法。     

Photodynamic therapy with verteporfin for choroidal neovascularisation associated with angioid streaks

Background Choroidal neovascularisations (CNV) is the major cause of significant visual loss in patients with angioid streaks. We evaluated the functional and morphological outcome of Verteporfin photodynamic therapy (PDT) in the treatment of these patients. Methods This was a retrospective study in two tertiary referral centres over a 3-year period. Examinations included visual acuity assessment with ETDRS charts, binocular fundoscopy and fluorescein angiography. PDT was performed with standard parameters; earlier retreatments were feasible in active CNV. Results Fifteen eyes from 12 patients (9 male, 3 female) with a follow-up of 12–50 months (mean 26.1, median 19 months) were included. Five lesions were extra-or juxtafoveal and ten were subfoveal. Baseline visual acuity was between 20/63 and 20/16 (mean 20/32, median 20/32). Eyes were treated with two to eight treatments of PDT (mean 4.2, median 4). Treatment intervals were between 5.6 and 72 weeks (mean 12.1, median 9.2 weeks). At the 1-year follow-up, visual acuity was below 20/200 in 27% (4/15), 20/200 or better in 73% (11/15) and 20/63 or better in 47% (7/15) with an improvement of >3 lines in 13% (2/15), no change in 27% (4/15) and a decrease of >3 lines in 60% (9/15). At the final follow-up examination, all lesions were located subfoveally. Visual acuity was below 20/200 in 47% (7/15), 20/200 or better in 53% (8/15) and 20/63 or better in 13% (2/15) with a change in visual acuity between +2 and −18 lines (mean −9 lines, median −8 lines). No change was noted in 7% (1/15) and a decrease of >3 lines in 93% (14/15) of eyes. The maximum measured greatest linear dimension of the lesion during the follow-up varied between 2400 μm and 6200 μm (mean 3680 μm, median 3600 μm) with an increase in the lesion size compared with baseline values between ±0 μm and +3700 μm (mean+1420 μm, median+1500 μm). Conclusion PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss. Further modifications of the treatments parameters or a combination with other therapeutical options seem warranted for a more effective treatment of these lesions.     

Long-term results after photodynamic therapy with verteporfin for choroidal neovascularizations secondary to inflammatory chorioretinal diseases

Background To evaluate the safety and the long-term effect on visual acuity of photodynamic therapy (PDT) for sub- and juxtafoveal choroidal neovascularizations (CNV) secondary to inflammatory conditions.Methods In a prospective pilot study, 19 patients with CNV due to inflammatory conditions underwent PDT treatment with verteporfin with standard parameters. Regular follow-up was carried out every 3 months with ETDRS visual acuity measurement and fluorescein angiography. The initial diagnosis included punctate inner choroidopathy (PIC) (n=7), presumed ocular histoplasmosis syndrome (POHS) (6), multifocal choroiditis with panuveitis (MCP) (2) and other inflammatory conditions (4).Results All patients had a minimum follow-up of one year. After a mean follow-up of 22.1 months, the mean change in visual acuity was +1.63 ETDRS lines. At their last visit, all eyes showed a disappearance of pretreatment leakage in fluorescein angiography and 63.2% (12/19) eyes had an improvement of 2 or more lines, while 26.3% (5/19) remained stable (±1 line) and 10.5% (2/19) lost 2 or more lines. A mean of 2.0 (1–5) treatments was performed. No clinically relevant side effects or complications were observed.Conclusions PDT is a safe and effective treatment option for CNV secondary to inflammatory conditions. The results are better than for CNV secondary to AMD. For juxtafoveal CNV, the results are similar to those of subfoveal CNV with no additional safety concerns. Based on this observation, we consider PDT as treatment of choice for subfoveal CNV secondary to inflammatory chorioretinal diseases and for selected cases with juxtafoveal CNV.Presented in part at the 100th annual meeting of the Deutsche Ophthalmologische Gesellschaft, 26–29 September 2002, Berlin