Chorioretinal anastomosis and photodynamic therapy:a two-year follow-up study

Background To evaluate the two-year efficacy of photodynamic therapy with Visudyne (PDT) in neovascular age-related macular degeneration (AMD) eyes with chorioretinal anastomosis (CRA). Methods A non-randomized, institutional, prospective study, of 28 consecutive eyes of 23 patients, with CRA, treated with PDT. Masked best corrected visual acuity (VA) and angiographic features at baseline and during the period of two years were evaluated. Results Twenty eight eyes completed one year and 19 eyes completed two years of follow-up. The number of treatments was 3 in the first year, and 0.8 in the second year. A VA loss < 3 lines occurred in 53% of the eyes, at two years. Treated eyes lost 0.5 lines in the first year and 2.4 lines in the second (p < 0,01). Recurrence with additional significant VA loss occurred in four eyes (21%) during the second year. Fourteen eyes (74%) showed no fluorescein leakage at two years. Conclusion AMD eyes with chorioretinal anastomosis can benefit from PDT with Verteporfin at two years. However, during the second year significant additional VA loss occurs mainly due to recurrence. New modalities of treatment are necessary to achieve VA improvement in CRA eyes.     

光动力疗法治疗高度近视眼的脉络膜新生血管

目的 :探讨光动力疗法 (Photodynamictherapy ,PDT)治疗高度近视眼脉络膜新生血管 (Choroidalneo vascularization ,CNV)的初步疗效及安全性。方法 :2例 3眼高度近视脉络膜新生血管患者 ,注射光敏剂Visu dyneTM(Verteporfin ,BPD)后予 5 0J/cm2 的红光 (6 90nm)照射CNV病变区 83秒 ,观察其不良反应及短期疗效。结果 :初步检查显示治疗后视力稳定或提高 ,未发现任何不良反应。结论 :PDT治疗高度近视所致的CNV是有效的、安全的     

Ocular changes after photodynamic therapy

PURPOSE: The aim of this study was to identify the changes in the primate visual system after a single session of photodynamic therapy (PDT) in an intact nonhuman primate retina. METHODS: As part of a larger study, PDT (wavelength 689 nm, 50 J/cm2, 600 mW/cm2, 83 seconds, 4-mm spot size) with verteporfin (6 mg/m2 intravenous infusion) was performed in one eye each of two cynomolgus monkeys. Fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICG), optical coherence tomography (OCT), and multifocal electroretinography (mfERG) were performed at baseline and 12 time points (1-283 days) after PDT. In addition, retinal histopathologic findings were evaluated at 9 months. RESULTS: Various morphologic changes, including whitening of the treated area, RPE proliferation, closure of the choroidal vasculature, and subretinal edema (followed by foveolar thinning) were observed. Most of the changes persisted and were detectable in histopathologic evaluation at 9 months. Reductions of the mfERG amplitude, followed by varying degrees of recovery from the treated and the border regions, were observed. This was accompanied by progressive delay of P1 peak time up to 3 months after treatment, followed by complete recovery at 9 months. In addition, the nontreated area showed amplitude and timing mfERG deficits, which underwent gradual (but not complete) recovery. CONCLUSIONS: In a primate model, under standard clinical parameters, a single PDT treatment resulted in various dynamic morphologic and functional retinal changes detectable for up to 9 months after treatment. The significance of the observed changes and possible ways of pharmacologic interference with PDT adverse effects are discussed.     

Choroidal neovascularization in pathologic myopia: three-year results after photodynamic therapy

PURPOSE: To examine whether the encouraging functional results one year after photodynamic therapy (PDT) can be maintained up to three years. DESIGN: Prospective interventional case series. METHODS: Highly myopic eyes that had been treated with PDT for subfoveal choroidal neovascularization and had been observed at least 36 months were included. Distance acuity (Early Treatment of Diabetic Retinopathy charts), reading acuity (Jaeger charts), 10-degree static threshold perimetry, fluorescein angiography, and optical coherence tomography were performed. The main outcome measures were the differences of the values among the baseline and the month 12 and the month 36 examinations. RESULTS: Twenty eyes of 18 patients were included: 15 patients were female, and 3 patients were male. The average age was 64 years (range, 36 to 85 years). The mean distance acuity was 43 letters at baseline and 53 letters after 12 months and after 36 months. The mean reading acuity changed from mean J10.8 to mean J8.1 after 12 months and to mean J9.85 after 3 years. The mean defect decreased from mean 13.5 dB at baseline to mean 12.5 dB after 12 months and mean 11.2 dB after 36 months. The maximum retinal thickness decreased from mean 360 mum at baseline to mean 259 mum after one year and mean 238 mum after 36 months. CONCLUSION: Distance acuity and central visual field showed stabilization after the month 12 examination up to the month 36 examination. The reading acuity decreased between the month 12 and the month 36 examinations, which might be related to an increase of retinal atrophy.     

光动力学疗法治疗AMD后OCT检查的特征性改变

目的：通过前瞻性观察PDT治疗湿性年龄相关性黄斑变性（aged-related macular degeneration,AMD）前后不同随访时间点光学相干断层成像（optical coherence tomography, OCT）的特征性改变,旨在更好地反馈PDT治疗后黄斑区结构的变化过程。方法：将在本院接受PDT治疗的26例30眼湿性AMD患者纳入本研究。维速达尔用量根据厂家推荐方法计算。治疗前后均行FFA,ICG,OCT及最佳矫正视力等相关临床检查,术后随访日期为术后2wk; 1,2,3mo。傅立叶OCT扫描以标准五线结合六线扫描,覆盖病变的关键部位并保持前后扫描位置的一致性。重点观察黄斑中心凹层间厚度、外层高反射带高度、囊肿（包括视网膜下积液和视网膜内积液）的总面积。分析这些变化与随访时间的依赖关系。统计分析使用SPSS 13.0软件。结果：至治疗后3mo,PDT治疗后22眼（73%）视力提高两行以上,3眼视力无明显改变,3眼视力下降,2例患者因故失访。视力提高的22眼治疗前平均黄斑厚度为 722.5±55.6μm,治疗后2wk,平均黄斑层间厚度为708.3±45.3μm,1mo 为584.4±49.3μm,2mo为430.7±50.2μm,3mo为 180.6±36.3μm。治疗前和治疗后外层高反射带厚度分别为302.3±50.2,277.5±42.3,202.7±40.1,180.6±35.7,100.8±22.9μm,囊肿的总面积为0.34±0.12,0.25±0.07,0.10±0.05,0.08±0.04,0.05±0.01mm2。结论：AMD患者在PDT治疗后1mo黄斑区视网膜下液有显著吸收,视网膜水肿显著吸收,黄斑中心凹层间厚度、外层高反射厚度也有明显变薄倾向。     

Reading ability after photodynamic therapy (PDT) for age-related macular degeneration (AMD) and for high myopia

BACKGROUND: A prospective uncontrolled follow-up of changes in reading ability after PDT with Verteporfin in patients with predominantly classic subfoveal choroidal neovascularization (CNV) due to AMD or high myopia was carried out. PATIENTS AND METHODS: A follow-up time of at least 6 months is documented for 48 patients with AMD and for 22 patients with high myopia. In addition to the usual clinical parameters the need for magnification was measured using standardized reading charts provided by the SZB.A need for magnification higher than 3.2-fold was defined as a severe loss in reading ability.PDT's were repeated every 3 months according to the usual guidelines. RESULTS: Before treatment, the mean reading acuity for patients with AMD was between 20/200 and 20/100.The average need for magnification was between 2.5-fold and 3.2-fold.Reading acuity, need for magnification and the percentage of patients with a need for magnification of 3.2-fold or less remained stable over a 6-12 months follow-up period.High myopic patients initially had a mean reading acuity of 20/200 and a need for magnification of 2.5-fold.After 9 months follow-up, reading acuity showed a mean improvement from 0.2 up to 0.3 ( p<0.05). There was also a trend towards improvement in the need for magnification and the percentage of patients with a need for magnification of 3.2-fold or less improved significantly from 68% to 78% ( p<0.05). CONCLUSION: Reading ability could be stabilized with PDT for predominantly classic subfoveal CNV in patients with high myopia or AMD for at least 9-12 months.The risk of developing a severe loss in reading ability (need for magnification >3.2-fold) was significantly reduced in high myopia and was stable over time in AMD.     

Choroidal neovascular membranes after photodynamic therapy: ultrastructural analysis of two surgically excised membranes

PURPOSE: To report on the ultrastructural electron microscopic findings of two surgically excised subfoveal choroidal neovascular membranes (CNV) that had undergone photodynamic therapy (PDT). METHODS: Two patients underwent PDT because of subfoveal neovascular membranes (CNV). Due to enlargement of the CNV seen on fluorescein angiography three months after PDT, one patient underwent surgical excision of the membrane; the other patient underwent both surgical membrane excision combined with macular translocation one month after PDT. The membranes were examined under the transmission electron microscope (TEM). RESULTS: The membranes were composed of a core and a rim, the latter being mainly composed of fibrin and collagen fibrils. The core was preeminently composed of endothelium-lined vascular channels associated with retinal epithelium cells. The endothelial cells of blood vessels appeared well-preserved. CONCLUSIONS: The lack of histological signs of recanalization and vascular thrombosis may indicate that in our cases the enlargement of the CNVs seen on fluorescein angiography three months and one month respectively after PDT may originate mainly from reproliferation of choroidal vessels rather than recanalization of previously occluded vessels.     

Choroidal thickness outside the laser irradiation area after photodynamic therapy in polypoidal choroidal vasculopathy

Purpose

To evaluate changes in choroidal thickness adjacent to the area of laser application after photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV) using enhanced depth imaging spectral-domain optical coherence tomography.

Methods

Masked observers measured the choroidal thickness at the subfovea and superior, inferior and temporal areas adjacent to the area of laser application before, 2 days, 1 week and 1 and 3 months after treatment.

Results

Thirty-seven patients with PCV treated with PDT with verteporfin were included. The mean subfoveal choroidal thickness decreased significantly (P < 0.001) from 256 ± 115 μm at baseline to 207 ± 111 μm at 3 months; the mean outside choroidal thickness including the superior, inferior and temporal areas decreased significantly (P < 0.001) from 240 ± 92 μm at baseline to 209 ± 86 μm at 3 months.

Conclusion

PDT affected not only the subfoveal choroid, but also the choroid outside the area of laser application in PCV.     

Long-term follow-up of polypoidal choroidal vasculopathy after photodynamic therapy with verteporfin

Purpose To report on the clinical features of three cases of polypoidal choroidal vasculopathy (PCV) during long-term follow-up after photodynamic therapy (PDT). Design Interventional case reports. Methods Among the participants in the Japanese Age-Related Macular Degeneration Trial (JAT) at our hospital, a PCV was seen in three eyes at baseline on retrospective analysis of indocyanine green angiography (ICGA) using fundus camera. We report the clinical features of these cases during more than 4 years follow-up. Results The mean number of PDT treatments was 5.7. Improved visual acuity (VA) and cessation of fluorescein leakage was achieved within 18 months in all eyes; however, subretinal hemorrhage and subfoveal fluid recurred due to new or recurrent PCV. The final VA decreased markedly in two eyes. Conclusions The eyes with PCV, which had been treated successfully with PDT, may have developed new or recurrent PCV during long-term follow-up. Periodical ICGA would be needed to detect abnormal choroidal vascular changes. The authors have no proprietary interest in any aspect of this report.     

Early optical coherence tomography changes after photodynamic therapy in patients with age-related macular degeneration

PURPOSE: To evaluate early changes after photodynamic therapy (PDT) in patients with age-related macular degeneration (AMD) by optical coherence tomography (OCT). DESIGN: Prospective interventional case series. METHODS: PDT was performed on 20 eyes of 20 patients who presented with subfoveal choroidal neovascularization (CNV) attributable to AMD. OCT was used to evaluate changes at 2, 12, and 24 hours and at 3, 7, 15, and 30 days after therapy. RESULTS: In the first 24 hours, OCT showed an increase in the subretinal fluid (SF) in all eyes and an increase in intraretinal fluid (IF) in 13 eyes. On the 15th day and the 30th day after therapy, reduction of SF and IF was observed in almost all eyes. CONCLUSIONS: Serial OCT evaluation of patients with subfoveal CNV attributable to AMD suggests that the initial response after PDT is an increase in SF and IF.     

Macular atrophy after combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for retinal angiomatous proliferation (RAP)

BACKGROUND: Retinal angiomatous proliferation (RAP) is a variant of exudative AMD that appears to respond poorly to standard PDT. This pilot study explores the potential efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA). PATIENTS AND METHODS: In a prospective interventional case series 10 eyes of 8 patients with RAP were treated with combined IVTA/PDT. RESULTS: After 3 months there was no evidence of significant exudative activity in 7/10 eyes treated with IVTA/PDT, three eyes required re-treatment. After 6 months 4/10 eyes were "dry" on fluorescein angiography, visual acuity was stable (loss of less than 3 Snellen lines) or had improved in 5/10 eyes. 5/10 eyes had lost 3 or more lines, due to central macular atrophy in 4/5 eyes and secondary to a progressive exudative lesion in 1/5 eyes. CONCLUSIONS: Intravitreal steroids combined with PDT appear to be a step ahead in the treatment of RAP. Our results, however, raise the question whether combined treatment may create more atrophy leading to vision loss in some cases.     

Combined therapy with bevacizumab and photodynamic therapy for myopic choroidal neovascularization:A one-year follow-up controlled study

AIM: To evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizumab monotherapy.METHODS: Thirty-four eyes with angiographic evidence of myopic CNV were randomly divided into two groups:17 were treated with one intravitreal bevacizumab injection (1.25 mg) and low-fluence-rate PDT within seven days of the injection (Group A). The other 17 received monotherapy with bevacizumab injections (Group B). Clinical evidence of complications, best corrected visual acuity (BCVA) and fluorescein leakage were evaluated. BCVA and optical coherence tomography (OCT) were evaluated monthly. The timepoints follow-up was established at 6 and 12mo. All patients were retreated following a PRN protocol.RESULTS:A total of 34 eyes of 34 patients (26 women and 8 men) with a mean age of 62.35 years were included. In Group A (17 eyes) the mean BCVA increased from 0.55±0.13 logMAR before the treatment to 0.40±0.09 logMAR at the 12mo follow-up (P<0.01). In Group B (17 eyes) the mean BCVA increased from 0.60±0.11 logMAR before the treatment to 0.55±0.12 logMAR at the 12mo follow-up (P<0.01). There was no statistically significant difference between the two groups in terms of LogMar visual acuity. In Group A the mean number of combined treatments was 1.8±0.11 per patient; in Group B the mean number of intravitreal bevacizumab injections was 3.1±0.08 per patient. The number of treatments was significantly fewer in Group A (P<0.01). No local or systemic side effects occurred among any of the patients treated in this study.CONCLUSION:The combination of anti-angiogenic injections and PDT appears to be a safe and effective option for myopic CNV treatment and allows for a significant reduction of intravitreal injections.     

Long-term chorioretinal changes after photodynamic therapy for chronic central serous chorioretinopathy

Purpose

To evaluate morphological and functional chorioretinal changes 5 years after standard photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).

Methods

A retrospective, nonrandomized study, including patients with chronic CSC treated with standard PDT and followed for at least 60 months. All patients underwent a complete ophthalmological examination, and the location and number of treatments were registered. Five or more years after treatment, subfoveal and non-subfoveal treated areas were evaluated with Spectralis optical coherence tomography and microperimetry.

Results

Seventeen eyes of 15 patients were included, with mean age of 48.3?±?8.4 years and a mean follow-up of 80.6?±?12.4 months (range from 62 to 104 months). All eyes had neurosensory detachment (NSD) at baseline. Treatment was performed under the fovea in 58.8 % and in a non-foveal area in 41.2 % of the eyes. At the final visit all eyes had resolution of the NSD, with a statistical significant reduction in central macular thickness (p?=?0.005) and preserved neuroretinal thickness (p?=?0.839). There was a statistical difference between initial and final BCVA (p?<?0.001) and a mean gain of 8.4?±?7.8 letters. Subfoveal morphological changes in external limiting membrane (ELM) and in photoreceptor inner and outer segment junction (IS/OS) were correlated with final BCVA (p?=?0.015 and p?=?0.014 respectively), but not with the variation of BCVA. There was a statistical correlation between morphological changes in IS/OS line and retinal sensitivity in the central 12° and 2° (p?=?0.003 and p?=?0.002 respectively). The morphological changes in the subfoveal layers were not dependent on treatment location (p?=?0.154, p?=?0.644, and p?=?1.0 for ELM, IS/OS line, and retinal pigment epithelium respectively). Subfoveal final mean choroidal thickness was 295.1?±?68.7 μm, and showed no statistical difference from the normal population (p?=?0.633).

Conclusions

Morphological and functional chorioretinal changes, observed 5 or more years after standard PDT for chronic CSC, were not correlated with the location of treatment, neither with the progression of visual acuity or with the location of treatment, and are more likely to be related to the disease itself than with the treatment provided.