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.     

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     

Choroidal vein and artery occlusion following photodynamic therapy in eyes with pathologic myopia

Purpose To describe highly myopic patients in which either the large choroidal veins or arteries were occluded following PDT treatment.Methods Demographic features of two highly myopic patients in which large choroidal vessels were occluded at 1 week following PDT, among a total of 23 patients who received PDT due to choroidal neovascularization (CNV) caused by high myopia, were demonstrated.Results In case 1, ICG angiography demonstrated the complete occlusion of several large choroidal veins within the laser-applied area at 1 week after PDT. In case 2, ICG angiography demonstrated an occlusion of choroidal artery emanating from beneath the CNV. One month after PDT, re-perfusion of the occluded choroidal vessels was noted in both patients.Conclusion Occlusion of choroidal veins has never been reported in eyes with CNV treated by verteporfin therapy. Although further studies are necessary, occlusion of large choroidal vessels might happen in highly myopic eyes more commonly than expected. ICG angiography at 1 week after PDT was useful to evaluate the impact of PDT on large choroidal vessels.This study was in part supported by 17591823 and 16390495 from Japan Society for Promotion of Science.     

Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study

BACKGROUND: Most patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green (ICG) angiography. A small percentage of patients develop chronic or progressive disease with widespread decompensation of the retinal pigment epithelium and severe vision loss. There is no known treatment for this variant of the disorder. PURPOSE: To study ICG-guided photodynamic therapy (PDT) with verteporfin as a potential treatment for patients with chronic CSC. METHODS: Twenty eyes of 15 patients were studied with fluorescein angiography, optical coherence tomography, and ICG angiography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. PDT with ICG guidance was applied to areas of choroidal hyperpermeability, and the patients were observed to determine the anatomic and functional outcomes. RESULTS: Photodynamic therapy guided by ICG was associated with complete resolution of exudative macular detachments in 12 patients and incomplete resolution in the remaining eight eyes. The vision improved in six eyes and remained unchanged in 14 eyes during a mean follow-up of 6.8 months. Six weeks after treatment, the mean visual acuity improved by 0.55 lines, an amount that was marginally significant. There was a significant inverse correlation between the baseline visual acuity and the amount of improvement in acuity at 6 weeks. No patient had any treatment-related side effects. CONCLUSIONS: Indocyanine green angiography-guided PDT with verteporfin seems to aid in the resolution of exudative detachments in patients with chronic CSC. This treatment was associated with a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.     

Selective photodynamic therapy for neovascular age-related macular degeneration with polypoidal choroidal neovascularization

PURPOSE: To evaluate the efficacy of selective treatment with indocyanine green (ICG) angiography-guided photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV). METHODS: In this retrospective consecutive series, 30 eyes of 30 patients with PCV were included. Complete ocular examination, digital fluorescein angiography (FA), ICG angiography, and optical coherence tomography were performed at baseline and at standard intervals thereafter. ICG angiography-guided PDT was performed on all eyes. Only the area of the active PCV or "hot spot" evident on the ICG angiogram was treated. A spot size was chosen to cover the active neovascular lesion with a 200-mum border. Retreatment was performed when angiography revealed a recurrent lesion. RESULTS: Thirty eyes with PCV were treated and followed for 1 year. Mean age of the patients was 75 years (range, 55-90 years). These patients were all classified as having occult choroidal neovascularization (CNV) with FA and polypoidal CNV with ICG angiography. Improvement of vision (>or=3 lines) was achieved in 15 eyes (50%). Nine eyes had stable vision (30%), and 6 eyes (20%) had a decrease in vision (>or=3 lines). Repeated treatment was required in 15 eyes (50%) for an average of 2.2 treatments in 1 year. CONCLUSION: This study indicates that stabilization or improvement of vision is achieved in most eyes (80%) with neovascular AMD from PCV after selected ICG angiography-guided PDT. These outcomes compare very favorably with those in previous reports on the treatment of occult CNV. Reduced collateral damage to the choriocapillaris and reduced upregulation of vascular endothelial growth factor are presumed to be the explanation for this apparently better outcome. Further studies with longer follow-up are warranted to investigate the long-term efficacy in these conditions.     

Anatomical and visual outcome of retinal angiomatous proliferation treated with photodynamic therapy and intravitreal triamcinolone

PURPOSE: To evaluate the efficacy and safety of photodynamic therapy (PDT) with verteporfin combined with intravitreal triamcinolone (TA) in retinal angiomatous proliferation (RAP). DESIGN: Retrospective, consecutive, noncomparative case series. METHODS: Patients newly diagnosed with RAP underwent indocyanine green angiography (ICGA)-guided PDT with verteporfin, immediately followed by intravitreal TA. Complete ocular examination, fluorescein angiography (FA), ICGA, and optical coherence tomography (OCT) were performed at baseline and follow-up visits every three months. RESULTS: Seventeen eyes of seventeen patients underwent this simultaneous combined treatment. All patients had 12 months of follow-up. Complete resolution of angiographic leakage was achieved in 83% at 12 months. Visual acuity improved in 35%, and was stable in 47%. Eleven patients developed recurrent leakage after six to 12 months, which settled completely after repeat combined treatment. CONCLUSIONS: This simultaneous combined treatment in patients with RAP was effective in reducing or eliminating retinal edema, regression of neovascularization, and stabilizing or improving visual acuity.     

Case series outcomes at 1 week following verteporfin photodynamic therapy.

PURPOSE: To examine the choroidal neovascularization (CNV) fluorescein angiographic perfusion and visual acuity 1 week after photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis AG, Switzerland) on predominantly classic, subfoveal lesions in age-related macular degeneration (AMD). METHOD: A retrospective case series study was conducted on the 1-week outcome of PDT treatment of 76 of 79 consecutive patients with the subfoveal, predominantly classic CNV form of AMD. Leakage from CNV was assessed by fluorescein angiography and best-corrected visual acuity determined on projected Snellen charts using a standardized protocol. RESULTS: One week after PDT treatment, absence of fluorescein leakage from CNV was observed in 100% of the 76 patients. Visual acuity improved (at least a three-line gain) in 11 patients (15%), remained unchanged (less than a three-line gain or loss) in 64 patients (84%), and deteriorated (at least a three-line loss) in only one patient (1%). CONCLUSION: The absence of fluorescein leakage from classic CNV at 1 week in all cases was consistent with the published outcome of the clinical Phase I and II PDT trials. Further, vision loss 1 week after PDT for predominantly classic CNV was very uncommon. Therefore 1-week post-PDT angiography is unnecessary for predominantly classic CNV in patients with AMD.     

Photodynamic therapy with verteporfin for choroidal neovascularization in patients with diabetic retinopathy.

PURPOSE: To report the use of photodynamic therapy (PDT) with verteporfin in three patients with choroidal neovascularization (CNV) from age-related macular degeneration and underlying diabetic retinopathy. The level of diabetic retinopathy would have excluded these patients from participation in previously reported randomized clinical trials evaluating PDT with verteporfin due to a theoretic concern of damage to the overlying retinal vasculature. DESIGN: Retrospective interventional case series. METHODS: Three patients from a referral practice with at least severe nonproliferative diabetic retinopathy and a history of clinically significant macular edema developed loss of vision from concurrent choroidal neovascularization evaluated with fundus photography and fluorescein angiography before and after PDT with verteporfin to identify adverse retinal vascular events. RESULTS: Four eyes in three patients had PDT using verteporfin. Three eyes received two treatments. With short follow-up, visual acuity remained stable in two eyes, improved from 20/400 to 20/320 in one eye, and decreased from 20/200 to 20/400 in one eye. Fluorescein angiograms at intervals from 2 weeks to 3 months after PDT showed no damage to the retinal vasculature or progression of the diabetic retinopathy, but did show a decreased area of fluorescein leakage from CNV. One eye that had new subretinal hemorrhage following treatment appeared to show new vasculopathy on initial evaluation of the post-treatment angiogram. Retrospective review suggested that the subretinal hemorrhage provided increased contrast to more easily visualize vasculopathy that was present before the PDT. CONCLUSIONS: Three patients with diabetic retinopathy undergoing a total of seven PDT treatments with verteporfin in four eyes had no new retinal vascular abnormalities develop. No other atypical responses of CNV to PDT were noted except new subretinal hemorrhage, providing increased contrast of the overlying vasculature, which gave the false impression of the development of new vasculopathy in one eye. Patients with diabetic retinopathy who have concurrent CNV for which PDT with verteporfin is recommended should be cautioned regarding the theoretical concerns of harming the retinal vasculature. Periodic surveillance for such concerns seems warranted until more experience is obtained.     

Photodynamic therapy with verteporfin in a rabbit model of corneal neovascularization

PURPOSE: To determine the efficacy of photodynamic therapy (PDT) with verteporfin (Visudyne; Novartis AG, Basel, Switzerland) for treatment of corneal neovascularization in a rabbit eye model. METHODS: Corneal neovascularization was induced in Dutch belted rabbits by placing an intrastromal silk suture near the limbus. Verteporfin was administered by intravenous injection at a dose of 1.5 mg/kg, and the pharmacokinetics of verteporfin distribution in the anterior segment or PDT-induced (laser energy levels 17, 50, and 150 J/cm(2)) regression of corneal blood vessels were then determined. To assess PDT-induced toxicity of the anterior segment, corneal and iris/ciliary body histology, and IOP were evaluated after PDT. RESULTS: Verteporfin accumulation in vascularized regions of the cornea and the iris/ciliary body tissue were time dependent and maximum levels achieved at 60 minutes after injection. In rabbits, PDT of corneal vessels using laser energy of 17 or 50 J/cm(2) resulted in 30% to 50% regression of corneal neovascularization; however, in these animals, a rapid regrowth of new blood vessels occurred between 3 and 5 days. In the rabbits receiving PDT using laser energies of 150 J/cm(2), the mean vessel regression was 56%. During the nine days of the laser therapy follow-up period, no vessel regrowth was observed in these rabbits. Histologic examination of the anterior segment after PDT (150 J/cm(2)) showed localized degeneration of the corneal blood vessels without observable change in other anterior segment structures. CONCLUSIONS: These results provide evidence that PDT can produce significant regression of neovascular corneal vessels with no observable toxicity to the anterior segments. However, the optimal laser energy necessary to induce long-term regression (150 J/cm(2)) was three times that used to treat choroidal neovascularization.     

Photodynamic therapy and intravitreal triamcinolone for a subretinal neovascularization in bilateral idiopathic juxtafoveal telangiectasis

PURPOSE: To report combined treatment of photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide injection for subfoveal neovascularization secondary to bilateral idiopathic juxtafoveal telangiectasis. DESIGN: Interventional case report. METHOD: A patient with a subfoveal neovascularization secondary to bilateral idiopathic juxtafoveal telangiectasis was treated with PDT plus an intravitreal injection of 4 mg of triamcinolone acetonide. RESULTS: Leakage in the late-phase of fluorescein angiography resolved with attenuation of telangiectatic vessels and improvement in visual acuity from 20/200 to 20/50. At 9 months post-treatment, recurrent leakage was treated with repeat PDT and intravitreal triamcinolone. One year after initial presentation, visual acuity was 20/60 with no leakage on fluorescein. CONCLUSION: Combined treatment with PDT and intravitreal triamcinolone acetonide resulted in regression of a subfoveal neovascular membrane and improvement in visual acuity during the course of follow-up.     

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。     

Verteporfin photodynamic therapy for anterior segment neovascularization secondary to ischaemic central retinal vein occlusion

Purpose: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for anterior segment neovascularizations (ASNVs) in patients affected by ischaemic form of central retinal vein occlusion (CRVO). Methods: Prospective non‐comparative case series including 10 consecutive patients (10 eyes) affected by ischaemic CRVO. Main outcome measure was the obliteration of ASNV. Results: One month after PDT, biomicroscopic examination showed partial obliteration of iris new vessels and complete closure of angle neovascularization. Iris fluorescein angiography performed 1 week after treatment showed partial closure of the iris new vessels with no evidence of leakage in the late phases. During the subsequent examinations, a partial reopening of the iris and angle new vessels in association with dye leakage on fluorescein angiography was evident. In any case, the fluorescein leakage turned out to be still reduced with respect to the baseline aspects. Conclusions: Our results show that PDT with verteporfin can partially obliterate ASNVs in eyes affected by ischaemic CRVO preventing from the evolution towards advanced stages of neovascular glaucoma, but is not effective in cases with complete angle synechial closure.     

Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series

OBJECTIVE: To determine the efficacy of photodynamic therapy (PDT) with verteporfin as a treatment for symptomatic polypoidal choroidal vasculopathy (PCV). DESIGN: Prospective consecutive, 2-centered, noncomparative interventional case series. PARTICIPANTS: Twenty-one Asian patients with 22 eyes presenting with serosanguinous maculopathy due to PCV and an initial best-corrected visual acuity (BCVA) of 20/40 or worse were recruited prospectively. All patients had angiographic leakage seen on fluorescein angiograms (FAs) and features of PCV seen with indocyanine green (ICG) angiography. METHODS: Intravenous infusion of verteporfin at a dose of 6 mg/m(2) of body surface area over 10 minutes was administered. Five minutes after the completion of infusion, a 689-nm laser was applied for 83 seconds, with a light dose of 50 J/cm(2). The laser spot size was chosen to cover the polyps and the surrounding abnormally dilated choroidal vessels shown on ICG angiography plus an extra 1000-microm margin. Photodynamic therapy retreatment was performed if leakage from the polyps was found on both repeat FAs and ICG angiography at regular 3-month follow-up intervals. MAIN OUTCOME MEASURES: The proportion of eyes with stable or improved vision at a 1-year follow-up. Secondary outcome measures included change in mean BCVA and the changes in clinical and angiographic features in FAs and ICG angiography. The total number of PDT sessions and any complications were also recorded. RESULTS: Stable or improved vision was achieved in 21 (95%) of the 22 eyes at the 1-year follow-up. Ten (45%) eyes had a moderate gain in vision (improved by > or =3 lines), whereas 1 (5%) eye suffered a moderate visual loss (decrease by > or =3 lines). The mean BCVA improved from a logarithm of the minimum angle of resolution(logMAR) of 0.73 to 0.60, an equivalent of 1.3 lines of improvement. The change in logMAR BCVA at 12 months was statistically significant (Wilcoxon signed-ranks test, P = 0.009). Complete absence of leakage in FAs and total regression of the polyps in ICG angiography were observed in 20 (91%) and 21 (95%) eyes, respectively. Severe loss of vision due to massive subretinal hemorrhage occurred in 1 eye; otherwise, there were no other serious treatment-related adverse events. CONCLUSIONS: The 1-year results of PDT in treating PCV of the macular type with serosanguinous presentations are encouraging. Further studies with longer follow-up and randomized controlled trials are warranted to assess the long-term safety and efficacy of PDT relative to observation or other treatment modalities.     

光动力疗法治疗湿性年龄相关性黄斑变性脉络膜新生血管膜的临床效果

目的探讨光动力疗法（PDT）对湿性年龄相关性黄斑变性（AMD）患者脉络膜新生血管（CNV）膜的临床疗效。方法回顾性分析2000年8月至2006年2月经PDT治疗后随访≥6个月的93例（98只眼）湿性AMD患者的临床效果,比较其治疗前后的视力、荧光素眼底血管造影（FFA）及吲哚氰绿眼底血管造影（ICGA）图像特征。结果PDT治疗后6个月,患者视力稳定不变的有59只眼（60．2％）,视力提高的有21只眼（21．4％）,视力下降的有18只眼（18．3％）。经FFA检查发现CNV复发且重复治疗者有54只眼（55．1％）;重复治疗时间：1个月者1只眼,3个月者24只眼,6个月者15只眼,9个月者6只眼,〉12个月者8只眼。54只眼重复治疗次数：2次40只眼,3次12只眼,4次2只眼,平均治疗次数为1．7次。随访时间：6—58个月,平均14个月。所有病例均未见严重的不良反应。结论PDT是治疗CNV的安全、有效方法,但需反复治疗。     

Selective occlusion of subfoveal choroidal neovascularization in pathologic myopia using a new technique of ingrowth site treatment

PURPOSE: To evaluate the visual and angiographic effects as well as optical coherence tomography findings after a new technique of ingrowth site treatment of subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia with the use of indocyanine green (ICG)-mediated photothrombosis. DESIGN: Interventional, noncomparative case series. METHOD: In the setting of a tertiary referral center, patients with pathologic myopia in whom fluorescein and conventional ICG angiography demonstrated distinct CNV vessels supplying the subfoveal neovascular complex were submitted to focal ingrowth site treatment using a new therapeutic modality termed ICG-mediated photothrombosis. Prospective evaluation including visual acuity assessment, fluorescein and ICG angiography, and optical coherence tomography (OCT) evaluation was performed at weeks 1, 12, 24, and 48 after treatment. RESULTS: Six consecutive patients (six eyes) had treatment using a single session of ICG-mediated photothrombosis at the CNV ingrowth site. Obliteration of the entire neovascular complex was achieved immediately after treatment in all patients. At last follow-up, visual acuity improvement of 1 or more Early Treatment Diabetic Retinopathy Study lines was observed in five of six patients, and fluorescein angiography showed an absence (four eyes) or minimal leakage (two eyes) from CNV. Indocyanine green angiography demonstrated selective obliteration of the neovascular complex. Accordingly, reduction of retinal edema was observed in the OCT evaluation in all patients. There was no significant complication related to the procedure. CONCLUSIONS: The use of lower irradiances of 810- nm continuous light application and intravenous ICG infusion for neovascular ingrowth site photothrombosis induced selective CNV hypoperfusion, as demonstrated by fluorescein and ICG angiography in patients with pathologic myopia. These findings were either consistent with the visual acuity improvement observed in five of six patients or with the partial restoration of the retinal architecture seen in OCT evaluation 12 months after treatment.     

Optical coherence tomography findings following photodynamic therapy of choroidal neovascularization

PURPOSE: To develop an optical coherence tomography (OCT) classification system that monitors the response of eyes treated with photodynamic therapy (PDT) with verteporfin for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD).DESIGN: Retrospective interventional case series.METHODS: Ninety eyes (88 patients) with AMD and predominantly classic subfoveal CNV treated with PDT using verteporfin were identified by a laser log and retrospectively reviewed. Optical coherence tomography and fluorescein angiography (FA) were performed before treatment and at subsequent follow-up examinations in all eyes. Optical coherence tomography findings were evaluated and compared with corresponding FA.RESULTS: A five-stage OCT classification of eyes treated with PDT was created from the evaluation of 79 total eyes (77 patients). Stage I (two eyes) is recognized within the first week of treatment and demonstrates an acute inflammatory response with increased subretinal fluid. Stage II (28 eyes) represents the restoration of a near-normal fovea contour with diminished subretinal fluid occurring 1 to 4 weeks after treatment. Stage III (79 eyes) occurs between 4 to 12 weeks following treatment and is subdivided into two categories based on the amount of subretinal fibrosis and fluid present. Stage IIIa (15 eyes) contains a greater subretinal fluid to fibrosis ratio indicating an active CNV process. Lesions in stage IIIb (64 eyes) less actively leak and have more prominent fibrosis with minimal intraretinal fluid. Cystoid macular edema defines a stage IV lesion (11 eyes). In stage V lesions (19 eyes) the subretinal fluid resolves with thinning of the retina as well as fibrosis merging with the retinal pigment epithelial layer (RPE).CONCLUSION: Optical coherence tomography appears to be useful in monitoring the retinal changes that occur following PDT of CNV and may assist in understanding the changes observed on angiography.     

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。     

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.     

Therapeutic effect of diode laser photodynamic therapy with ICG dye in ARMD: a case report

PURPOSE: To evaluate the diode laser photodynamic therapy efficacy on choroidal neovascularization (CNV) in the treatment of three patients with age-related macular degeneration (ARMD). METHODS: The authors selected three patients with ARMD whose vision has decreased due to CNV, and applied diode laser treatment after injecting an indocyanine green (ICG) solution. The patients were followed for at least three months after treatment, and examinations included evaluating vision changes and possible leakage on fluorescein angiography (FAG). RESULTS: The final vision of two patients improved by more than one line on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart after at least three months of follow-up. However, the final vision of the third patient decreased by one line on ETDRS chart. FAG was done in all patients, and in two of the patients, there was no evidence of leakage at the laser-applied site. In the other patient, there was evidence of minimal leakage, with the area of leakage decreasing by more than fifty percent. Side effects of ICG were not found during or after the photodynamic therapy sessions. CONCLUSIONS: The photodynamic usage of ICG treatment of CNV in patients with ARMD, was effective in preventing or improving the visual outcome. Compared to the widely used verteporfin, ICG is more stable and is more cost effective. The authors therefore came to a conclusion that ICG can be very useful in the treatment of CNV. However, further studies are necessary.     

Lacquer crack formation after photodynamic therapy

PURPOSE: To report the occurrence of a lacquer crack after photodynamic therapy (PDT) of choroidal neovascularization (CNV) in a patient with pathologic myopia. METHODS: PDT was performed with verteporfin, which was activated by a diode laser light at 690 nm. RESULTS: The left eye of a 42-year-old woman was treated with PDT because of juxtafoveal CNV caused by pathologic myopia. No lacquer crack was present in the macula on either fluorescein or indocyanine green angiography before treatment. The CNV subsided after treatment. However, a large lacquer crack underlying a subretinal hemorrhage was formatted in the macula of the treated eye soon after PDT. CONCLUSIONS: Although the chorioretinal damage produced by PDT is minimal, it is enough to create, directly or indirectly, the basis for the formation of a lacquer crack in an eye with pathologic myopia.