Role of photodynamic therapy in polypoidal choroidal vasculopathy

PURPOSE: To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. MATERIALS AND METHODS: We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. RESULTS: Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. CONCLUSION: PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.     

Recurrence of polypoidal choroidal vasculopathy after photodynamic therapy

Purpose  To evaluate the recurrence of polypoidal lesions after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). Methods  This is a retrospective review of data on 28 patients with PCV treated with PDT. The recurrent polypoidal lesions were observed with fluorescein and indocyanine green angiography. Results  In 26 of the 28 eyes the PCV remained inactive for more than 12 months after one to three treatments with PDT. Recurrence of the polypoidal lesions after more than a 12-month inactive period was reported in eight eyes: three at 15 months, two at 18 months, and three at 21 months. Kaplan-Meier estimates of recurrence were 11.5% at 15 months, 20.4% at 18 months, and 38.8% at 21 months, with no subsequent recurrence until passage of 36 months of inactivity after the last PDT. Additional PDT after recurrence improved or preserved visual acuity in 80% of those treated compared to the visual acuity before the first PDT. Conclusions  Recurrence of PCV occurs in about 40% of eyes treated for PCV even after a long period of inactivity, so careful follow-up is needed.     

Treatment of polypoidal choroidal vasculopathy with photodynamic therapy

PURPOSE: To study the effects of photodynamic therapy using verteporfin in the treatment of patients with subfoveal polypoidal choroidal vasculopathy (PCV). METHODS: A retrospective chart review of 16 consecutive patients with subfoveal PCV treated with photodynamic therapy using verteporfin was performed. RESULTS: The mean age of the patients involved was 70.5 years. The mean follow-up time was 12 months. The visual acuity improved in 9 (56.3 %), remained the same in 5 (31.3 %), and decreased in 2 (12.5 %). The mean change in visual acuity was an improvement of 2.38 lines, a difference that was highly significant ( = 0.004). The change in visual acuity was negatively correlated with increasing age. The final visual acuity was positively correlated with initial acuity and negatively correlated with age. These results were confirmed by multiple linear regression. No patient had any lasting complication from the treatment. CONCLUSIONS: Subfoveal PCV has no proven method of treatment. Although the follow-up time and the number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.     

Aqueous humor levels of vascular endothelial growth factor and pigment epithelium-derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization

PURPOSE: To determine the aqueous levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in patients with active polypoidal choroidal vasculopathy (PCV) and choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathologic myopia. DESIGN: Prospective, comparative control study. METHODS: Aqueous humors were collected from 32 eyes of 32 patients for either active PCV or CNV. Among them, 11 eyes had active and symptomatic PCV, 12 eyes had active CNV secondary to AMD, and nine eyes had active CNV of pathologic myopia. Levels of VEGF and PEDF were determined by commercially available enzyme-linked immunosorbent assay kits. A group of 10 aqueous samples from 10 patients who underwent cataract surgery without other ocular or systemic diseases comprised the controls. RESULTS: VEGF concentrations in aqueous humor were markedly increased in patients with PCV, CNV of AMD, and CNV of myopia when compared with the controls (analysis of variance [ANOVA], P < .001). VEGF levels in eyes with PCV were, however, significantly lower than those of exudative AMD (P = .045). The PEDF levels were also significantly different among the groups (ANOVA, P = .001), and we observed increased levels in PCV, CNV of AMD, and CNV of myopia. CONCLUSIONS: VEGF and PEDF factors were coexpressed and increased with positive correlation in aqueous humor of eyes with active PCV. The different levels of both factors in eyes of PCV and AMD might suggest distinct clinical entities or different angiogenesis courses between PCV and AMD.     

Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy

PURPOSE: To report a case of recurrent bleeding after photodynamic therapy (PDT) in an eye with polypoidal choroidal vasculopathy (PCV). DESIGN: Interventional case report. METHODS: A 73-year-old man was treated in the left eye for PCV with PDT. RESULTS: Two weeks after PDT, his left eye showed extensive subretinal hemorrhage, with a slight vision loss. Three months after PDT, subretinal hemorrhage was almost absorbed. He received a second session of PDT to the remaining choroidal neovascularization. Two weeks thereafter, his left eye showed massive suprachoroidal hemorrhage with further vision loss. One month after the second PDT, visual acuity was decreased to no light perception as a result of massive vitreous hemorrhage. Although the patient underwent pars plana vitrectomy, visual acuity in the left eye remained hand motion as a result of massive suprachoroidal hemorrhage. CONCLUSIONS: Ophthalmologists and patients should be aware of the risk of massive bleeding after PDT in eyes with PCV.     

Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy

PURPOSE: This study evaluated the results of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) 24 months or more after treatment. METHODS: The study involved 47 eyes of 47 patients with PCV followed for 24 months or more after the first PDT. Fundus appearance, indocyanine green angiographic findings, and visual acuity (VA) were compared before PDT, and then at 3 months, 12 months, and the final visit after the first PDT. RESULTS: At the final visit, VA was preserved or improved in 37 (79%) of the 47 eyes. Recurrence of polypoidal lesions was noted in 30 eyes (64%). An abnormal branching vascular network persisted in all subjects. In 26 of the 30 eyes exhibited recurrence of polypoidal lesions, which appeared in the periphery of the expanded abnormal branching vascular network. CONCLUSION: Patients with PCV need to be followed for long periods of time after PDT because of the high incidence of polypoidal lesion recurrence. However, since polypoidal lesions often recur outside the fovea, and thus have little effect on VA, PDT can be expected to exert long-term efficacy in treating PCV.     

Chorioretinal anastomosis after photodynamic therapy for polypoidal choroidal vasculopathy

An 80-year-old woman was treated with photodynamic therapy (PDT) to the left eye for polypoidal choroidal vasculopathy (PCV). About 3 months after PDT, her left eye developed a chorioretinal anastomosis with severe atrophy of the retinal pigment epithelium in the macula; visual acuity in this eye was 20/1000. She received a second session of PDT, plus an intravitreal injection of triamcinolone acetonide. About 3 months after the second treatment, the chorioretinal anastomosis was enlarged and the retinal vessels involved in the anastomosis were more dilated. About 1 year after the first PDT, visual acuity in the left eye had stabilized at 20/400. Development of a chorioretinal anastomosis is a distinct possibility following PDT in eyes with PCV, and can lead to poor visual recovery.     

Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE: To evaluate the clinical features and risk factors of hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after photodynamic therapy (PDT). METHODS: We retrospectively reviewed data for 91 consecutive eyes of 85 patients who underwent PDT for the treatment of PCV. The diagnosis of PCV was based on indocyanine green angiographic findings, showing a branching vascular network terminating in polypoidal swelling. The greatest linear dimension included all polypoidal lesions, leaking vascular network, and type 2 choroidal neovascularization. RESULTS: During the follow-up period after PDT, postoperative subretinal hemorrhage was seen in 28 (30.8%) of 91 eyes. In 22 (78.6%) of these 28 eyes, subretinal hemorrhage was absorbed without treatment. In 6 eyes (21.4%), however, bleeding resulted in vitreous hemorrhage, and 2 eyes underwent pars plana vitrectomy. Although visual acuity was maintained or increased in 18 (81.8%) of 22 eyes with subretinal hemorrhage alone, it decreased significantly in 3 (50.0%) of 6 eyes with postoperative vitreous hemorrhage. Various systemic diseases and medication with an anticoagulant had no correlation with these hemorrhagic complications. Laser irradiation spot size for PDT was significantly larger in eyes with postoperative vitreous hemorrhage (P = 0.017) than in those without. CONCLUSION: Subretinal hemorrhage after PDT can be a common complication in patients with PCV and may have a minor effect on visual outcome. However, postoperative hemorrhage is occasionally so massive that it leads to vitreous hemorrhage and poor visual prognosis. When considering PDT for eyes with a large PCV lesion, ophthalmologists should be aware of the risk of serious hemorrhagic complications.     

光动力疗法治疗息肉状脉络膜血管病变随访三年效果观察

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

Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy

Purpose  

To evaluate the visual outcomes and changes in abnormal vascular networks and polypoidal lesions of polypoidal choroidal vasculopathy (PCV) 3 years after photodynamic therapy (PDT).     

Exudative idiopathic polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin

PURPOSE: To report two cases of exudative idiopathic polypoidal choroidal vasculopathy treated by photodynamic therapy with verteporfin. DESIGN: Interventional case reports. METHODS: Two patients, a man aged 58 years and a woman aged 57 years, with recent visual impairment in the right eye (OD) (both eyes best-corrected visual acuity: 10/50 and Pelli-Robson contrast sensitivity 1.35 and 1.20) and angiographically proved subfoveal idiopathic polypoidal choroidal vasculopathy were treated with photodynamic therapy using verteporfin (Visudyne; Novartis SA, Rueil Malmaison, France). Functional and angiographic outcomes were assessed 6 weeks and 3, 6, and 12 months after treatment. RESULTS: In Patient 1, 3 months after treatment, best-corrected visual acuity and contrast sensitivity improved (10/16 and 1.50) and then remained stable throughout the 12 months after treatment. In Patient 2, 6 weeks after treatment, vision and contrast sensitivity were 10/20 and 1.35; and at 3 months, were improved and stabilized at 10/12.5 and 1.50. Angiographically, photodynamic therapy with verteporfin was associated with nonperfusion and occlusion of the exudative polypoidal dilations. No acute recurrence was noted during the follow-up period. CONCLUSION: In subfoveal exudative idiopathic polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin may be associated with beneficial functional results.     

维替泊芬光动力疗法治疗息肉状脉络膜血管病变的随访观察

目的 观察维替泊芬光动力疗法(photodynamic therapy,PDT)对息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)的1年治疗效果.方法 9例(10只眼)经眼底彩照、荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)确诊的PCV患者,进行常规的PDT治疗,治疗后随访第2周、1月、3月、6月、1年,观察治疗前后的视力、眼底彩照、FFA和(或)ICGA.结果 PDT治疗后1年视力提高3只眼,视力稳定6只眼,1只眼PDT治疗后出血吸收第2月复发黄斑区出血视力下降;1只眼治疗后第2周出现严重视网膜下出血,随访后渐吸收,其余患眼底出血、渗出均吸收消失.第3个月造影检查渗漏停止7只眼,3只眼轻微渗漏,末次随访3只眼仍轻微渗漏.PDT治疗过程无一例出现严重全身并发症.结论 PDT是一种安全有效的PCV治疗方法,可以短期内减轻或封闭异常血管的渗漏,促进出血、渗出吸收,稳定或提高患者视力,个别患者治疗后出现严重网膜下出血能自行吸收.

Abstract：

Objective To observe prospectively one-year's effect of photodynamic therapy (PDT)with verteporfin in polypoidal choroidal vasculopathy (PCV). Methods Nine patients (10 eyes) diagnosed as PCV according to fundus color, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed PDT. Visual acuity, Fundus appearance, FFA and/or ICGA were compared before PDT, and then at 2 weeks, 1 month, 3 months, 6 months and 12 months afier PDT.Results One year after the PDT, visual acuity was improved in 3 eyes and stabilized in 6 eyes. Visual acuity in one eye decreased again because of recurred macular bleeding. Massive subretinal hemorthage in one eye appeared two weeks after PDT and absorbed during the period of follow-up. The bleeding and exudates in the last 8 eyes were absorbed during the follow-up. At the 3 months, FFA and/or ICGA showed no Ieakage in 7 eyes, slight leakage in 3 eyes and still leakage at the final follow-up. No systemic adverse effect was found during and after PDT. Conclusions PDT offers an effective and safe way of treating PCV. PDT may relieve or stop vascular leakage, promote the elimination of the retinal hemorrhage and exudates, improve or stable the visual acuity. Massive retinal hemorrhage after PDT appears and absorbs in individual patients.     

Classic choroidal neovascularization developing after photodynamic therapy in eyes with polypoidal choroidal vasculopathy

Purpose  

To investigate the characteristics of eyes with polypoidal choroidal vasculopathy (PCV) which develop secondary classic choroidal neovascularization (CNV) after photodynamic therapy (PDT).