Transient accumulation of subretinal fluid after half-fluence photodynamic therapy in neovascular age-related macular degeneration

Min Ho Kim,Ji Hun Song,Yoo-Ri Chung

doi:10.1186/s12886-021-01867-w

Min Ho Kim, Ji Hun Song + Show 1 more

Open Access

https://doi.org/10.1186/s12886-021-01867-w

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Journal: BMC ophthalmology	Publication Date: Feb 22, 2021
Citations: 2	License type: open-access

Affiliation: Onnuri Smile Eye Clinic, Ajou University

Abstract

BackgroundPhotodynamic therapy (PDT) is known to occlude choroidal neovascularisation selectively, and there have been several reports on its adverse effects on the normal choroid and retinal pigment epithelium, resulting in decreased vision.MethodsThis retrospective interventional case series aimed to investigate the changes in visual acuity and retinal thickness in the immediate post-treatment period after half-fluence PDT, administered alone or with anti-vascular endothelial growth factor and steroids, in 29 eyes (26 patients) with neovascular age-related macular degeneration. The patients’ best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography images were measured 1 day, 1 week, and 1 month post-treatment.ResultsCompared to the pre-treatment CFT (270.38 μm), the mean CFT was significantly increased 1 day post-treatment (387.07 μm, P = 0.001), which then started to decrease, with a mean CFT of 269.32 μm (P = 0.516) at 1 week, and of 240.66 μm (P = 0.066) at 1 month post-treatment. All CFT increases were due to the accumulation of subretinal fluid (SRF), rather than the intraretinal or subretinal pigment epithelium fluid. Relative to the pre-treatment BCVA (0.59 logMAR), the mean BCVA at 1 day (0.74 logMAR, P = 0.005) and 1 week (0.75 logMAR, P = 0.002) post-treatment was significantly deteriorated; however, it recovered to 0.62 logMAR at 1 month. The patterns of change in CFT and BCVA did not differ according to treatment modality.ConclusionsHalf-fluence PDT resulted in accumulation of SRF in the immediate post-treatment period; this damage mostly recovered within a week, and the BCVA was restored within a month.

Highlights

Photodynamic therapy (PDT) is known to occlude choroidal neovascularisation selectively, and there have been several reports on its adverse effects on the normal choroid and retinal pigment epithelium, resulting in decreased vision
Severe vision loss often occurs in neovascular Age-related macular degeneration (AMD) with choroidal neovascularisation (CNV) or polypoidal choroidal vasculopathy (PCV) [1]
Anti-vascular endothelial growth factor (VEGF) agents have become the mainstay for the treatment of CNV [7], there is still a need for PDT, especially in eyes that are refractory to various anti-VEGF agents

Summary

Introduction

Photodynamic therapy (PDT) is known to occlude choroidal neovascularisation selectively, and there have been several reports on its adverse effects on the normal choroid and retinal pigment epithelium, resulting in decreased vision. Severe vision loss often occurs in neovascular AMD with choroidal neovascularisation (CNV) or polypoidal choroidal vasculopathy (PCV) [1]. Photodynamic therapy (PDT) has been shown to be effective in the treatment of CNV, especially PCV; PDT has limitations that include inadequate vision improvement and the risk of choroidal atrophy [4, 5]. Anti-vascular endothelial growth factor (VEGF) agents have become the mainstay for the treatment of CNV [7], there is still a need for PDT, especially in eyes that are refractory to various anti-VEGF agents. Studies have demonstrated that PDT combined with intravitreal injection of an anti-VEGF agent is non-inferior or even superior to monotherapy with PDT or anti-VEGF in eyes with PCV or CNV [8,9,10]

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