Photodynamic Therapy For Subfoveal Choroidal Neovascularization Research Articles

Outcome of photodynamic therapy in choroidal neovascularization due to pathologic myopia and related factors

To evaluate the outcome of photodynamic therapy (PDT) and the factors influencing its outcome in patients with subfoveal choroidal neovascularization (CNV) due to pathologic myopia. Twenty-three eyes of 21 consecutive patients who received PDT for subfoveal CNV due to pathologic myopia and who were followed for >12 months were included in the study. The relationship between the factors that might affect the treatment outcome were evaluated. Mean age was 48.7 ± 16.0 years (23-74 years). Mean follow-up was 23.2 ± 7.7 months (15-41 months). Mean logMAR visual acuity was 0.85 ± 0.24 before treatment, 0.89 ± 0.37 at 12 months, and 0.92 ± 0.46 at the final visit. Mean logMAR visual acuity did not change significantly at 12 months or at the final visit (P = 0.47 and 0.36, respectively). The baseline visual acuity strongly correlated with the final visual acuity (P = 0.001). Age showed an inverse correlation with change in logMAR visual acuity at 12 months (P = 0.01). PDT prevented significant visual loss in eyes with subfoveal CNV due to pathologic myopia. Better initial visual acuity resulted in better final visual acuity. Younger age was correlated with better treatment outcome at 12 months.

Peripapillary choroidal neovascularization in best disease.

Best disease is an autosomal dominant retinal dystrophy with a variable phenotypic expression. Clinically, it is characterized by a vitelliform lesion in the macula because of the deposition of yellow material in a dome-shaped configuration, believed to be lipofuscin that accumulates within and beneath the retinal pigment epithelium. Best disease is occasionally complicated by the development of choroidal neovascularization (CNV), which typically occurs in the macula. We report a case of peripapillary CNV in Best disease. Interventional case report. A 12-year-old boy who was previously diagnosed with Best disease was treated with reduced fluence photodynamic therapy for subfoveal CNV in the right eye. After 2 months, he presented with peripapillary CNV in the left eye, which was treated with repeated sessions of reduced fluence photodynamic therapy. Ophthalmologists must be aware that peripapillary CNV may occasionally complicate Best disease and can be successfully treated with photodynamic therapy.

Is reduction in the risk of vision loss the only benefit of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization?

To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV). A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT. After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001). This study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.

Retinal Pigment Epithelial Marginal Retraction after Photodynamic Therapy for Choroidal Neovascularization in Pathologic Myopia

To report the incidence of retinal pigment epithelial (RPE) marginal retraction after verteporfin photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) in pathologic myopia (PM). Retrospective review of 236 patients treated with PDT for subfoveal CNV due to PM. RPE marginal retraction was found in 3 eyes (1.3%), and a decrease of a mean of five lines of vision was reported to occur 10-15 days after treatment. At the end of followup two eyes lost three lines and one six lines from baseline. RPE marginal retraction as an early complication of PDT for subfoveal CNV secondary to PM is rare. The low incidence of this adverse event, however, should not preclude recommendations for PDT in myopic eyes that could benefit from this treatment modality.

Choroidal Neovascularization in Pathologic Myopia: Three-Year Results After Photodynamic Therapy

To examine whether the encouraging functional results one year after photodynamic therapy (PDT) can be maintained up to three years. Prospective interventional case series. 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. 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. 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.

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration: results of an effectiveness study.

To determine the postapproval effectiveness of photodynamic therapy (PDT) with verteporfin for the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. Forty-five consecutive patients treated with PDT for subfoveal CNV were compared with an untreated historical control group. Control patients had subfoveal CNV and were first seen by us within 1 year before Health Canada's approval of verteporfin. Both groups were followed up for the development of significant visual loss, stability, or improvement. Multivariate models were constructed to evaluate the effectiveness of PDT, controlling for multiple covariates (age, sex, baseline visual acuity, follow-up time, lesion size, and number of treatments). Significant differences were noted in the change in visual acuity between those who did and did not receive PDT (chi(2) = 5.9, P =.048). Patients who received PDT were 2.9 times (95% confidence interval, 0.9-9.1) less likely to develop a moderate (>2 lines) visual loss (chi(2) = 3.2, P =.07). Controlling for covariates, patients who received PDT were 13.7 times (95% confidence interval, 1.4-132.6) more likely to develop a visual improvement of at least 1 line. Compared with historical controls, PDT was demonstrated to be effective for the treatment of predominantly classic subfoveal CNV.

Photodynamic therapy for choroidal neovascularization associated with pattern dystrophy.

To report the results of photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) associated with nine eyes affected by pattern dystrophy of the retinal pigment epithelium. Each patient underwent an ophthalmologic examination complete with electroretinogram, electrooculogram, fluorescein angiography, and indocyanine green angiography to define the characteristics of the CNV. PDT was administered according to the TAP protocol. Re-treatment was decided on the basis of the detection of leakage on fluorescein angiography. Classic subfoveal CNV was associated with four cases of reticular dystrophy, one case of butterfly-shaped dystrophy, and one case of pattern dystrophy simulating fundus flavimaculatus. Moreover, three cases of adult-onset foveomacular vitelliform dystrophy showed occult subfoveal CNV. The mean follow-up was 15.6 +/- 2.1 months. Adult-onset foveomacular vitelliform dystrophy has the worst visual outcome, passing from 20/59 to 20/640 (mean variation, -10.7 lines), whereas the other forms of pattern dystrophy overall retain their baseline best-corrected visual acuity of 20/51 (mean variation, +0.17 lines). Photodynamic therapy for subfoveal CNV associated with pattern dystrophy of the retinal pigment epithelium can stabilize visual acuity, except for occult CNV associated with adult-onset foveomacular vitelliform dystrophy.