Single Session Of Photodynamic Therapy Research Articles

Internalization-Responsive Poly(lactic-co-glycolic acid) Nanoparticles for Image-Guided Photodynamic Therapy against HER2-Positive Breast Cancer

Oncotheranostic nanoagents are powerful artificial tools that significantly outperform traditional antitumor therapies. Among the wide variety of nanoagents, poly(lactic-co-glycolic acid) (PLGA) nanoparticles have proven to be one of the most successful candidates for translation into clinical practice. Here, we present PLGA nanoparticles for HER2-targeted diagnostic and photodynamic therapy with proven efficacy in vivo. Namely, we developed an oncotheranostic platform that is based on PLGA nanoparticles and possesses red/green light dual-activated diagnostic/therapeutic properties for HER2-targeted photodynamic therapy of aggressive breast cancer. PLGA nanoparticles were loaded with a red light-activated dye Nile Blue with pronounced solvatochromic properties for diagnostic applications and with a green light-activated photodynamic sensitizer Rose Bengal for photodynamic therapy. Targeted delivery was ensured by the noncovalent decoration of nanoparticles with anti-HER2 antibodies, which can be readily adapted for large-scale biotechnological production. In vitro and in vivo studies proved the effectiveness of red light-mediated HER2-specific imaging and green light-induced cytotoxicity of anti-HER2 PLGA. Interestingly, these particles fluoresced only after cellular internalization, which minimizes background signals inside the organism, thus facilitating real-time diagnostics. The particles allowed efficient and selective visualization of the HER2-positive primary tumor node and metastases spread and led to complete remission in BALB/c Nu/Nu mice with the HER2-positive xenografts after a single session of photodynamic therapy.

Фотодинамическая терапия культи прямой кишки у больных язвенным проктитом

INTRODUCTION: Ulcerative colitis is a severe disease significantly reducing the patient’s quality of life. Approximately one third of patients per year suffering from this disease have indications for a surgical treatment — colectomy with ileostomy. Subsequently, not all patients appear suitable for reconstructive surgery, for which reason they are doomed to a life-long ileostomy. These facts stimulate us to search for new methods of treatment of the rectal stump remaining after colectomy. In this study, 10 patients having been operated for ulcerative colitis and having rectal proctitis, underwent a single session of photodynamic therapy. The effectiveness of photodynamic therapy was controlled before the session and one month after it using rectoscopy with rectal mucosa biopsy. Endoscopy results were evaluated on Shroeder and UCEIS scales. The results of histological examination were evaluated on Geboes scale. Maximum accumulation of Photoditazin in rectal stump affected with ulcerative proctitis, was determined after 1.5–2 hours. Upon achievement of this maximum, fluorescence of the rectal mucosa 10.8 times exceeded the initial level, while in the intact tissues, fluorescence increases only 2.8 times. After a session of photodynamic therapy, the level of fluorescence of the rectal mucosa reduced 3.11 times, which indicates a photochemical reaction (positive photobleaching) in the tissue. In evaluation of effectiveness of photodynamic therapy after a month, 9 patients of 10 showed improvement of endoscopic and histologic picture. In 2 patients, remission was achieved, in 7, the activity of ulcerative proctitis declined from moderate to mild level. In one patient, no changes were revealed on evaluated scales. In 90% of patients, a single session of photodynamic therapy showed a positive effect, but taking into account a small sample size and the absence of control group, further data collection with subsequent statistical analysis is planned. CONCLUSION: Photodynamic therapy of rectal stump in the operated patients with ulcerative proctitis can be considered an additional method of treatment and preparation for reconstructive surgery for formation of ileorectal anastomosis.

Lectin-Modified Magnetic Nano-PLGA for Photodynamic Therapy In Vivo

The extreme aggressiveness and lethality of many cancer types appeal to the problem of the development of new-generation treatment strategies based on smart materials with a mechanism of action that differs from standard treatment approaches. The targeted delivery of nanoparticles to specific cancer cell receptors is believed to be such a strategy; however, there are no targeted nano-drugs that have successfully completed clinical trials to date. To meet the challenge, we designed an alternative way to eliminate tumors in vivo. Here, we show for the first time that the targeting of lectin-equipped polymer nanoparticles to the glycosylation profile of cancer cells, followed by photodynamic therapy (PDT), is a promising strategy for the treatment of aggressive tumors. We synthesized polymer nanoparticles loaded with magnetite and a PDT agent, IR775 dye (mPLGA/IR775). The magnetite incorporation into the PLGA particle structure allows for the quantitative tracking of their accumulation in different organs and the performing of magnetic-assisted delivery, while IR775 makes fluorescent in vivo bioimaging as well as light-induced PDT possible, thus realizing the theranostics concept. To equip PLGA nanoparticles with targeting modality, the particles were conjugated with lectins of different origins, and the flow cytometry screening revealed that the most effective candidate for breast cancer cell labeling is ConA, a lectin from Canavalia ensiformis. In vivo experiments showed that after i.v. administration, mPLGA/IR775-ConA nanoparticles efficiently accumulated in the allograft tumors under the external magnetic field; produced a bright fluorescent signal for in vivo bioimaging; and led to 100% tumor growth inhibition after the single session of PDT, even for large solid tumors of more than 200 mm3 in BALB/c mice. The obtained results indicate that the mPLGA/IR775 nanostructure has great potential to become a highly effective oncotheranostic agent.

Superficial shaving combined with photodynamic therapy is effective as a treatment for condyloma acuminatum

AbstractCondyloma acuminatum is a common sexually transmitted disease caused by human papillomavirus. Its prevalence and recurrence rates are high. While there are multiple treatment options for condyloma acuminatum, no single therapy form is effective in achieving complete remission. Photodynamic therapy (PDT) was shown to be very promising as a treatment option for condyloma acuminatum. However, for some patients the therapeutic result after a single PDT session is not satisfactory. Thus, it is necessary to develop an effective treatment method for recalcitrant condyloma acuminatum.We hypothesize that suboptimal therapeutic results after a single PDT may be caused by an insufficient penetration of the photosensitizer into the tissue. Here, we applied a combination of superficial shaving and PDT to address this issue. All patients were satisfied with the effect of the treatment, and their quality of life improved significantly. Pain was the major adverse event during treatment but was acceptable to all patients. Therefore, superficial shaving in combination with PDT is safe and effective.

Assessment of clinical and radiographic peri‑implant parameters in the obese and non-obese, along with destructive pro-inflammatory cytokines IL-1β - and IL-6 in patients treated with Photodynamic therapy

AimThe present study aims to compare and evaluate radiographic and clinical parameters along with salivary proinflammatory cytokine profiles (IL-1β - and IL-6) in the obese with peri‑implantitis. Material and methodsObese and non-obese participants in the present study were 80. The nonobese and obese participants were scrutinized based on inclusion and exclusion criteria. All participants both obese and non-obese were subjected to full mouth mechanical debridement (MD). A single session of Photodynamic therapy (PDT) was provided to all obese participants. Clinical peri‑implant parameters peri‑implant plaque index (PIPI), Peri-implant bleeding on probing (PIBoP), peri‑implant probing depth (PIPD) were assessed at baseline, three months, and six months. Marginal bone loss (MBL) was also assessed. Enzyme-linked immunosorbent assay (ELISA) was used to check the levels of IL-1β - and IL-6 in unstimulated whole saliva samples. All the parameters were assessed using the Kruskal Wallis test and analysis of variance (ANOVA). Overall characteristics were assessed using descriptive statistics. SPSS software was used for statistical analysis. ResultsClinical baseline periodontal parameters PIPI, PIBoP, PIPD, and MBL in non-obese participants were significantly lower compared to group I obese participants at baseline (p < 0.05). At 3 months follow-up PDT adjunct to MD in group 1 obese participants PIPI and PIPD were significantly lower compared to MD alone in non-obese participants PIP1 and PIPD. At 6 months follow up, non-obese participants with peri‑implantitis treated with MD demonstrated PIPI and PIPD significantly lower compared to obese participants treated with PDT adjunct to MD ConclusionPDT adjunctive to MD enhanced periodontal parameters i.e., peri‑implant probing depth, peri‑implant plaque index, and peri‑implant bleeding on probing in obese with peri‑implantitis. Moreover, obese individuals with peri‑implantitis demonstrated high levels of proinflammatory cytokines IL-1β and IL-6 than control.

Effect of photodynamic therapy on the morphological changes of periapical inflammation: An experimental study in rats.

We aimed to explore the morphological changes with photodynamic therapy (PDT) in experimentally produced periapical lesions in rats, and to investigate if PDT used as an adjunct to conventional root canal debridement helps to enhance healing the inflammatory response around root apex of rats. Sixty adult Sprague-Dawley male rats (70-90 days/140-160 g) were experimented. Pulp was removed from the mesial root of the first maxillary molar and left open to oral environment to allow the formation of periapical lesion. The rats were numbered and randomly divided into two groups: (i) PDT group (n = 30) received a single session of PDT with conventional debridement and, (ii) Control group (n = 30) received conventional debridement but with no PDT. PDT application involved the use of methylene blue photosensitizer for 5 min inside the root canals and irradiated with diode laser of 805 nm and 20 W power output for 90 s and sealed. After 4 weeks, the experimental rats were sacrificed by cervical dislocation. The maxillary first molar was then collected along with the surrounding tissue for further processing. Hematoxylin and eosin and immunohistochemical staining were used to observe the morphological effects. Proliferating Cell Nuclear Antigen (PCNA), STRO-1 and CD-44 were used as the primary antibodies for the immunohistochemical study. A reduction in inflammatory cells, which were mainly composed of lymphocytes, was observed in the periapical lesions after PDT. The number of PCNA-positive cells increased to approximately twice in the PDT as compared to the control group. These PCNA-positive cells included STRO-1 and CD-44 positive cells, indicating enhancement of wound healing and reduction in inflammatory cells. The findings of the present experimental study indicate that PDT application induced proliferation of PCNA-positive cells, which included STRO-1 and CD44-positive cells. This suggests that PDT may help to enhance healing periapical lesion, indicating the potential of PDT in the treatment of periapical periodontitis.

5-Aminolevulinic acid patch (Alacare) photodynamic therapy for actinic cheilitis: data from a prospective 12-month follow-up study on 21 patients.

BackgroundActinic cheilitis (AC) is a variant of actinic keratosis (AK) affecting the lips and caused by chronic ultraviolet exposure.ObjectiveAlacare is a self‐adhesive, skin‐coloured 5‐aminolaevulinic acid patch that has been developed for use in photodynamic therapy (PDT) of mild‐to‐moderate AK. Based on promising preliminary results in the treatment of AC with Alacare patch PDT, we decided to extend our previous investigation to gain more data on the efficacy, tolerability, safety and cosmetic outcome of Alacare patch PDT for AC.MethodsTwenty‐one patients with a clinical diagnosis of mild‐to‐moderate AC were included in the study and subjected to one single session of PDT. After occlusion with the Alacare patch for 4 h, the AC lesions were illuminated for 10 min with red light at a dose of 37 J/cm2. All patients received local anaesthesia prior to illumination. Additionally, all lesions were cooled during PDT with a cold air blower. PDT‐induced pain and skin phototoxicity were monitored during and up to 7 days after PDT. Clinical assessment of efficacy, cosmetic outcome and global patient satisfaction was performed at 3, 6 and 12 months after treatment.ResultsNineteen patients completed the study. Three months after PDT, 17 patients (89.5%) had achieved complete remission. Of these, one patient presented with recurrence of AC at the 6‐month follow‐up, whereas all other patients remained in remission until the end of the observation period. The complete clinical cure rate at 1 year after a single Alacare patch PDT thus was 84.2%. Pain during illumination and the phototoxic skin reaction were in general mild to moderate. The cosmetic outcome was excellent.ConclusionThe present prospective study on Alacare patch PDT for AC confirms its high clinical efficacy, good tolerability and favourable cosmetic effects. Alacare patch PDT should be considered as a valid treatment option for patients with AC.

Clinical comparison between photodynamic therapy and pulsed dye laser for the treatment of port wine stains

Objective To compare the clinical efficacy and adverse effects of photodynamic therapy(PDT)versus pulsed dye laser(PDL)for the treatment of port wine stains(PWS). Methods Forty-five patients with PWS were enrolled in this study. The PWS lesions in each patient were randomly divided into PDT and PDL areas. Hematoporphyrin monomethyl ether of 5 mg/kg was injected intravenously into the PDT area protected from light, followed by 20-minute irradiation with a 532-nm, solid-state, continuous-wave laser(power density: 80-100 mw/cm2; spot diameter: 7 cm)10 minutes later. The PDL area was treated with a single session of 595-nm pulsed dye laser radiation(spot diameter: 7 mm; pulse width: 10 ms; energy density: 10-12 J/cm2). The interval between PDT and PDL treatment was no shorter than two months. Follow up visits were scheduled on day 4 and week 8 after each treatment. Adverse reactions were recorded, and photographs were taken before and 8 weeks after the treatment for evaluation of lesion regression. Results In the case of PDT area, 10 cases(22.22%)were nearly cured, 22(48.89%)achieved marked improvement, 9(20.00%)improvement, 4(8.89%)no improvement. As far as the PDL area is concerned, 6 cases(13.33%)were nearly cured, 16(35.56%)achieved marked improvement, 18(40.00%)improvement, and 5(11.11%)no improvement. The response rate was significantly higher in the PDT area than in the PDL area(Z = 2.48, P 0.05). Conclusion For the treatment of PWS, both PDT and PDL are effective and safe, and single-session PDT appears to be superior to single-session PDL. Key words: Port-wine stain; Phototherapy; Hematoporphyrin photoradiation

Photodynamic Therapy for Choroidal Metastasis

To evaluate the effectiveness of photodynamic therapy (PDT) in the management of choroidal metastasis. Retrospective, interventional case series. Patients with choroidal metastasis treated with PDT at a single institution were reviewed. PDT was applied with verteporfin at a dose of 6 mg/m(2) body surface area and a 689 nm diode laser for 83 seconds. Visual acuity, tumor basal diameter, tumor thickness by ultrasonography, and enhanced depth imaging optical coherence tomography (EDI-OCT), as well as associated features including subretinal fluid, were recorded before PDT and during follow-up examinations. Twenty-one tumors in 13 eyes of 10 patients were included. Eight tumors were treated with a single session of PDT, 11 tumors received 2 sessions, 1 tumor received 3 sessions, and 1 tumor received 5 sessions. At the end of a mean follow-up of 12 months (range, 3-42 months), 9 eyes (69%) had stable or improved visual acuity, while 4 eyes (31%) had decreased visual acuity. Mean logMAR change in visual acuity was -0.09 (range, -1.3 to 0.8). Seventeen of 21 tumors (81%) were flat at last follow-up. The mean decrease in ultrasound-measured thickness was 0.83 mm (range, 2.6 mm decrease to 1.4 mm increase), while the decrease in EDI-OCT-measured thickness was 400 μm (range, 1280 μm decrease to 280 μm increase). Eighteen tumors (86%) had complete resolution of subretinal fluid. There were no PDT-related complications. Photodynamic therapy may be an effective therapeutic option for the management of choroidal metastasis in selected cases.

Diffuse choroidal hemangioma associated with exudative retinal detachment in a Sturge–Weber syndrome case: Photodynamic therapy and intravitreous bevacizumab

We report the case of a young female patient with a diffuse choroidal hemangioma (DCH) and glaucoma as part of Sturge-Weber syndrome (SWS) and symptomatic retinal detachment that was treated successfully with photodynamic therapy (PDT) and intravitreal bevacizumab (IVB). The patient was treated with a single session of PDT, a 689-nm laser was used to deliver 50J/cm(2) with a maximum spot size of 6400μm, for 166s. IVB was administered 3 days later. The exudative retinal detachment (ERD), macular edema and visual acuity improved one week after treatment. The patient was followed for 18 months with no recurrence of ERD, and her visual acuity was preserved. PDT followed by IVB may be an effective treatment option for visual deterioration due to ERD in patients with DCHs, as are found in SWS.

Three-year visual outcome of photodynamic therapy plus intravitreal bevacizumab with or without subtenon triamcinolone acetonide injections for polypoidal choroidal vasculopathy

PurposeTo compare the 3-year visual outcome after double therapy of photodynamic therapy (PDT) with intravitreal bevacizumab (IVB) and triple therapy of PDT combined with IVB and subtenon triamcinolone acetonide (STTA)...

Single-session photodynamic therapy combined with intravitreal ranibizumab for neovascular age-related macular degeneration: a comprehensive functional retinal assessment

To explore functional retinal changes in neovascular AMD patients (nAMD) treated with ranibizumab 0.5 mg combined with photodynamic therapy (PDT) 3 days after the first injection in the long term. Patients with no prior treatment for nAMD were treated with 3 injections of ranibizumab 0.5 mg 1 month apart and a single session of standard PDT 3 days after the first injection. Best-corrected visual acuity and time-domain OCT at baseline and every 28 ± 2 days were performed; microperimetry at 3, 6, and 12 months and multifocal electroretinogramm (mfERG) at 3 and 12 months were repeated. Fluorescein angiography and vision-related quality-of-life questionnaire were performed at baseline and 12 months. 12/15 nAMD patients completed the 12 months study and received an average of 3.4 ± 0.7 injections. Mean VA changed from 54.67 ± 15.72 to 59.0 ± 24.77 letters (p = 0.371), while mean retinal sensitivity from 5.5 ± 4.8 to 6.6 ± 6.0 dB (p = 0.216). MfERG N1-P1 response amplitude densities (RADs) were significantly different from baseline (p < 0.01) in the central 0°-2.5°, whereas in the peripheral retinal areas (2.5°-20°), not significant (p > 0.01) changes in N1-P1 RADs were detected. The "general vision" VFQ-25 subscale showed a statistically significant improvement at 3 and 12 months. Ranibizumab 0.5 mg combined with standard PDT 3 days after the first injection determines an improvement of mfERG values in the retinal central area in nAMD patients in long-term follow-up.

Comparison of the Effect of Ranibizumab and Verteporfin for Polypoidal Choroidal Vasculopathy: 12-Month LAPTOP Study Results

To compare the effect of photodynamic therapy (PDT) and intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy (PCV). Randomized clinical trial. Multicenter. Total of 93 patients with treatment-naïve PCV. Patients were randomized to 2 arms. Patients in the PDT arm underwent a single session of PDT with verteporfin, and patients in the ranibizumab arm received 3 monthly ranibizumab injections at baseline. Additional treatment was performed as needed in each arm. Primary outcome measurement was the proportion of patients gaining or losing more than 0.2 logarithm of minimal angle of resolution (logMAR) units from baseline. Mean change of logMAR and central retinal thickness (CRT) were also evaluated. In the PDT arm (n = 47), 17.0% achieved visual acuity gain, 55.3% had no change, and 27.7% experienced visual acuity loss. The results were 30.4%, 60.9%, and 8.7%, respectively, in the ranibizumab arm (n = 46), significantly better than the PDT arm (P = .039). In the PDT arm, mean CRT improved (366.8 ± 113.6 μm to 289.1 ± 202.3 μm, P < .001), but logMAR was unchanged (0.57 ± 0.31 to 0.62 ± 0.40). The ranibizumab arm demonstrated improvement in both CRT (418.9 ± 168.6 μm to 311.2 ± 146.9 μm, P < .001) and logMAR (0.48 ± 0.27 to 0.39 ± 0.26, P = .003). Mean change of logMAR was also greater in the ranibizumab arm (P = .011). Intravitreal injection of ranibizumab is more effective than PDT for treatment-naïve PCV.

Side-by-side comparison of photodynamic therapy and pulsed-dye laser treatment of port-wine stain birthmarks

Pulsed-dye laser (PDL)-mediated photothermolysis is the current standard treatment for port-wine stain (PWS) birthmarks. Vascular-targeted photodynamic therapy (PDT) might be an alternative for the treatment of PWS. To compare clinical outcomes of PDT and PDL treatment of PWS. Two adjacent flat areas of PWS lesions were selected from each of 15 patients (two male and 13 female; age 11-36 years) and randomly assigned to either single-session PDL or PDT. PDL was delivered using a 585-nm pulsed laser. PDT was carried out with a combination of haematoporphyrin monomethyl ether (HMME) and a low-power copper vapour laser (510.6 and 578.2 nm). Clinical outcomes were evaluated colorimetrically and visually during follow-up. A total of nine red PWS lesions and six purple PWS lesions were treated. For red PWS, colorimetric assessment showed that the blanching rates of PDL and PDT at 2 months ranged from -11% to 24% and 22% to 55%, respectively. For purple PWS, blanching rates of PDL and PDT ranged from 8% to 33% and 30% to 45%, respectively. Overall, there was a significant difference between the blanching effect of single-session PDL treatment and a single-session PDT treatment. This side-by-side comparison demonstrates that PDT is at least as effective as PDL and, in some cases, superior. The true value of PDT for the treatment of PWS deserves further investigation.

Can photodynamic therapy reverse the signs of photoageing and field cancerization?

ORIGINAL ARTICLE, 150 Topical photodynamic therapy (PDT) is an effective and now widely approved therapy for actinic keratosis (AK), squamous cell carcinoma (SCC) in situ and certain basal cell carcinomas (BCC).1 As the photosensitizer can be applied to lesional and surrounding skin, with large area LED light sources available, PDT is increasingly used to treat field cancerization, the presence of multiple nonmelanoma skin cancers and precursor lesions including dysplastic keratinocytes in photoexposed sites.2 Several studies, predominantly in organ transplant recipients on long-term immunosuppressants, observed that field PDT can delay and reduce the development of a number of new nonmelanoma skin cancer lesions.3 Although a single treatment was shown to prevent AK, BCC and SCC during a 1-year follow-up study, other studies suggest repeated PDT sessions are necessary, with the current consensus that PDT can prevent AK, and potentially SCC, in transplant recipients.4 The development of multiple AK is also common against a background of severe photodamage in immunocompetent patients. A significant delay in the development of new AK has recently been observed in a split-face, placebo-controlled study of field PDT in photodamaged skin.5 Several clinical studies show that PDT can also improve other aspects of photodamage, with improvement in wrinkles, tactile roughness, sallowness and mottled pigmentation.6 Can PDT therefore achieve reversal of signs of photoageing and field cancerization? Beyond clinical observation, do we have evidence that PDT does anything more than treat emerging as well as visible superficial skin cancers, with a favourable healing profile? A recent study showed the potential for PDT to reduce the histological features of actinic damage and elastosis, and significantly decrease expression of Ki-67 and TP53, although expression of cyclin D1 remained stable following biopsies taken from lesional skin.7 Evidence that a single PDT session was insufficient to clear the early oncogenic markers supports clinical experience that multiple treatments are required to optimize the preventive effect of PDT. In this issue of BJD, Szeimies et al. report on the clinical, histological and immunohistochemical effect of three consecutive monthly treatments with PDT using methyl aminolaevulinate (MAL) on photodamaged skin with multiple AK.8 In addition to clearing 90% of visible AKs, a significant decrease in keratinocyte atypia (following biopsy from clinically normal skin) was reported, in addition to an increase in collagen deposition and improvement in solar elastosis. A decrease in TP53 expression using nonspecific staining was not significant but a smaller change might be anticipated pre- to post-PDT given that clinically normal skin was sampled. We are therefore accumulating evidence that PDT has the potential to reduce the carcinogenic potential in areas of field cancerization and promote improvement in certain aspects of photoageing. More studies please! None declared.

CLINICAL AND HISTOPATHOLOGIC FINDINGS AFTER PHOTODYNAMIC THERAPY OF CHOROIDAL MELANOMA

Photodynamic therapy (PDT) has been used occasionally as an alternative treatment for uveal melanomas. The present study describes the clinical and histopathologic features of five choroidal melanomas after PDT. Three patients with pigmented choroidal melanomas were treated with PDT and intravitreal bevacizumab 1 week before undergoing biopsy and brachytherapy to minimize the risks of bleeding during the biopsy. Another two patients received PDT as a primary treatment for peripapillary amelanotic melanomas, one of them also in combination with bevacizumab. The tumors treated with PDT and bevacizumab showed a marked reduction in tumor vascularity assessed by indocyanine angiography, and the biopsies were conducted without recognizable bleeding, showing viable tumor cells. The tumors receiving PDT as a primary treatment were followed by progressive tumor growth that led to enucleation years after. The histopathology revealed overlying fibrosis with invasion of sclera and optic nerve. Photodynamic therapy and bevacizumab can induce closure of the superficial vasculature of a pigmented choroidal melanoma, but in none of our cases, there was evidence of tumor destruction from this treatment. Preoperative PDT may be useful to reduce the potential of bleeding at the time of tumor biopsy. Our cases do not support the use of a single session of PDT as a primary treatment for pigmented small choroidal melanomas.

Photodynamic Therapy for Best Disease Complicated by Choroidal Neovascularization in Children

To describe the results of photodynamic therapy (PDT) with verteporfin for the treatment of choroidal neovascularization (CNV) associated with Best vitelliform macular dystrophy (BVMD) in children. Five eyes of four children diagnosed as having BVMD complicated by CNV received a single session of PDT. Response to treatment was monitored with fluorescein angiography and optical coherence tomography. All eyes responded well to one session of PDT with significant increases in visual acuity in four of the five eyes. Increase or stabilization of visual acuity was preserved during a mean follow-up period of 25 months. PDT may be an effective treatment for CNV associated with BVMD in children.

A Randomized Pilot Study of Low-Fluence Photodynamic Therapy Versus Intravitreal Ranibizumab for Chronic Central Serous Chorioretinopathy

To report 6-month outcomes of a prospective, randomized study comparing the efficacy and safety between low-fluence photodynamic therapy (PDT) and intravitreal injections of ranibizumab in the treatment of chronic central serous chorioretinopathy. Prospective, randomized, single-center pilot study. Sixteen eyes with chronic central serous chorioretinopathy were randomized to receive either low-fluence PDT or intravitreal injections of ranibizumab: 8 eyes in the low-fluence PDT group and 8 in the ranibizumab group. Rescue treatment was considered if subretinal fluid was sustained after completion of primary treatment: low-fluence PDT for the ranibizumab group and ranibizumab injection for the low-fluence PDT group. Main outcome measures were excess foveal thickness, resolution of subretinal fluid, choroidal perfusion on indocyanine green angiography, and best-corrected visual acuity. At 3 months, the mean excess foveal thickness was reduced from 74.1 ± 56.0 μm to -35.4 ± 44.5 μm in the low-fluence PDT group (P = .017) and from 26.3 ± 50.6 μm to -23.1 ± 56.5 μm in the ranibizumab group (P = .058). After a single session of PDT, 6 eyes (75%) in the low-fluence PDT group achieved complete resolution of subretinal fluid and reduction of choroidal hyperpermeability, whereas 2 (25%) eyes in the ranibizumab group achieved this after consecutive ranibizumab injections. Four eyes (50%) in the ranibizumab group underwent additional low-fluence PDT and accomplished complete resolution. At 3 months, significant improvement of best-corrected visual acuity was not demonstrated in the low-fluence PDT group (P = .075), whereas it was observed in the ranibizumab group (P = .012). However, the tendency toward improvement of best-corrected visual acuity was not maintained. In terms of anatomic outcomes, the effect of ranibizumab injections was not promising compared with that of low-fluence PDT.

One-Year Results of Intravitreal Ranibizumab with or without Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

Purpose: To evaluate the safety and efficacy of intravitreal ranibizumab with or without photodynamic therapy (PDT) in the treatment of polypoidal choroidal vasculopathy (PCV) in Korean patients. Methods: A retrospective chart review of 22 patients (24 eyes) with PCV was conducted. Nine eyes were treated with intravitreal ranibizumab combined with a single session of PDT (group 1), and 15 eyes were treated only with ranibizumab (group 2). Such clinical evaluations as best-corrected Snellen visual acuity, central retinal thickness (CRT) by optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA) were done at baseline, 1, 3, 6, 9 and 12 months after the first injections. Ranibizumab was reinjected on an as-needed basis guided by OCT, FA and ICGA, or at the doctor’s discretion. Results: The mean follow-up duration was 22.5 months (range 12–37). The mean best-corrected visual acuity (logMAR) improved, and the mean CRT decreased throughout 12 months in both groups; no statistically significant difference between the groups was found (p = 0.327, p = 0.073, respectively). The number of ranibizumab injections was not significantly different either (p = 0.555). Conclusions: Intravitreal ranibizumab with or without PDT for PCV in Korean patients resulted in visual and anatomical improvement over the 1-year follow-up period.

Field treatment of facial and scalp actinic keratoses with photodynamic therapy: Survey of patient perceptions of treatment satisfaction and outcomes

Diffuse field change with actinic keratoses (AK) is a ubiquitous skin disease in Australia, with potential for malignant transformation. We report on 35 consecutive patients who had field therapy with single session photodynamic therapy (PDT) using 1 h incubation time for 5-aminolevulinic acid (5-ALA) or 3 h for methyl-aminolevulinate (MAL). We retrospectively telephone surveyed our patient cohort regarding their satisfaction and perceptions of the effectiveness, side-effect profile and benefits of PDT. We also reviewed all patients' notes for significant side-effects. Sixty-nine per cent (n = 24/35) of patients responded to the telephone survey; 66% (n = 16/24) of the respondents reported good clearance of AK and claimed a good cosmetic outcome. All respondents reported moderate or severe pain (42% and 58%, respectively) during the illumination phase. Twenty per cent of all patients treated had suffered from one or more of the following side-effects: pustulation; severe erythema; and skin erosions. Overall, our results compared favourably with previously published studies using 5-ALA or MAL PDT. However, our patient cohort experienced a greater side-effect profile. This may have been due to our patients having greater disease burden compared to other studies and possibly due to our use of topical retinoids prior to PDT in selected patients.