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Sakaeda Y, Kato A, Kuwayama S, Hirahara S, Suzuki N, Ogura Y, Nakazawa Y, Yasukawa T. Long-Term Prognosis of Patients with Polypoidal Choroidal Vasculopathy Treated with Photodynamic Therapy. J Clin Med 2023; 12:4707. [PMID: 37510825 PMCID: PMC10381275 DOI: 10.3390/jcm12144707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
We evaluated the long-term prognosis of the eyes of patients with polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT). In total, 60 eyes of 57 patients diagnosed with PCV and treated with PDT were reviewed retrospectively in real-world settings. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), anatomical findings (vision-threatening findings), and treatment history were assessed. In total, 38 eyes underwent PDT as the initial treatment (initial PDT group) and 22 eyes underwent PDT as a rescue treatment (rescue PDT group). In the initial PDT group, 11 eyes (29%) did not require additional therapy throughout the observation period and maintained good BCVA. A total of 27 eyes (71%) underwent additional treatments and the mean BCVA was only stabilized for 2 years; thereafter, decreased vision occurred even with additional treatments. In the rescue PDT group, 22 eyes (95%) required additional treatment. Hard exudate, serous pigment epithelial detachment, and the total vision-threatening score were related to worse BCVA. Initial PDT may be effective in about 30% of cases with preservation of good vision and no need for additional treatment. However, patients with received rescue PDT needed additional treatment in most cases and the vision decreased in many cases.
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Affiliation(s)
- Yukinori Sakaeda
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Aki Kato
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Soichiro Kuwayama
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shuichiro Hirahara
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Norihiro Suzuki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yoko Nakazawa
- Department of Ophthalmology, Nagoya City University, West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Ando R, Hirooka K, Saito M, Kase S, Noda K, Ishida S. Two-year clinical outcomes of triple therapy with photodynamic therapy, anti-vascular endothelial growth factor agent, and triamcinolone acetonide for neovascular age-related macular degeneration. Jpn J Ophthalmol 2023; 67:50-58. [PMID: 36346553 DOI: 10.1007/s10384-022-00955-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To analyze the 2-year treatment outcomes of triple therapy with standard-fluence photodynamic therapy (PDT), intravitreal injection of ranibizumab (IVR)/aflibercept (IVA), and sub-tenon injection of triamcinolone acetonide (STTA) for neovascular age-related macular degeneration (nAMD) in Japanese patients. STUDY DESIGN A retrospective, clinical case-series study. METHODS Forty-four eyes of 44 patients with treatment-naïve nAMD followed for more than 24 months were evaluated. Initial treatment was given with triple therapy and retreatment with IVR/IVA as a pro re nata regimen. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), the number of treatments, and intraocular pressure elevation were analyzed. RESULTS The mean age was 73.3 ± 10.0 years. The mean BCVA significantly improved from 0.61 ± 0.30 at baseline to 0.50 ± 0.46 at 24 months (p = 0.034). CRT significantly improved from 373 ± 162 μm at baseline to 200 ± 107 μm at 24 months (p < 0.001). The number of treatments given during the 2-year treatment period was 2.7 ± 1.8. No retreatments were necessary in 18 of 44 eyes (40.9%), with no significant difference between IVR (46.4%) or IVA (31.3%) used during the 2-year follow-up of triple therapy (p = 0.51). Four eyes (9.1%) temporarily required glaucoma eye drop treatments. CONCLUSION In nAMD patients, induction treatment with triple therapy resulted in approximately 40% of the patients requiring no retreatment for 2 years. The type of anti-VEGF agents used made no difference in the results.
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Affiliation(s)
- Ryo Ando
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kousuke Noda
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
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Formica M, Ullio Gamboa G, Tártara L, Luna J, Benoit J, Palma S. Triamcinolone acetonide-loaded lipid nanocapsules for ophthalmic applications. Int J Pharm 2020; 573:118795. [DOI: 10.1016/j.ijpharm.2019.118795] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/09/2019] [Accepted: 10/12/2019] [Indexed: 12/17/2022]
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Sakai T, Kato N, Kubota M, Tsuneoka H. Effects of photodynamic therapy plus intravitreal aflibercept with subtenon triamcinolone injections for aflibercept-resistant polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2017; 255:1565-1571. [PMID: 28601912 DOI: 10.1007/s00417-017-3700-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/14/2017] [Accepted: 05/30/2017] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the outcome of triple therapy of photodynamic therapy combined with injections of intravitreal aflibercept (IVA) and subtenon triamcinolone acetonide for polypoidal choroidal vasculopathy (PCV) resistant to IVA. METHODS A retrospective chart review at a single institution was conducted to identify patients with PCV resistant to treatment with IVA who were switched to treatment with triple therapy. In total, 13 eyes from 13 patients were included in the study. Demographic data, visual acuities, central retinal thickness (CRT) and height of pigment epithelial detachment (PED) on optical coherence tomography (OCT), complications, and number of injections were reviewed. RESULTS The patients had a mean age of 68 years (range 53-83). The number of prior injections with IVA ranged from 5 to 10. At 12 months follow-up after triple therapy, there was a significant improvement in visual acuity (P = 0.0039), a significant decrease in CRT (P = 0.003), and a significant reduction of the height of PED (P = 0.015). Only one patient had retinal pigment epithelium tear. CONCLUSIONS Triple therapy improved visual and anatomical outcomes in patients with PCV with recurrent or resistant retinal fluid and PED after multiple injections with IVA.
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Affiliation(s)
- Tsutomu Sakai
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan. .,Jikei Daisan Hospital, Komae, Japan.
| | - Noriko Kato
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaomi Kubota
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Teh BL, Megaw R, Borooah S, Dhillon B. Optimizing cataract surgery in patients with age-related macular degeneration. Surv Ophthalmol 2016; 62:346-356. [PMID: 28012877 DOI: 10.1016/j.survophthal.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of visual impairment. The development of cataract in AMD patients poses challenges in assessing timing of surgery, predicting potential benefit to the patient of surgery, and predicting short- and long-term effects of surgery on progression of their AMD. Although traditional cataract surgery remains the mainstay of treatment, recently several devices have been developed to address the specific needs of AMD patients with cataract. We look at the associations between cataract and AMD and outline the treatment approaches to cataract surgery in AMD, looking at the potential benefits and risks of both traditional approaches and newer devices. We provide clinicians treating patients with AMD and cataract with a framework for choosing the appropriate management.
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Affiliation(s)
| | - Roly Megaw
- Princess Alexandra Eye Pavilion, Edinburgh, UK
| | | | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Liang IC, Lin YR, Chien HW, Liu KR. Vision Preservation in Eyes of Polypoidal Choroidal Vasculopathy with Low-Dose Intravitreal Triamcinolone Acetonide. J Ocul Pharmacol Ther 2016; 33:42-49. [PMID: 27991837 DOI: 10.1089/jop.2015.0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To evaluate the efficacy and adverse effects of using low-dose intravitreal triamcinolone acetonide (IVTA) to preserve vision in polypoidal choroidal vasculopathy (PCV) eyes. METHODS This retrospective chart review study examined 8 eyes of 7 PCV patients, for whom verteporfin photodynamic therapy (vPDT) or antivascular endothelial growth factor (VEGF) therapy was not affordable/available and also with intolerable risk because of underlying cardiovascular and/or cerebrovascular ischemia. Low-dose IVTA (1 mg/0.025 mL) monotherapy was administered and repeated every 4 weeks if intraretinal edema or subretinal fluid persisted. RESULTS The median follow-up time was 26.4 months. Three eyes (3/8) maintained their initial best-corrected visual acuity and 4 eyes (4/8) exhibited improvement, whereas 1 eye (1/8) sustained some loss. The mean injection number per month was 0.7 for the first 6 months, after which it decreased to 0.4. In regard to adverse effects, intraocular pressure (IOP) of more than 21 mmHg was noted as persisting for a few weeks in 4 eyes and that of more than 30 mmHg was noted once in 1 eye. The increased IOP was adequately controlled by using IOP-lowering agents. Two initially phakic eyes each underwent cataract surgery in the 12th and 14th months after treatment. CONCLUSIONS Low-dose IVTA therapy may be valuable for preserving the vision of PCV patients, while vPDT or anti-VEGF is not affordable/available or of those with underlying diseases for whom anti-VEGF therapy is with intolerable risk.
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Affiliation(s)
- I-Chia Liang
- 1 Cathay General Hospital , Taipei, Taiwan .,2 Fu-Jen University, New Taipei City, Taiwan
| | - Yi-Ru Lin
- 1 Cathay General Hospital , Taipei, Taiwan .,3 Taiwan Adventist Hospital , Taipei, Taiwan
| | | | - Kwan-Rong Liu
- 1 Cathay General Hospital , Taipei, Taiwan .,3 Taiwan Adventist Hospital , Taipei, Taiwan .,4 National Taiwan University Hospital , Taipei, Taiwan
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Hashemi S, Faramarzi MA, Ghasemi Falavarjani K, Abdollahi M. Bevacizumab for choroidal neovascularization secondary to age-related macular degeneration and pathological myopia. Expert Opin Biol Ther 2014; 14:1837-48. [DOI: 10.1517/14712598.2014.967210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Barthelmes D, Walton R, Campain AE, Simpson JM, Arnold JJ, McAllister IL, Guymer RH, Hunyor AP, Essex RW, Morlet N, Gillies MC. Outcomes of persistently active neovascular age-related macular degeneration treated with VEGF inhibitors: observational study data. Br J Ophthalmol 2014; 99:359-64. [PMID: 25249615 DOI: 10.1136/bjophthalmol-2014-305514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To describe outcomes of eyes with wet age-related macular degeneration (AMD) subdivided by lesion activity in a large multicentre cohort study. METHODS Treatment-naive eyes with subfoveal choroidal neovascularisation receiving antivascular endothelial growth factor therapy enrolled in the Fight Retinal Blindness observational study were included. Lesions were graded at each visit as active if there was intraretinal or subretinal fluid attributable to leak from choroidal neovascularisation lesion or fresh haemorrhage. Eyes were divided into four groups; based on the proportion of visits, each eye was graded as active during the first 12 months of treatment (persistent, high, moderate and low activity). RESULTS 655 eyes were included. Similar mean visual acuity changes compared with baseline were observed in all four groups at 12 months (+6.8, +8.3, +6.2 and +5.5 letters for the low, moderate, high and persistent groups, respectively; p<0.001 for each group). The mean number of injections given increased only modestly in groups with more active lesions (7.6, 7.9, 8.4 and 8.3, respectively, p=0.015). Occult and minimally classic lesions were more frequent in the more active groups (p=0.024). CONCLUSIONS Persistent activity of neovascular lesions during 12 months after starting intravitreal therapy was not associated with worse visual outcomes in this observational study of AMD.
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Affiliation(s)
- Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard Walton
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anna E Campain
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Judy M Simpson
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Robyn H Guymer
- Center for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia Retina Associates, Chatswood, New South Wales, Australia
| | - Rohan W Essex
- Department of Ophthalmology, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Nigel Morlet
- Department of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Sakai T, Ohkuma Y, Kohno H, Hayashi T, Watanabe A, Tsuneoka H. Three-year visual outcome of photodynamic therapy plus intravitreal bevacizumab with or without subtenon triamcinolone acetonide injections for polypoidal choroidal vasculopathy. Br J Ophthalmol 2014; 98:1642-8. [PMID: 25053762 DOI: 10.1136/bjophthalmol-2014-305189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To 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) injections for polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective, comparative, interventional case series. METHODS Medical records for 36 eyes in 36 patients (33 men, 3 women; mean age 73.5 years old; range 63-82 years old) with treatment-naive subfoveal PCV were reviewed retrospectively. Of the 36 eyes, 17 were treated with double therapy and 19 with triple therapy. RESULTS The change in visual acuity after triple therapy was significantly better than that after double therapy (p<0.05). At 36 months, improvement in visual acuity was seen in 5 eyes (29.4%) in the double therapy group and 10 eyes (52.6%) in the triple therapy group. Retreatment using the initial treatment was performed for six eyes (35.3%) in the double therapy group and five eyes (26.3%) in the triple therapy group, and treatment-free period was significantly longer in the triple therapy group (p<0.05). The mean number of additional antivascular endothelial growth factor therapy was higher in the double therapy group. Post-treatment vitreous haemorrhage or retinal pigment epithelium tear occurred only in the double therapy group, in one eye (5.9%) and one eye (5.9%), respectively. CONCLUSIONS Initial therapy consisting of a single session of PDT combined with IVB and STTA improves vision in treatment-naive subfoveal PCV. Compared with double therapy, this triple therapy may be more effective for PCV.
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Affiliation(s)
- Tsutomu Sakai
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Ohkuma
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Hideo Kohno
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Takaaki Hayashi
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Watanabe
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
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Ogino K, Tsujikawa A, Yamashiro K, Ooto S, Oishi A, Nakata I, Miyake M, Takahashi A, Ellabban AA, Yoshimura N. Multimodal evaluation of macular function in age-related macular degeneration. Jpn J Ophthalmol 2013; 58:155-65. [DOI: 10.1007/s10384-013-0295-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
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