The role of oral steroids in the treatment of photodynamic therapy-associated exudative maculopathy, a case report and review of the literature

PHOTODYNAMIC THERAPY-INDUCED ACUTE EXUDATIVE MACULOPATHY IN A CASE SERIES OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA

PURPOSE

To describe the incidence, features, and clinical outcomes of photodynamic therapy-induced acute exudative maculopathy (PAEM) in circumscribed choroidal hemangioma.

METHODS

Prospective series of 10 patients who underwent standard-fluence photodynamic therapy for circumscribed choroidal hemangioma. Best-corrected visual acuity in the Early Treatment Diabetic Retinopathy Score and swept-source optical coherence tomography were performed before PDT and 3 days and 1 month after PDT. Central retinal thickness, circumscribed choroidal hemangioma retinal thickness, and subretinal fluid were measured. Photodynamic therapy-induced acute exudative maculopathy was considered as an increase ≥50 µ m in subretinal fluid or intraretinal fluid or the appearance of fibrin 3 days after photodynamic therapy.

RESULTS

Six men and four women were included; median age was 55 years (19-69 years). The incidence rate of PAEM was 7 of 10. Five PAEM patients showed an increase in intraretinal fluid, two in subretinal fluid, and one developed abundant fibrin. Median best-corrected visual acuity at baseline was 57.5 letters (5-76 letters) being stable at 1 month (64 letters; 5-80) ( P = 0.03). Median central retinal thickness increased from 516 µ m (262-1,265 µ m) to 664.5 µ m after 3 days and diminished to 245 µ m after 1 month (156-1,363) ( P ≤ 0.022). In 6 of 7 of PAEM, a complete resolution of the fluid was obtained.

CONCLUSION

Photodynamic therapy-induced acute exudative maculopathy was frequent in circumscribed choroidal hemangioma, although a favorable prognosis was observed in most cases.

Photodynamic Therapy-Induced Acute Exudative Maculopathy (PAEM): Prevalence, Impact and Management Strategies

Photodynamic therapy (PDT) has a niche role in treating various choroidal pathologies. PDT-induced acute exudative maculopathy (PAEM) is an uncommon complication of PDT that results in exudative retinal detachment and mild to severe decrease in vision. Successful management strategies include observation, local or systemic corticosteroids, and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Most cases return to visual acuity near baseline. This review summarizes what is known about PAEM to date including etiology, prevalence, management strategies, and outcomes. We conclude that management of PAEM must take into consideration various patient-specific factors. Treatment with corticosteroids or anti-VEGF agents may expedite time to recovery, though lack of randomized controlled trials preclude firm conclusions regarding a standardized approach to managing this complication of PDT.

Early anatomical changes and association with photodynamic therapy induced acute exudative maculopathy in patients with macular diseases

The purpose of this study was to investigate the occurrence rate and predictors of photodynamic therapy (PDT) induced acute exudative maculopathy (PAEM). This retrospective study included 39 eyes of 39 patients (32 males and 7 females), who were treated with initial PDT. PAEM was defined as an increase in central retinal thickness (CRT) of 15% or more measured by OCT on day 3 after PDT compared with baseline. Sixteen of 39 eyes (41%) were classified in the PAEM+ group. CRT and central choroidal thickness (CCT) were significantly increased at 3 days in the PAEM+ group and significantly decreased at 1 month after PDT in the PAEM- group. In a multiple comparison, neovascular age-related macular degeneration (nAMD) had a significantly higher incidence of PAEM compared to polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC). The incidence of PAEM was lower in PCV and CSC, and higher in nAMD. BCVA at 1 month was significantly worse in the PAEM group, which may be related to visual prognosis after PDT. Since both CRT and CCT decrease at 1 month, the detection of PAEM needs to be assessed a few days after PDT.

ACUTE EXUDATIVE MACULOPATHY AND BACILLARY LAYER DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY PATIENTS AFTER PHOTODYNAMIC THERAPY

PURPOSE

To describe the incidence and characteristics of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) and bacillary layer detachment (BALAD) in patients with chronic central serous chorioretinopathy (CSCR).

METHODS

Prospective observational case series including 92 eyes of 75 patients that underwent PDT. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and OCT angiography were performed before, 3 days, 1 month and 3 months after half-fluence PDT. Two groups were established depending on the presence or absence (N=28 and N=64 respectively) of PAEM. Choriocapillaris flow voids increase, subfoveal choroidal thickness (SFCT) and the presence of choroidal neovascularization (CNV) were collected.

RESULTS

The incidence of PAEM was 28/92 (30.4%). There was no difference in the age, gender, baseline subretinal fluid (SRF), SFCT or the presence of CNV between groups (p≥0.094). No differences emerged in the SRF at one and three months after PDT between groups (p≥0.524), nor in the mean BCVA gain at three months (4.1±7.6 versus 3.6±6.4 letters; p=0.773). A BALAD was observed in 13 patients with PAEM (46.4%).

CONCLUSION

PAEM is frequent in patients with chronic CSCR but has a favorable prognosis. There was no association between PAEM and age, gender, SFCT or CNV, however, it was related to choriocapillaris flow voids increase.