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Garg SJ, Hadziahmetovic M. Verteporfin Photodynamic Therapy for the Treatment of Chorioretinal Conditions: A Narrative Review. Clin Ophthalmol 2024; 18:1701-1716. [PMID: 38881707 PMCID: PMC11178081 DOI: 10.2147/opth.s464371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Photodynamic therapy (PDT) with verteporfin involves intravenous administration of a photosensitizer followed by its laser light activation at the target site to inhibit aberrant choroidal vascularization. This narrative review provides an overview of the role verteporfin PDT plays in the management of chorioretinal conditions. A PubMed literature review of all English-language articles published through October 19, 2023, was conducted to identify relevant references. Verteporfin PDT has been shown to be safe and effective for the treatment of patients with choroidal neovascularization (CNV) due to neovascular age-related macular degeneration and is often used in combination with a vascular endothelial growth factor (VEGF) inhibitor. Additionally, patients with polypoidal choroidal vasculopathy, a subtype of neovascular age-related macular degeneration, also benefit from verteporfin PDT combined with a VEGF inhibitor for improving visual acuity. Verteporfin PDT has also been effective in treating patients with peripapillary CNV, as well as eyes with CNV due to ocular histoplasmosis and pathologic myopia. Reduced dose and/or fluence PDT protocols have been effective in patients with central serous chorioretinopathy while reducing adverse effects. In eyes with choroidal hemangioma, tumor regression and visual outcomes have been improved with verteporfin PDT treatment. Photodynamic therapy with verteporfin continues to play an important role in the management of chorioretinal conditions.
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Affiliation(s)
- Sunir J Garg
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
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Arora S, Zur D, Iovino C, Chhablani J. Peripapillary fluid: Obvious and not so obvious! Surv Ophthalmol 2024; 69:311-329. [PMID: 38016521 DOI: 10.1016/j.survophthal.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Intraretinal or subretinal fluid in the peripapillary area can be clinically visualized in conditions such as peripapillary choroidal neovascularization, optic disc pit maculopathy, and optic nerve head tumors and granulomas. Optical coherence tomography (OCT) helps to visualize peripapillary fluid in many other chorioretinal conditions such as peripapillary pachychoroid syndrome, posterior uveitis, central retinal vein occlusion, malignant hypertension, hypotonic maculopathy as well as neuro-ophthalmological conditions such as glaucoma, microcystic macular edema and disc edema due papilledema, non-arteritic anterior ischemic optic neuropathy, neuroretinitis, and diabetic papillopathy. Often, the differential diagnosis of peripapillary fluid is a bit tricky and may lead to misdiagnosis and improper management. We describe a diagnostic algorithm for peripapillary fluid on OCT and outline the salient features and management of these conditions.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas
| | - Dinah Zur
- Division of Ophthalmology, 26738 Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, United States.
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Hoyek S, Lu Y, Mukai S, Patel NA. Longitudinal Characteristics of Choroidal Neovascular Membrane in Pediatric Patients. Am J Ophthalmol 2024; 261:76-84. [PMID: 38195046 DOI: 10.1016/j.ajo.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE To report the clinical and imaging characteristics, including optical coherence tomography angiography (OCTA), and treatment outcomes of choroidal neovascular membranes (CNVMs) in children. DESIGN Retrospective clinical cohort study. METHODS Thirty eyes from 25 children (56% girls) with CNVM from 2 centers were examined from 2005 to 2022. Clinical features, imaging findings, treatment regimens, and outcomes are described. RESULTS The most common causes of CNVM were idiopathic (48%) and inflammatory (20%). At diagnosis, most CNVMs were unilateral (80%), active (83.3%), and juxtafoveal (46.7%). Twenty-five eyes (83.3%) of 21 patients (84%) were treated. The most common first-line treatment was intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) (92%), with a retreatment rate of 52.2% at an average of 237 days. The average number of total injections per eye was 2.3. Injections were safely administered in the clinic (52.2%). A gain of 3 lines or 15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters was observed at final visit. The average duration of follow-up was 56.46 ± 42.51 months. No ocular or systemic complication related to treatment was reported. Sixteen eyes (64%) had OCTA images at both presentation and final visit, which showed a decrease in CNVM vessel density and vessel-length density, and in the height of retinal pigment epithelium detachment (RPED). CONCLUSIONS There are a variety of underlying etiologies for pediatric CNVMs, which are most often unilateral. Treatment with intravitreal anti-VEGF can be beneficial and does not often require frequent or chronic dosing. OCTA demonstrated a decrease in the CNVM vessel density and vessel-length density as well as in the height of RPED.
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Affiliation(s)
- Sandra Hoyek
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Yifan Lu
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Shizuo Mukai
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimesh A Patel
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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Stanescu N, Friehmann A, Nemet A, Keshet Y, Ohayon A, Greenbaum E, Rabina G, Nemet AY, Geffen N, Segal O. Long-term outcomes of anti-vascular endothelial growth factor treatment in peripapillary choroidal neovascularisation due to age-related macular degeneration. Eye (Lond) 2023; 37:1202-1206. [PMID: 35581371 PMCID: PMC10102213 DOI: 10.1038/s41433-022-02089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/03/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To report the long-term outcomes of anti-vascular endothelial growth factor (VEGF) treatment in eyes with peripapillary choroidal neovascularisation (PPCNV) associated with age-related macular degeneration (AMD). METHODS A retrospective cohort study included patients with AMD-related PPCNV. Eyes were treated with anti-VEGF according to pro re nata regimen. Inactivation index was calculated as the proportion of disease inactivity from the total follow up time. RESULTS Sixty-seven eyes of 66 consecutive patients were included in the study; mean follow-up time was 53.2 months. Best corrected visual acuity (BCVA) remained stable for the first four years of follow up, with a significant deterioration in BCVA thereafter. Baseline BCVA was a significant predictor of final BCVA (p < 0.001). The mean inactivation index was 0.38 ± 0.23. Subretinal fluid (SRF) at presentation was significantly associated with decreased inactivation index (p < 0.05). Worse baseline BCVA, SRF and pigment epithelium detachment (PED), male sex, and younger patient age were associated with increased risk for recurrence after first inactivation (p < 0.05). CONCLUSION The use of anti-VEGF agents in the treatment of AMD-related PPCNV managed to preserve BCVA in the first four years of follow-up. Male sex, SRF and PED at presentation and baseline BCVA are associated with increased risk for PPCNV recurrence after the first inactivation, and should prompt careful follow-up in these patients.
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Affiliation(s)
- Nir Stanescu
- Department of Ophthalmology, Assuta Samson Hospital, affiliated with the Faculty of Medicine, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Asaf Friehmann
- Department of Ophthalmology, Meir Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Achia Nemet
- Department of Ophthalmology, Meir Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Yariv Keshet
- Division of Ophthalmology, Beilinson Hospital, Rabin Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Avi Ohayon
- Department of Ophthalmology, Tel Aviv Sourasky Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Greenbaum
- Department of Ophthalmology, Meir Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Gilad Rabina
- Department of Ophthalmology, Tel Aviv Sourasky Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Y Nemet
- Department of Ophthalmology, Meir Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Noa Geffen
- Division of Ophthalmology, Beilinson Hospital, Rabin Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Ori Segal
- Department of Ophthalmology, Meir Medical Centre, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel.
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Peng PH, Liao WP, Cheng CK. Peripapillary choroidal neovascularization associated with optic nerve sheath meningioma. Taiwan J Ophthalmol 2022; 12:360-363. [PMID: 36248086 PMCID: PMC9558471 DOI: 10.4103/2211-5056.353125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/29/2022] [Indexed: 11/10/2022] Open
Abstract
Peripapillary choroidal neovascularization (PPCNV), a rare presentation of optic nerve sheath meningioma (ONSM), is associated with various ocular pathologies. Herein, we report a case with characteristics of age-related macular degeneration, PPCNV, optic disc edema, and a retinal–choroidal venous collateral. In addition to the recognition of an orbital base ONSM, magnetic resonance imaging revealed a distended perioptic subarachnoid space with the accumulation of cerebrospinal fluid anterior to the tumor. On the basis of these clinical findings, we postulated the pathogenesis of PPCNV-associated ONSMs.
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Singh SR, Fung AT, Fraser-Bell S, Lupidi M, Mohan S, Gabrielle PH, Zur D, Iglicki M, M López-Corell P, Gallego-Pinazo R, Farinha C, Lima LH, Mansour AM, Casella AM, Wu L, Silva R, Uwaydat SH, Govindahari V, Arevalo JF, Chhablani J. One-year outcomes of anti-vascular endothelial growth factor therapy in peripapillary choroidal neovascularisation. Br J Ophthalmol 2019; 104:678-683. [PMID: 31401554 DOI: 10.1136/bjophthalmol-2019-314542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 07/27/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the visual and anatomical outcomes in eyes with peripapillary choroidal neovascularisation (CNV) through 12 months. METHODS This was a multicentre, retrospective, interventional case series which included treatment-naïve cases of peripapillary choroidal neovascular membrane (CNVM) with a minimum follow-up of 12 months. Multimodal imaging which comprised optical coherence tomography (OCT), fluorescein angiography and/or indocyanine green angiography was performed at baseline and follow-up visits. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and retinal and choroidal thickness at site of CNV. Patients were treated with anti-vascular endothelial growth factors (VEGF) on pro re nata protocol, photodynamic therapy, laser photocoagulation or a combination. Main outcome measures were change in best corrected visual acuity (BCVA) and OCT parameters. RESULTS A total of 77 eyes (74 patients; mean age: 61.9±21.8 years) with a mean disease duration of 9.2±14.1 months were included. BCVA improved significantly from 0.55±0.54 logMAR (20/70) at baseline to 0.29±0.39 logMAR (20/40) at 12 months (p<0.001) with a mean of 4.9±2.9 anti-VEGF injections. CMT, SFCT and retinal thickness at site of CNVM reduced significantly (p<0.001, <0.001 and 0.02, respectively) through 12 months. The most common disease aetiologies were neovascular age-related macular degeneration, and idiopathic, inflammatory and angioid streaks. Age (p=0.04) and baseline BCVA (p<0.001) were significant predictors of change in BCVA at 12 months. CONCLUSION Peripapillary CNVM, though uncommon, is associated with diverse aetiologies. Anti-VEGF agents lead to significant visual acuity and anatomical improvement in these eyes over long term irrespective of the aetiology.
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Affiliation(s)
- Sumit Randhir Singh
- Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India.,Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Hanumanthawaka Junction, Visakhapatnam, Andhra Pradesh, India
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Sydney University, Sydney, New South Wales, Australia
| | - Marco Lupidi
- Department of Ophthalmology, University of Perugia, Perugia, Italy
| | - Sashwanthi Mohan
- Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pierre-Henry Gabrielle
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, France
| | - Dinah Zur
- Division of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Matias Iglicki
- Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Paula M López-Corell
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Cláudia Farinha
- Ophthalmology Department, Coimbra University Hospital Center, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Luiz H Lima
- Ophthalmology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Ahmad M Mansour
- Deaprtment of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Lihteh Wu
- Vitreo-retinal Department, Instituto de Cirugia Ocular, San Jose, Costa Rica
| | - Rufino Silva
- Ophthalmology Department, Coimbra University Hospital Center, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Sami H Uwaydat
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Vishal Govindahari
- Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India.,Retina and Uveitis Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
| | - Jose Fernando Arevalo
- Retina Division, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jay Chhablani
- Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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