Photodynamic therapy for choroidal neovascularization: a review

Intravitreal CendR peptides target laser-induced choroidal neovascularization sites in mice

Choroidal neovascularization (CNV) is a common ocular pathology that may be associated in a variety of eye diseases. Although intravitreal injection treatment of anti-vascular endothelial growth factor (anti-VEGF) drugs shows significant clinical benefits in CNV treatment, the limitations of the current therapy need to be addressed. The aim of our study was to investigate the potential utility of three C-end Rule (CendR) peptides (RPARPAR, PL3, iRGD) for CNV targeting and to evaluate the efficacy of peptides for treating experimental CNV in mice. We observed that the CendR peptides localize to the CNV lesion sites after intravitreal injection and were mainly found in the outer nuclear cell layer (ONL) of the mouse retina. Interestingly, experimental therapy with tenascin-C (TNC-C) and neuropilin-1 (NRP-1)-targeting PL3 peptide, reduced angiogenesis and decreased vascular leakage. The results suggest that PL3 and potentially other CendR peptides could serve as affinity targeting ligands and therapeutics for ocular diseases that involve pathological CNV.

Electronic Retinal Prostheses

Retinal prostheses are a promising means for restoring sight to patients blinded by photoreceptor atrophy. They introduce visual information by electrical stimulation of the surviving inner retinal neurons. Subretinal implants target the graded-response secondary neurons, primarily the bipolar cells, which then transfer the information to the ganglion cells via the retinal neural network. Therefore, many features of natural retinal signal processing can be preserved in this approach if the inner retinal network is retained. Epiretinal implants stimulate primarily the ganglion cells, and hence should encode the visual information in spiking patterns, which, ideally, should match the target cell types. Currently, subretinal arrays are being developed primarily for restoration of central vision in patients impaired by age-related macular degeneration (AMD), while epiretinal implants-for patients blinded by retinitis pigmentosa, where the inner retina is less preserved. This review describes the concepts and technologies, preclinical characterization of prosthetic vision and clinical outcomes, and provides a glimpse into future developments.

Photodynamic Therapy in Ocular Oncology

Over the past two decades, we have witnessed the increasing use of photodynamic therapy (PDT) in the field of ocular oncology. Based on a review of the literature and our own experience, we herein review the role of PDT for the management of intraocular tumors. The discussion includes two main topics. First, we discuss the application of PDT for benign tumors, including circumscribed choroidal hemangioma, choroidal osteoma, retinal astrocytoma, retinal capillary hemangioma (retinal hemangioblastoma), and retinal vasoproliferative tumor. Second, we assess the role of PDT for malignant tumors, including choroidal melanoma and choroidal metastasis.

Hypericin-Enhanced Argon Laser Photocoagulation for Subfoveal Choroidal Neovascular Membrane in Age-Related Macular Degeneration: A Pilot Study

Purpose

To evaluate the efficacy and safety of hypericin-enhanced argon laser photocoagulation (H-ALP) in the treatment of subfoveal choroidal neovascular membrane (CNM) secondary to age-related macular degeneration (ARMD).

Methods

After preliminary studies for definition of parameters, argon-green laser was administered 4 hours after single dose of oral 1800 mg hypericin (Saint-John's wort tablets, 0.3%, 300 mg) with a subthreshold light fluence, 24 J/cm2 in 34 eyes (20 with subfoveal classical and 14 with subfoveal occult CNM). Additionally, histopathologic examination was done in two eyes destined for enucleation and exenteration. Maintenance therapy (one tablet, twice a day) was performed for the following 6 months. Anatomic (complete closure of CNM) and functional success (improvement of final visual acuity in three or more Snellen lines) were analyzed with minimum 6-month follow-ups.

Results

Histopathologic examinations revealed photothrombosed choriocapillaries together with minimal retinal pigment epithelial disruption in H-ALP exposed areas. One to four (mean 1.88±0.91) treatment sessions were applied in 6 to 29 months (mean 12.2±5.1 months) follow-up period. Twenty-three (67.6%) eyes had 12 months follow-up. Two eyes in each group had functional success (20% in subfoveal classical and 14.3% in subfoveal occult CNM), which had a minimum 12-month follow-up. Anatomic success was achieved in 16 of 20 (80%) eyes with subfoveal classical and 10 of 14 (71.4%) eyes with subfoveal occult CNM. Severe gastric irritation was noted in 1 (2.9%) and pigment epithelial rupture in 2 (5.9%) patients.

Conclusions

H-ALP is a novel and low-cost treatment for subfoveal CNM secondary to ARMD. It seems its efficacy depends on the photodynamic and antiproliferative properties of hypericin. Comparative studies are required to apply this new technique in ophthalmic practice.

Evolution of Concepts and Technologies in Ophthalmic Laser Therapy

Ophthalmology was the first medical specialty to adopt lasers right after their invention more than 50 years ago, and they gradually revolutionized ocular imaging, diagnostics, therapy, and surgery. Challenging precision, safety, and selectivity requirements for ocular therapeutic and surgical procedures keep advancing the laser technologies, which in turn continue enabling novel applications for the preservation and restoration of sight. Modern lasers can provide single-cell-layer selectivity in therapy, submicrometer precision in three-dimensional image-guided surgery, and nondamaging retinal therapy under optoacoustic temperature control. This article reviews the evolution of laser technologies; progress in understanding of the laser-tissue interactions; and concepts, misconceptions, and accidental discoveries that led to modern therapeutic and surgical applications of lasers in ophthalmology. It begins with a brief historical overview, followed by a description of the laser-tissue interactions and corresponding ophthalmic applications.

Correlation of platelet activating factor and age-related macular degeneration

OBJECTIVE

To investigate the role of Platelet Activating Factor (PAF) in the pathogenesis and development of Age-Related Macular Degeneration (ARMD).

RESEARCH DESIGN AND METHODS

Fifty six patients with ARMD (24 patients with dry ARMD and 32 patients with wet ARMD) and 25 age-matched control participants underwent ophthalmological examination, including visual acuity measurement and evaluation of the retina. The participants were classified into three groups according to their retinal status, based on indirect fundoscopy, Optical Coherence Tomography and fluorescein angiography findings. In order to evaluate the concentrations of PAF in serum, blood samples were collected from all participants and were analyzed with ELISA technique.

RESULTS

The concentrations of PAF differed significantly according to macular lesions and were found to be lower in patients with ARMD than control participants.

CONCLUSIONS

PAF levels are decreased along with the severity of ARMD. Understanding the role of PAF in pathogenesis of ARMD could be the impetus for the development of new therapies field of treatment of ARMD or even other retinal diseases.

PDT with TOOKAD(®) studied in the chorioallantoic membrane of fertilized eggs

BACKGROUND

The potential application of TOOKAD(®)-PDT for the treatment of blood vessels was investigated. TOOKAD(®) (WST09), a novel palladium-bacteriopheophorbide absorbs light in the near IR with a high quantum yield of intersystem crossing. Our study assessed the efficacy of this drug in inducing vascular damage with a view to its possible use in the treatment of age-related macular degeneration.

METHODS

Vascular damage of TOOKAD(®)-PDT was studied in neovessels of the chorioallantoic membrane of fertilized eggs. Pharmacokinetic investigations were done by video microscopy and laser scanning microscopy. To induce damage vessels were irradiated with 763nm light from a diode laser.

RESULTS

TOOKAD(®) was accumulated in the vessels in the first minutes following injection. TOOKAD(®) fluorescence was seen predominantly in the lumen and not in the vascular endothelial layer. Although fluorescence was very weak it could be attributed to TOOKAD(®) from the fluorescence spectrum in the circulation. Damage assessment was done 24h after application of 763nm light. No significant difference in the degree of damage was observed with different short drug-light intervals (1-10min), but damage increased with the light energy dose. Closure of smaller vessels and vanished capillaries could be achieved by irradiation with 5J/cm(2) and a TOOKAD(®) dose of 33μg/embryo, corresponding to a phototoxic efficacy of 0.0062.

CONCLUSIONS

From the results discussed in this work, TOOKAD(®) could be a potential drug for the PDT of age-related macular degeneration in which the growth of new vessels in the choroids can lead to loss of vision.

The evolution of laser therapy in ophthalmology: a perspective on the interactions between photons, patients, physicians, and physicists: the LXX Edward Jackson Memorial Lecture

PURPOSE

To present the evolution of laser therapy in modern ophthalmic practice.

DESIGN

Review of published experimental and clinical studies.

METHODS

A review was undertaken of the work of multiple investigators leading to the invention of the laser, its biophysical effects on ocular tissues from which it derives its name (light-amplified stimulation of emitted radiation), and the development of various laser-based devices and methods to treat common ophthalmologic disorders, with particular emphasis on new and emerging retinal and anterior segment applications.

RESULTS

Because the eye is optimized for the transmission of light and its transduction into neural signals, lasers are particularly well suited for ophthalmic therapy. This fact and the high demands for precision in therapy have inspired the development of highly sophisticated laser systems that have impacted the treatment of common diseases. These include diabetic retinopathy, age-related macular degeneration, retinal venous occlusive disease, retinopathy of prematurity, and optical aberrations including ametropia, cataract, and glaucoma, among others. Recent developments in scanning laser systems, including image-guided systems with eye tracking, real-time feedback, and ultra-short pulse durations, have enabled increased selectivity, precision, and safety in ocular therapy. However, improved outcomes have been associated with increased cost of medical care, and attention to and optimization of their cost effectiveness will continue to be required in the future.

CONCLUSIONS

The invention and evolution of modern ophthalmic lasers have enhanced therapeutic options and can serve as a heuristic model for better understanding the process of innovation, including the societal benefits and also unintended consequences, including increased costs.

New techniques for drug delivery to the posterior eye segment

Ocular drug delivery has become an increasingly important field of research especially when treating posterior segment diseases of the eye, such as age-related macular degeneration, diabetic retinopathy, posterior uveitis and retinitis. These diseases are the leading causes of vision loss in developed countries which require repeated long-term administration of therapeutic agents. New drugs for the medication of the posterior ocular segment have emerged, but most drugs are delivered by repeated intravitreal injections associated with ocular complications. Advances in ocular drug delivery system research are expected to provide new tools for the treatment of the posterior segment diseases, providing improved drug penetration, prolonged action, higher efficacy, improved safety and less invasive administration, resulting in higher patient compliance. This review provides an insight into the recent progress and trends in ocular drug delivery systems for treating posterior eye segment diseases, with an emphasis on transscleral iontophoresis.

Photodynamic therapy for neovascular age-related macular degeneration

BACKGROUND

In neovascular age-related macular degeneration (AMD) new vessels grow under the retina distorting vision and leading to scarring. This is exacerbated if the blood vessels leak. Photodynamic therapy (PDT) has been investigated as a way to treat the neovascular membranes without affecting the retina.

OBJECTIVES

The aim of this review was to examine the effects of PDT in the treatment of neovascular AMD.

SEARCH STRATEGY

We searched CENTRAL (Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007). We contacted experts in the field and searched the reference lists of relevant studies.

SELECTION CRITERIA

We included randomised trials of PDT in people with choroidal neovascularisation due to AMD.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data. Risk ratios were combined using a fixed-effect model after testing for heterogeneity.

MAIN RESULTS

Three published trials were identified that randomised 1022 participants to verteporfin therapy compared to 5% dextrose in water. The TAP and VIP trials were performed by the same investigators using largely the same clinical centres and funded by manufacturers of verteporfin. Outcome data were available at 12 and 24 months after the first treatment. Participants received on average five treatments over two years. The risk ratio of losing three or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.77 (95% confidence interval 0.69 to 0.87). The risk ratio of losing six or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.62 (95% confidence interval 0.50 to 0.76). The results at 12 months were similar to those at 24 months. The most serious adverse outcome, acute (within seven days of treatment) severe visual acuity decrease, occurs in about one in 50 patients. Some outcomes from the more recent VIM trial could be included in the meta-analysis but have not greatly altered the findings.

AUTHORS' CONCLUSIONS

Photodynamic therapy in people with choroidal neovascularisation due to AMD is probably effective in preventing visual loss though there is doubt about the size of the effect. Outcomes and potential adverse effects of this treatment should be monitored closely. Further independent trials of verteporfin are required to establish that the effects seen in this study are consistent and to examine important issues not yet addressed, particularly relating to quality of life and cost. However, the advent of new interventions for AMD make this unlikely.

Photodynamic treatment in a rabbit model of glaucoma surgery

PURPOSE

To evaluate the safety and efficacy of postoperative verteporfin photodynamic treatment as an adjunct to glaucoma experimental filtration surgery in rabbits.

METHODS

Dutch belted (n = 15) rabbits underwent full thickness sclerectomy in one eye. The experimental group (group 1, n = 7) underwent i.v. injection of verteporfin and subsequent photoactivation at the operative site on postoperative day 1 (POD 1). Control groups of animals received either light exposure (group 2, n = 4) or verteporfin (group 3, n = 2), or no intervention (group 4, n = 2). Intraocular pressure (IOP) was measured prior to the procedure (POD 0) and daily thereafter for the first week after sclerectomy (PODs 1-7) and every other day for the second week (PODs 9, 11, 13, 15). Percentage IOP reductions of operated over contralateral control eyes were compared among the various groups. Success rates (percentage IOP reduction > 15%) were also compared between the experimental and control groups. Eyes were histologically examined for evaluation of fibrosis.

RESULTS

Rabbits in the experimental group (group 1) had a mean +/- SEM percentage IOP reduction of 25 +/- 3% during the follow-up period. In contrast, groups 2, 3 and 4 had IOP reductions of 4 +/- 5%, 12 +/- 7% and 4 +/- 6%, respectively (p < 0.005, anova among all four groups). Successful IOP reduction (> or = 15%) over the contralateral eye at POD 15 was achieved in six of seven experimental animals, but only in one of eight control animals (p < 0.02, chi-squared test). Bleb failure occurred significantly earlier in the control eyes compared with eyes receiving PDT (p < 0.003, log rank test). Blebs in the experimental group differed from those in the control groups histologically, lacking significant collagen deposition in the area of the sclerostomy.

CONCLUSIONS

Wound healing in glaucoma surgery may be successfully modulated postoperatively using photodynamic therapy with i.v. administered photosensitizer.

Preclinical evaluation of a novel water-soluble chlorin E6 derivative (BLC 1010) as photosensitizer for the closure of the neovessels

In the present study, photodynamic activity of a novel photosensitizer (PS), Chlorin e(6)-2.5 N-methyl-d-glucamine (BLC 1010), was evaluated using the chorioallantoic membrane (CAM) as an in vivo model. After intravenous (i.v.) injection of BLC 1010 into the CAM vasculature, the applicability of this drug for photodynamic therapy (PDT) was assessed in terms of fluorescence pharmacokinetics, i.e. leakage from the CAM vessels, and photothrombic activity. The influence of different PDT parameters including drug and light doses on the photodynamic activity of BLC 1010 has been investigated. It was found that, irrespective of drug dose, an identical continuous decrease in fluorescence contrast between the drug inside and outside the blood vessels was observed. The optimal treatment conditions leading to desired vascular damage were obtained by varying drug and light doses. Indeed, observable damage was achieved when irradiation was performed at light doses up to 5 J/cm(2) 1 min after i.v. injection of drug doses up to 0.5 mg/kg body weight(b.w.). However, when irradiation with light doses of more than 10 J/cm(2) was performed 1 min after injection of drug doses up to 2 mg/kg body weight, this led to occlusion of large blood vessels. It has been demonstrated that it is possible to obtain the desired vascular occlusion and stasis with BLC 1010 for different combinations of drug and/or light doses.

Modelling the natural history of geographic atrophy in patients with age-related macular degeneration

PURPOSE

To model the natural course of geographic atrophy (GA) in patients with age-related macular degeneration (AMD).

METHODS

Data on the natural course of GA were collected in the multi-center, longitudinal, prospective observational FAM study. The size of GA was measured by autofluorescence scanning laser ophthalmoscopy. The natural course of GA is modelled by two different mixed effect models (MEM). Both models are compared with respect to the correctness of the model assumptions, goodness of fit, and predictive behavior.

RESULTS

The linear model results in better prediction, the non-linear model is more in agreement with the model assumptions. The non-linear model fits the data for small and large areas of GA better, while the linear model seems to be more adequate for the medial areas. More data will be needed to study the interplay of both models in more detail.

CONCLUSIONS

The natural course of GA varies extremely between individuals. However, reliable factors for the explanation of this variability have so far not been established. MEM are useful for describing "inter-individual" as well as "intra-individual" influences without the need for precise knowledge of the influencing factors. Using MEM to evaluate data on the natural history of GA allows one to derive parameter estimates, which could be used to design interventional trials for modes of therapy with a potential to reduce or stop the progression of GA in patients with AMD.

Psychosocial Adaptation to Visual Impairment and Its Relationship to Depressive Affect in Older Adults With Age-Related Macular Degeneration

PURPOSE

In this study we examined psychosocial adaptation to vision loss and its relationship to depressive symptomatology in legally blind older adults with age-related macular degeneration (ARMD).

DESIGN AND METHODS

The 144 study participants were outpatients of a large regional vision clinic that specializes in the diagnosis and treatment of ARMD in older adults. They were administered a battery of cognitive and psychological screening instruments including the Adaptation to Vision Loss Scale, the Short Portable Mental Status Questionnaire, and the short form of the Geriatric Depression Scale.

RESULTS

A principal components analysis of the Adaptation to Vision Loss Scale identified three distinct adaptation factors, namely, acceptance of vision loss, negative impact on relationships, and attitudes toward compensation. Of these, acceptance of vision loss and attitudes toward compensation were positively associated with depressive affect. In addition, self-reported use of outpatient rehabilitative services was less frequent in those reporting greater depressive symptomatology.

IMPLICATIONS

These findings support the contention that depressive symptomatology as measured by self-report in older adults with ARMD is mediated by one's perceived sense of individual control as it relates to intrapersonal factors underlying adaptation to profound vision loss in old age caused by ARMD.

Does Hypericum perforatum L. extract show any specificity as photosensitizer for HL-60 leukemic cells and cord blood hemopoietic progenitors during photodynamic therapy?

Autologous bone marrow transplantation is a therapeutic modality that increases the survival rates for children with malignancies with poor prognosis but relapse rates are high and attributed partially to the existence of residual malignant cells. Photodynamic treatment (PDT) has been developed among purging strategies. We investigated the effect of the methanolic extract (ME) and its polar methanolic fraction (PMF) of Hypericum perforatum L., as a new photosensitizer for the leukemic cell line HL-60 and cord blood (CB) hemopoietic progenitors as well as the subcellular localization of the photosensitizer.

METHODS

ME and PMF were prepared after extraction of the dry herb with methanol (ME), followed by liquid-liquid extraction with petroleum ether (PMF). Cells were incubated with the extracts before irradiation with Nd-Yvo Laser. Various concentrations of PMF or ME as well as irradiation doses were tested. Following irradiation, cell viability was determined by trypan blue in continuous liquid cultures for HL-60 cells and in clonogenic assays for CB cells. The subcellular localization of the photosensitizer was determined by confocal microscopy.

RESULTS

Laser photoirradiation in the presence of both PMF and ME induces the killing of HL-60 cells. This effect is dose dependent. No CFU-GM and BFU-E growth was observed from CB mononuclear cells under the tested experimental conditions. Confocal microscopy revealed that the extracts localize mainly in the cytoplasm of the cells.

CONCLUSIONS

PDT with both PMF and ME induces the killing of HL-60 leukemic cells and the optimal conditions of treatment were determined. This effect of PDT/PMF was also exerted on CB progenitor cells indicative of the non-selective uptake of the photosensitizer by malignant cells. Though this suggests that PDT/PMF cannot be helpful in autologous bone marrow purging, these novel extracts can however be beneficial in the PDT treatment of tumors given their photostability, low toxicity and low cost.

Photodynamic therapy for neovascular age-related macular degeneration

BACKGROUND

In neovascular age-related macular degeneration (AMD) new vessels grow under the retina distorting vision and leading to scarring. This is exacerbated if the blood vessels leak. Photodynamic therapy (PDT) has been investigated as a way to treat the neovascular membranes without affecting the retina.

OBJECTIVES

The aim of this review was to examine the effects of PDT in the treatment of neovascular AMD.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which includes the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 1, 2005), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005). We used the Science Citation Index to search for reports that cited relevant studies. We contacted experts in the field and searched the reference lists of relevant studies.

SELECTION CRITERIA

We included randomised trials of PDT in people with choroidal neovascularisation due to AMD.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data. Relative risks were combined using a fixed-effect model after testing for heterogeneity.

MAIN RESULTS

Two published trials were identified that randomised 948 participants to verteporfin therapy compared to 5% dextrose in water. Both trials were performed by the same investigators using largely the same clinical centres and funded by manufacturers of verteporfin. Outcome data were available at 12 and 24 months after the first treatment. Participants received on average five treatments over two years. The relative risk of losing three or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.77 (95% confidence interval 0.69 to 0.87). The relative risk of losing six or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.62 (95% confidence interval 0.50 to 0.76). The results at 12 months were similar to those at 24 months. The most serious adverse outcome, acute (within 7 days of treatment) severe visual acuity decrease, occurs in about one in 50 patients.

AUTHORS' CONCLUSIONS

Photodynamic therapy in people with choroidal neovascularisation due to AMD is probably effective in preventing visual loss though there is doubt about the size of the effect. Outcomes and potential adverse effects of this treatment should be monitored closely. Further independent trials of verteporfin are required to establish that the effects seen in this study are consistent and to examine important issues not yet addressed, particularly relating to quality of life and cost.

Liposomal delivery of photosensitising agents

Photodynamic therapy is a clinically approved treatment for cancer and noncancer diseases. This modality utilises light-activatable chemicals (photosensitising agents) to capture photons and use light energy for the production of cytotoxic reactive molecular species. Most photosensitisers that are in use clinically or in preclinical development are hydrophobic and tend to aggregate in the aqueous environment, which limits their delivery and photosensitising efficiency. Liposomal delivery of photosensitisers will often overcome or decrease these problems. In addition, as with chemotherapeutic agents, liposomal formulations of photo-sensitising agents may help to achieve better selectivity for tumour tissue compared with normal tissue. Over the past years, liposomal photosensitisers have emerged as therapeutic agents in many experimental studies, and have obtained approval for clinical applications. Recent progress in liposomal technology further opens up the possibility of generating more selectively targeted photosensitisers encapsulated in liposomes. This review will cover progress in the use of liposomal photosensitisers, summarise current liposomal formulations, and project future directions for the liposomal delivery of photosensitising agents.

Downregulation of ICAM-1 and VCAM-1 expression in endothelial cells treated by photodynamic therapy

Photodynamic therapy (PDT) is a treatment for cancer and several noncancerous proliferating cell diseases that depends on the uptake of a photosensitizing compound followed by selective irradiation with visible light. In the presence of oxygen, irradiation leads to the production of reactive oxygen species (ROS). A large production of ROS induces the death of cancer cells by apoptosis or necrosis. A small ROS production can activate various cellular pathways. Here, we show that PDT by pyropheophorbide-a methyl ester (PPME) induces the activation of nuclear factor kappa B (NF-kappaB) in HMEC-1 cells. NF-kappaB is active since it binds to the NF-kappaB sites of both ICAM-1 and vascular cell adhesion molecule-1 (VCAM-1) promoters and induces the transcription of several NF-kappaB target genes such as those of IL-6, ICAM-1, VCAM-1. In contrast, expression of ICAM-1 and VCAM-1 at the protein level was not observed, although we measured an IL-6 secretion. Using specific chemical inhibitors, we showed that the lack of ICAM-1 and VCAM-1 expression is the consequence of their degradation by lysosomal proteases. The proteasome and calpain pathways were not involved. All these observations were consistent with the fact that no adhesion of granulocytes was observed in these conditions.

Chronic central serous chorioretinopathy: photodynamic therapy

PURPOSE

To demonstrate, using optical coherence and fluorescien angiography, the efficacy of photodynamic therapy in treating chronic central serous chorioretinopathy.

DESIGN

Interventional case series.

METHODS

A retrospective study in a clinical practice setting of four patients (five eyes) with chronic central serous chorioretinopathy. The patients were treated with verteporfin photodynamic therapy and evaluated by optical coherence tomography and fluorescien angiography with average follow-ups of 10 months.

RESULTS

Compared to pre-treatment optical coherence tomography, an acute reduction in subretinal fluid accumulation and serous detachment with stoppage of leakage was noted in the five eyes treated. Dramatic improvement in visual acuity was also noted, especially among patients with better vision initially. However, pigmentary changes persisted.

CONCLUSION

Serial optical coherence tomography demonstrates that photodynamic therapy with verteporfin appears to have a beneficial effect in treating patients with chronic central serous chorioretinopathy by reducing fluid leakage, subretinal fluid accumulation, and serous detachment with resultant improvement in vision. Better visual results might be expected if photodynamic therapy is applied earlier in the course of the disease.

First case of post-conception Verteporfin exposure: pregnancy and neonatal outcome

PURPOSE

To assess pregnancy and neonatal outcomes in a woman accidentally exposed to Verteporfin photodynamic therapy in the third week of pregnancy.

METHODS

Post-conception counselling and prospective follow-up by telephone interview at Telefono Rosso (Teratology Information Service) were carried out. The baby was examined at birth and at 26 months.

RESULTS

The outcome of the pregnancy was normal and a healthy female child with a normal birthweight was born. The baby's follow-up was normal at 26 months.

CONCLUSIONS

This is the first reported case of a childbearing woman being accidentally exposed to Verteporfin during pregnancy. No fetal or neonatal adverse effects were documented.

Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study

BACKGROUND

Most patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green (ICG) angiography. A small percentage of patients develop chronic or progressive disease with widespread decompensation of the retinal pigment epithelium and severe vision loss. There is no known treatment for this variant of the disorder.

PURPOSE

To study ICG-guided photodynamic therapy (PDT) with verteporfin as a potential treatment for patients with chronic CSC.

METHODS

Twenty eyes of 15 patients were studied with fluorescein angiography, optical coherence tomography, and ICG angiography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. PDT with ICG guidance was applied to areas of choroidal hyperpermeability, and the patients were observed to determine the anatomic and functional outcomes.

RESULTS

Photodynamic therapy guided by ICG was associated with complete resolution of exudative macular detachments in 12 patients and incomplete resolution in the remaining eight eyes. The vision improved in six eyes and remained unchanged in 14 eyes during a mean follow-up of 6.8 months. Six weeks after treatment, the mean visual acuity improved by 0.55 lines, an amount that was marginally significant. There was a significant inverse correlation between the baseline visual acuity and the amount of improvement in acuity at 6 weeks. No patient had any treatment-related side effects.

CONCLUSIONS

Indocyanine green angiography-guided PDT with verteporfin seems to aid in the resolution of exudative detachments in patients with chronic CSC. This treatment was associated with a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.