CIRCULATORY CHANGES IN THE CHOROIDAL VASCULATURE AFTER VERTEPORFIN-BASED PHOTODYNAMIC THERAPY FOR CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION

Choroidal morphology and short-term outcomes of combination photodynamic therapy in polypoidal choroidal vasculopathy

PURPOSE

To investigate outcomes of combined photodynamic therapy (PDT) and intravitreal bevacizumab in association with choroidal morphology in polypoidal choroidal vasculopathy (PCV).

METHOD

Eighty-six PCV eyes (83 patients) treated with PDT in combination with intravitreal bevacizumab and followed for 1 year were evaluated. Choroidal morphological features including subfoveal choroidal thicknesses, diameter of pachyvessel, and choroidal vascularity were analyzed for association with responsiveness and recurrence.

RESULT

Total choroid, Haller's layer, and pachyvessel were thicker in responders (n = 70) compared with non-responders (n = 16) at baseline (298 vs. 227 μm, 213 vs. 144 μm, and 276 vs. 210 μm, respectively; all P ≤ 0.001). Choroidal vascularity was significantly higher (0.68 vs 0.60, P < 0.001) and choroidal hyperpermeability was more frequent in responders (44 vs 13%, P = 0.018). Significant thinning of total choroid was observed in both responders and non-responders at 3 months after combination PDT (both P < 0.05), but the reduction was greater in responders (- 33 μm vs. - 10 μm, P = 0.036). In recurrent eyes (n = 26), increase in pachyvessel diameter and choroidal vascularity was observed at recurrence.

CONCLUSION

Choroidal morphology including characteristic features of pachychoroid and high vascularity can serve as predictive factors for outcomes after combination PDT in eyes with PCV.

Is There any Relationship between Photodynamic Therapy for Exudative Age-Related Macular Degeneration and Choroidal Neovascularization Recurrence? A Rationale for Combined Treatments

Purpose

Photodynamic therapy (PDT) is the treatment of choice for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). Interpretation of PDT mechanism of action is not yet fully understood and causes of CNV recurrences are unclear. The authors have conducted a retrospective analysis of fluorescein and indocyanine green angiographies in patients treated with multiple PDT in order to identify risk factors for recurrence.

Methods

A total of 342 eyes of 342 patients (207 women and 135 men) with ARMD and subfoveal CNV were treated with at least two PDT. Angiographic (fluorescein and indocyanine green) features of recurrences were confronted to pretreatment examinations in all patients. RESULTS. Post-PDT angiographies showed in all eyes a dark circle corresponding to the laser spot even 1 year after treatment. Persistence or progressive regrowth of CNV developed in an area adjacent or corresponding to the original lesion, without any specific relationship with the location of fluorescein and indocyanine green late leakage or with presence of abnormal fluorescence due to pigment abnormalities. At the 3-month angiographic follow-up, 23 patients (6.7%) showed a recurrent CNV resembling shape and dimension of the laser spot used for the PDT treatment.

Conclusions

The authors failed to identify angiographic signs helpful to predict the risk of CNV persistence or recurrence. PDT leaves minor but persistent changes in the choroidal vasculature within the treatment area. In some cases, the recurrent CNV seems to be related to the laser spot of the PDT.

Half-dose verteporfin combined with half-fluence photodynamic therapy for chronic central serous chorioretinopathy

PURPOSE

This study evaluated the safety and efficacy of half-dose verteporfin combined with half-fluence photodynamic therapy (half-half photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).

METHODS

This was a retrospective case series. Fourteen eyes with chronic CSC receiving half-half PDT were included in group 1. Another 28 eyes receiving half-dose verteporfin combined with standard fluence PDT were included in group 2 as a control group. Main outcome measures were the success rates, major complications, best-corrected visual acuity (BCVA), and central subfield foveal thickness (CFT) on optical coherence tomography (OCT) at 6 months in both groups. Success of treatment was defined as complete resolution of subretinal fluid on OCT after treatment without recurrence.

RESULTS

There was no significant difference between groups in their age, gender, duration of symptoms, baseline BCVA, baseline CFT, PDT spot size, and follow-up duration. The success rate was 64% (9/14 eyes) in group 1 and 93% (26/28 eyes) in group 2 at 6 months (P=0.031). No major complications were found in either group. Mean CFT showed significant reduction at 6 months in both groups (-115 μm and P<0.001 in group 1; -150 μm and P<0.001 in group 2). The mean BCVA in group 2 improved significantly (P<0.001) at 6 months. The mean BCVA in group 1 showed a trend of improvement but was not statistically significant (P=0.25) at 6 months.

CONCLUSIONS

Half-half PDT is a feasible treatment for chronic CSC. However, there was a lower success rate at 6 months compared with the control group.

Comparison of efficacy and safety between half-fluence and full-fluence photodynamic therapy for chronic central serous chorioretinopathy

PURPOSE

To compare the efficacy and safety of half-fluence photodynamic therapy (PDT) and conventional PDT in chronic central serous chorioretinopathy.

METHODS

A multicenter retrospective comparison study. Retrospective review of 60 patients including 29 patients (34 eyes) who received half-fluence PDT and 31 patients (33 eyes) who received conventional PDT for the treatment of chronic central serous chorioretinopathy. Best-corrected visual acuity, central fovea retinal thickness and resolution of subretinal fluid on optical coherence tomography, and choroidal perfusion decrease on indocyanine green angiography were assessed. Choriocapillaris perfusion decrease was quantified as mean gray value ratio of treated and nontreated areas using commercial imaging software.

RESULTS

Treatment success without recurrence was achieved in 32 of 34 eyes (94.1%) treated with half-fluence PDT and 33 of 33 eyes (100%) treated with conventional PDT (P = 0.493). There was no difference in final best-corrected visual acuity (logarithm of the minimal angle of resolution) between the 2 groups (0.17 ± 0.32 vs. 0.21 ± 0.39; P = 0.603). Choriocapillaris perfusion decrease quantified from post-PDT indocyanine green angiography was significantly more severe in the conventional PDT group (P = 0.006), and it showed a positive correlation with retinal thinning after PDT (R = 0.380; P < 0.001).

CONCLUSION

Half-fluence PDT is as effective as conventional PDT, while minimizing the deleterious effect on choriocapillaris perfusion and retinal thickness.

Choroidal ischemia after photodynamic therapy with verteporfin for choroidal neovascularization

PURPOSE

To report delay in choroidal perfusion suggestive of ischemia after photodynamic therapy (PDT) with verteporfin for choroidal neovascularization (CNV).

DESIGN

Observational case series.

METHODS

Retrospective review of all patients who developed choroidal ischemia after PDT.

RESULTS

This vascular change was found in eight (2.1%) of 373 eyes of patients treated for CNV as a result of age-related macular degeneration (AMD) and in one (0.9%) of 114 eyes treated for pathologic myopia. A decrease of 3 lines of vision was reported to occur one week after treatment in patients with AMD. At the 12-month examination, patients did not exhibit any marked changes in visual acuity.

CONCLUSIONS

Choroidal ischemia was an uncommon manifestation owing to the selectivity of verteporfin therapy and the existence of abundant anastomotic vascular connections in the choroid. The low incidence of this vascular event should not preclude counseling PDT in eyes that could benefit greatly from this therapy.