Choroidal Nonperfusion with Significant Subretinal Exudation after PDT of Predominantly Classic CNV: An OCT and FFA Study

Jalil, Assad; Mercieca, Karl; Chaudhry, Nadia; Stanga, Paulo E

doi:10.1177/112067210901900330

Cited by 11 publications

(3 citation statements)

References 4 publications

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“…Since resistance to anti-VEGF therapy is higher in PCV, and since PDT is more effective in PCV than AMD, then it is reasonable to consider PDT as a part of the therapeutic regimen for eyes with PCV and weaker baseline visual acuity. Targeting eyes with weaker baseline visual acuity is also important due to the uncommon but definite risk of acute vision loss with PDT related to subretinal or subretinal pigment epithelial hemorrhage [23], or choroidal nonperfusion [24,25]. The use of combination PDT and antiangiogenic therapy has shown promising results, with 12-month [26,27] results showing up to 56.3% improvement by 3 lines or more in a small series of 16 eyes treated with reduced fluence PDT and bevacizumab [26].…”

Section: Discussionmentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy Exudation and Hemorrhage: Results of Monthly Ranibizumab Therapy at One Year

et al. 2013

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Purpose: To evaluate the efficacy and safety of monthly intravitreal injections of ranibizumab in patients with polypoidal choroidal vasculopathy (PCV) and active exudation or hemorrhage. Methods: A prospective, single practice, open label trial of monthly intravitreal ranibizumab (0.5 mg) injections for PCV in 13 eyes of 13 patients who completed the 1-year study. The primary outcome measure was stabilization of vision (loss of <15 ETDRS letters). Secondary outcome measures included incidence of ocular and systemic adverse events, changes in subretinal hemorrhage, central foveal thickness, and polypoidal complexes on indocyanine green angiography at 1 year. Results: No patient lost ≥15 letters in visual acuity at 1 year. Three patients (23%) gained ≥15 letters at 12 months. Subretinal hemorrhage resolved in 9/9 eyes (100%). Macular edema improved in 5/5 eyes (100%). Subretinal fluid completely resolved in 4/9 eyes (44%), decreased in 2/9 eyes (22%), and increased in 3/9 eyes (33%). Polypoidal complexes decreased in 5/13 eyes (38%). Conclusion: Continuous monthly intravitreal ranibizumab decreases leakage and hemorrhage in eyes with exudative and hemorrhagic complications of PCV. Branching vascular networks persisted, and polypoidal complexes decreased in only 5/13 (38%) eyes with continuous antiangiogenic therapy at 1 year.

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Section: Discussionmentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy Exudation and Hemorrhage: Results of Monthly Ranibizumab Therapy at One Year

et al. 2013

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“…These highly-reactive oxygen molecules damage the choroidal neovascular endothelium and lead to the thrombosis of the subretinal choroidal network 1011. Due to the non-thermal nature of the process collateral damage to the adjacent retina is theoretically avoided, however occasional thrombosis of the retinal or choroidal vessels has been reported 12. Clinical benefits from PDT were demonstrated in two large multicenter randomized clinical trials: the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) study , and the Visudyne in Photodynamic Therapy (VIP) Trial 13.…”

Section: The Pastmentioning

confidence: 99%

The past, present, and future of exudative age-related macular degeneration treatment

Barak

Heroman

Tezel

2012

Middle East Afr J Ophthalmol

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Treatment of exudative age-related macular degeneration has been revolutionized within the last 6 years with the introduction of vascular endothelial growth factor neutralizing agents. Previously popular “destructive treatments,” such as laser photocoagulation and photodynamic treatment have either been abandoned or used as an adjunct to pharmacotherapy. Despite the increase in vision after antivascular endothelial growth factor (VEGF) agents, they require repetitive and costly intravitreal injections that also carry the inherit risks of infection, retinal tears, and detachment. Several new and more potent VEGF inhibitors are at different stages of development. The goal of evolving pharmacotherapy is to preserve the therapeutic effect while reducing or eliminating the discomfort of intravitreal drug delivery, as well as identify new therapeutic targets. Complement inhibitors, immunomodulators, integrin inhibitors are a few of the new class of drugs that are expected to be in our armamentarium soon. Current medications act to decrease leakage through abnormal subretinal choroidal vasculature and promote involution. However, these medications are only effective in treating the active stage of the choroidal neovascular membrane. Restoration of vision of a large number of patients with involuted choroidal neovascular membranes is warranted. For this purpose, tissue engineering techniques have been employed to reconstruct the subretinal anatomy. Discovery of biomarkers, pharmacogenetics, and very specific targeting holds the promise of increased potency and safety in the future.

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“…23 Because these eyes with better baseline visual acuity have good useful vision, PDT may be more likely to be avoided because of the rare risk of acute vision loss with PDT, most commonly due to subretinal or sub-RPE hemorrhage 24 or due to choroidal nonperfusion. 25,26 However, when visual acuity is poor in eyes with PCV, or when there is poor response to anti-VEGF therapy, then therapeutic regimens, including PDT for PCV, become important to consider. Indocyanine green angiography can be used to diagnose PCV and then to guide PDT therapy to the location of the polypoidal vessels.…”

mentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy—An Important Diagnosis to Make with Therapeutic Implications

Kokame

2012

Retina

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Choroidal Nonperfusion with Significant Subretinal Exudation after PDT of Predominantly Classic CNV: An OCT and FFA Study

Abstract: Although reported separately, these two complications have not been previously reported to occur in association after PDT treatment of classic CNV and may represent exaggeration of normal events occurring after PDT.

Cited by 11 publications

References 4 publications

Polypoidal Choroidal Vasculopathy Exudation and Hemorrhage: Results of Monthly Ranibizumab Therapy at One Year

Polypoidal Choroidal Vasculopathy Exudation and Hemorrhage: Results of Monthly Ranibizumab Therapy at One Year

The past, present, and future of exudative age-related macular degeneration treatment

Polypoidal Choroidal Vasculopathy—An Important Diagnosis to Make with Therapeutic Implications

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