Factors influencing poor visual outcome in patients treated with photodynamic therapy for choroidal neovascularization secondary to age‐related macular degeneration

Manku, Kiran; Rotchford, Alan P; Whitaker, John K.; Amoaku, Winfried

doi:10.1111/j.1442-9071.2007.01482.x

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…The positive results for predominantly classic subfoveal lesions in the TAP trial has since prompted a large number of studies ( Sharma et al 2004;Arias et al 2005;Michels et al 2005;Brown et al 2006;Heier et al 2006;Slakter et al 2006;Gelisken et al 2007) and retrospective (Essex et al 2003;Axer-Siegel et al 2004a;Frennesson & Nilsson 2004;Pawlak et al 2004;Wachtlin et al 2005;Potter et al 2008;Yang et al 2006;Ghanchi et al 2007;Manku et al 2007;Pece et al 2007;Sharp et al 2007). In several of these reports, PDT monotherapy was used as a The VIP, VIO and VIM trials examined the efficacy of PDT in patients whose lesions either did not meet the TAP Study inclusion criteria or who were included but required further study (Table 1).…”

Section: The Tap Study: Pdt In Predominantly Classic Lesionsmentioning

confidence: 99%

Photodynamic therapy with verteporfin in age‐related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic properties

Cruess

Zlateva

Pleil

et al. 2009

Acta Ophthalmologica

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ABSTRACT.Photodynamic therapy (PDT) with verteporfin has been used less comprehensively in the treatment of exudative age-related macular degeneration (AMD), and specifically of choroidal neovascularization (CNV), since the advent of antiangiogenic therapies. Recently, there has been a renewed interest in PDT as an adjunct to these and other agents in the treatment of neovascular AMD. In light of this new development and the European Medicines Evaluation Agency's (EMEA) recent labelling decision to rescind approval for the use of PDT in occult CNV lesions, the present systematic review was undertaken to revisit the evidence supporting its clinical application. Photodynamic therapy provided the first pharmacological treatment for patients suffering from subfoveal CNV, the major cause of severe vision loss in AMD. Key clinical trials evaluating efficacy and safety have examined patients with all lesion subtypes, with the primary labelled indication (i.e. lesions containing a classic component of ‡ 50% ) deriving from the results of the Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study. The subsequent TAP Study Group post hoc categorization of lesions as predominantly classic is open to question, however, as it appears that the overall efficacy in this group only may have reflected the especially strong response in 100% classic lesions. Based on a subgroup analysis of the Verteporfin in Photodynamic Therapy Study, the indication for PDT subsequently was expanded in some jurisdictions, including that of the EMEA, to include occult lesions with no classic component. However, the subsequent Visudyne in Occult Study found no benefit in 100% occult lesions, resulting in the EMEA rescinding its approval for this indication.

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Section: The Tap Study: Pdt In Predominantly Classic Lesionsmentioning

confidence: 99%

Photodynamic therapy with verteporfin in age‐related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic properties

Cruess

Zlateva

Pleil

et al. 2009

Acta Ophthalmologica

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“…The clinical applicability of our, recently reported, predictive outcomes [31,32] mainly concerns the opportunity to improve the eligibility criteria of standardized PDT-V, currently centered just on the morphological composition of CNV [7,8,[27][28][29][30]. A pre-operative assessment of individual genetic backgrounds for designated coagulation-balance polymorphisms should make possible a more rational selection of candidates to PDT-V which, at present, is especially utilized in combination with anti-VEGF drugs [21][22][23][24][25][26].…”

Section: Current and Future Developmentsmentioning

confidence: 99%

“…baseline visual acuity and CNV size) were considered to explain the individually variable efficacy of PDT-V -- Fig. (1), this investigative approach has just partially improved the applicative criteria of verteporfin therapy [8,[27][28][29][30]. A new predictive scenario has been recently opened by the pharmacogenetic assessment of PDT-V efficacy profile, considering the role of coagulation-balance genetic backgrounds in changing its therapeutic response.…”

Section: Introductionmentioning

confidence: 99%

Predictive Role of Gene Polymorphisms Affecting Thrombin-Generation Pathway in Variable Efficacy of Photodynamic Therapy for Neovascular Age-Related Macular Degeneration

Parmeggiani

Gemmati²,

Costagliola³

et al. 2009

DNAG

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Age-related macular degeneration (AMD) represents the leading cause of central blindness in developed countries. The majority of severe vision loss occurs in the neovascular form of AMD, generally characterized by the presence of choroidal neovascularization (CNV) beneath the fovea. Photodynamic therapy with verteporfin (PDT-V) and drugs acting against vascular endothelial growth factor are the most commonly employed treatments for AMD-related subfoveal CNV. The combined use of both these strategies is the most promising therapeutic approach towards this harmful disease. The therapeutic action of PDT-V depends to a photochemical perturbation of thrombo-coagulative processes within CNV. Predictive correlations between peculiar coagulation-balance gene polymorphisms and different levels of post-PDT-V benefit have been recently documented in Caucasian patients with neovascular AMD. Particularly, heterozygous A-allele carriers of factor V Leiden 1691 or prothrombin 20210 gene are characterized by a greater possibility to exhibit clinical benefit after PDT-V. Both mutations induce thrombophilia increasing the thrombin generation in plasma and, thus, they can consistently intensify the photothrombotic phase of the therapeutic CNV occlusion. In prospect, considering the different individual susceptibility to PDT-V, a preoperative assessment of the genotypic thrombophilic background could optimize the eligibility criteria of this intriguing treatment. This review summarizes some of the recent published patents on treatment of neovascular AMD, with a particular attention to PDT-V application in combined therapeutic modalities.

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“…Although several ocular factors (i.e. baseline size of CNV and initial VA) have been examined as individual predictors of the variable PDT-V efficacy [127][128][129][130], these studies have been weakly contributed to an applicative optimization of this intriguing treatment. On the other hand, both Chan et al and Yang et al have interestingly reported the presence of a remarkable difference in CNV responsiveness to standardized PDT-V between Asian and Caucasian patients [131,132].…”

Section: Mechanisms Of Action Of Pdt-vmentioning

confidence: 99%

Pharmacogenetic Aspects in Therapeutic Management of Subfoveal Choroidal Neovascularisation: Role of Factor XIII-A 185 T-Allele

Parmeggiani

Costagliola²,

Incorvaia³

et al. 2011

CDT

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In Western Countries, the occurrence of choroidal neovascularization (CNV) secondary to different forms of macular degeneration represents a common cause of blindness. Particularly, age-related macular degeneration (AMD) and pathologic myopia (PM) are the most frequent diseases related to CNV development. At present, the combined employment of drugs acting against vascular endothelial growth factor (anti-VEGF) and photodynamic therapy with verteporfin (PDT-V) is a promising therapeutic strategy for neovascular macular degenerations. However, this approach inevitably leads to an increase in health-resource utilization. In several clusters of patients treated for CNV, correlations among common gene polymorphisms implicated in coagulation- or complement-cascade and different levels of, respectively, post-PDT-V or post-anti-VEGF benefit have been reported. Factor XIII-A G185T substitution (rs5985), a frequent anti-thrombophilic genetic variant of Caucasian ethnic groups, unequivocally influences a worsening of the CNV responsiveness to PDT-V in patients affected by either AMD- or PM-related CNV. These coherent pharmacogenetic findings point out the opportunities to: i. optimize the eligibility criteria of PDT-V and, ii. customize the interventional strategy against CNV, for finally minimizing the socio-economic burden of neovascular macular degenerations.

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Factors influencing poor visual outcome in patients treated with photodynamic therapy for choroidal neovascularization secondary to age‐related macular degeneration

Cited by 7 publications

References 12 publications

Photodynamic therapy with verteporfin in age‐related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic properties

Photodynamic therapy with verteporfin in age‐related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic properties

Predictive Role of Gene Polymorphisms Affecting Thrombin-Generation Pathway in Variable Efficacy of Photodynamic Therapy for Neovascular Age-Related Macular Degeneration

Pharmacogenetic Aspects in Therapeutic Management of Subfoveal Choroidal Neovascularisation: Role of Factor XIII-A 185 T-Allele

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