Photodynamic therapy as a treatment option for peripapillary pachychoroid syndrome: a pilot study

Iovino, Claudio; Peiretti, Enrico; Tatti, Filippo; Querques, Giuseppe; Borrelli, Enrico; Sacconi, Riccardo; Chhablani, Jay; Agrawal, Hitesh; Boon, Camiel J F; Dijk, Elon H. C. van; Cennamo, Gilda; Lupidi, Marco; Muzi, Alessio; Iorio, Valentina Di; Iglicki, Matías; Smadar, Lital; Loewenstein, Anat; Zur, Dinah

doi:10.1038/s41433-021-01515-z

Cited by 20 publications

(22 citation statements)

References 24 publications

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“…Baek and colleagues proposed a similar pathophysiological mechanism of arteriovenous shunting in eyes with peripapillary polypoidal choroidal vasculopathy (Baek et al 2019a). PDT has been shown to be effective in PPS in a recent pilot study that included 25 eyes of 23 patients (Iovino et al 2021). Similar to the proposed effects of PDT described above for CSC, the efficacy of PDT in PPS may involve closure of arteriovenous shunting, between a choroidal artery and choroidopial vein instead of a choroidal vein.…”

Section: Peripapillary Pachychoroid Syndromementioning

confidence: 91%

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Brinks

Dijk

Meijer

et al. 2022

Acta Ophthalmologica

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The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role.

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Section: Peripapillary Pachychoroid Syndromementioning

confidence: 91%

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Brinks

Dijk

Meijer

et al. 2022

Acta Ophthalmologica

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“…In some cases, there was no immediate response to treatment with most patients showing anatomical improvement with VA stabilization. A recent study by Iovino et al [ 8 ] supports the use of PDT for PPS since in their cohort, best-corrected VA significantly improved from baseline to month 3. On the other hand, in a recent PPS case report, it is emphasized that CME in PPS may show significant fluctuations and sometimes observation should be the initial approach especially if vision is not considerably affected [ 9 ].…”

Section: Discussionmentioning

confidence: 87%

Peripapillary Pachychoroid Syndrome (PPS): Diagnosing and Treating a Rare Entity

Bouzika

Georgalas

Sotirianakou

et al. 2022

Case Reports in Ophthalmological Medicine

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Two cases with peripapillary pachychoroid syndrome (PPS) along with the challenges concerning correct diagnosis and treatment are presented. In the first case, the patient presented with painless unilateral gradual visual loss. Fundoscopy and optical coherence tomography (OCT) revealed cystoid macular edema (CME) in the left eye (LE), extending from the temporal optic disc margin towards the fovea, with no additional findings. Enhanced-depth imaging- (EDI-) OCT provided additional information and increased choroidal thickness nasally to the macula and pachyvessels in the outer choroidal layer, findings supportive of PPS. Photodynamic therapy (PDT) was applied at the leakage sites. Two months later, CME and subretinal fluid (SRF) had resolved, and VA had significantly improved. In the second case, a patient presented with reduced vision and metamorphopsia bilaterally over the previous 5 days. Fundoscopy revealed CME in both eyes. OCT confirmed the presence of CME in the papillomacular area in the right eye; similarly, CME was recorded in the macula of the LE with SRF located subfoveally. EDI-OCT showed increased choroidal thickness in both eyes. Treatment was administered, originally with dorzolamide eye drops along with eplerenone tablets, and then dexamethasone eye drops that eventually led to significant anatomic and functional improvement. It is important for ophthalmologists to be able to recognize the unique clinical entity of PPS, as its resemblance to disorders with similar features may lead to misdiagnoses and unnecessary, or even incorrect, interventions.

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“…Due to relatively new recognition of this entity, only limited studies had evaluated the result of intervention for PPS. A retrospective study [ 84 ] of 25 eyes showed that PDT was effective in reducing SRF and CCT at 3 months, and the effect remained stable at 12 months. VA also improved from 0.59 logMAR units at baseline to 0.51 logMAR units at 3 months; however, the VA gain subsided with time afterwards to 0.60 logMAR units at 6 months and 0.65 at 12 months.…”

Section: Efficacy Of Photodynamic Therapy In Different Pachychoroid Diseasesmentioning

confidence: 99%

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

Chan

et al. 2021

Journal of Ophthalmology

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Recent advances in retinal imaging technology have improved our understanding in the pathogenesis and evolvement of various chorioretinal diseases. Central serous chorioretinopathy and polypoidal choroidal vasculopathy are now recognized to belong to the same spectrum of disorders known as pachychoroid diseases. Pachychoroid diseases have similar pathogenesis pathway and common characteristics of thickened choroid, dilated outer choroidal vessels, and thinning of choriocapillaris. More disease entities have been identified to belong to this disease spectrum. Photodynamic therapy can induce choroidal hypoperfusion, remodeling of abnormal choroidal vessels, and reduction of choroidal congestion. It is known to be an effective treatment for chronic central serous chorioretinopathy and polypoidal choroidal vasculopathy. Many new studies are being performed to investigate its efficacy in other pachychoroid diseases. In this review, we provided an overview of the rationale, efficacy, and treatment strategies of photodynamic therapy in different pachychoroid diseases and discussed its role in the management along with other treatment modalities with most updated clinical evidence.

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Photodynamic therapy as a treatment option for peripapillary pachychoroid syndrome: a pilot study

Cited by 20 publications

References 24 publications

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Peripapillary Pachychoroid Syndrome (PPS): Diagnosing and Treating a Rare Entity

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

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