Photodynamic therapy for age-related macular degeneration in a clinical setting: visual results and angiographic patterns

Abstract

• PURPOSE: To evaluate the visual outcome of patients with subfoveal choroidal neovascularization due to agerelated macular degeneration, who received photodynamic therapy (PTD) in a clinical setting and to identify potential predictive visual and angiographic factors.• DESIGN: Interventional case series.• METHODS: The study included 74 patients with subfoveal choroidal neovascularization who underwent PDT from January 2000 to March 2001 and completed at least 1 year follow-up. All patients received verteporfin PDT and were followed clinically, with fluorescein angiography (74 eyes), and with indocyanine green angiography (65 eyes). A review of the medical records and angiograms was performed.• RESULTS: Mean follow-up was 15.6 months. Patients received a mean of 3.4 treatments per year. Sixty-six percent lost less than 3 Snellen lines of visual acuity. Three patients (4%) experienced profound visual acuity loss to finger counting. Final visual acuity was positively correlated with lesion size and visual acuity at presentation. Visual outcome was worse in the presence of cystoid macular edema. On indocyanine green angiography, a round hypofluorescent spot was seen at the site of the PDT, with maintenance of medium and large choroidal vessels.• CONCLUSION: Smaller lesion size and better visual acuity at presentation were good predictive signs, whereas cystoid macular edema was found to be a poor A GE-RELATED MACULAR DEGENERATION IS THE LEADing cause of legal blindness in white persons aged 50 years and older in the United States, with choroidal neovascularization accounting for the majority of cases. [1][2][3] Photodynamic therapy (PDT) has been reported to result in vaso-occlusion of choroidal neovascularization, with minimal effect on the sensory retina and the retinal pigment epithelium. 4 The Treatment of Age-Related Macular Degeneration With PDT (TAP) Study Group 5,6 concluded that PDT is a safe and effective mode of treatment for patients with predominantly classic subfoveal choroidal neovascularization due to age-related macular degeneration.The purpose of this retrospective study was to evaluate the visual acuity of patients with subfoveal choroidal neovascularization caused by age-related macular degeneration after administration of PDT in a clinical setting. We also sought to identify possible predictive visual and angiographic factors for the outcome of this treatment. METHODSTHE STUDY WAS CONDUCTED AT OUTPATIENT OPHTHALmology clinics in a university-affiliated medical institution. We reviewed the clinical charts and fluorescein and indocyanine green angiographies of 74 consecutive patients with subfoveal choroidal neovascularization due to age-related macular degeneration who were treated with verteporfin PDT from

Photodynamic therapy with verteporfin for choroidal neovascularisations in clinical routine outside the TAP study. One- and two-year results including juxtafoveal and extrafoveal CNV

“…Similar results (66% at a mean follow-up period of 15.6 months) were presented recently in another study [1] with a smaller number of cases. However, in that study only mean follow-up intervals were analysed; therefore, it cannot really be compared with studies such as the TAP study and ours, where all patients had exactly the same follow-up duration at the time of analysis.…”

Loss of E‐cadherin mediated cell–cell adhesion as an early trigger of apoptosis induced by photodynamic treatment

“…PDT has revealed a great potential for palliative and even curative treatment of endoscopically accessible tumors, such as lung and bladder carcinomas and it is increasingly used for the treatment of gastrointestinal and gynecological neoplasms (Sharman et al, 1999;Maier et al, 2000;Dougherty, 2002). PDT has also been applied in other medical fields such as ophthalmology, for the treatment of the neovascular age-related macular degeneration and other ocular diseases (Kalka et al, 2000;Axer-Siegel et al, 2004), and dermatology, for proliferative skin diseases (Dougherty, 2002;Lopez et al, 2004).…”

Does lesion size determine the success rate of photodynamic therapy for age-related macular degeneration?

“…The mean lesion size of predominantly classic CNV was noted to be smaller than the other CNV subtypes. 3 This was substantiated by other studies 4,5 .…”