Photodynamic Therapy for Angioid Streaks

Browning, Andrew C.; Amoaku, Winfried; Chung, Andrew; Ghanchi, Faruk; Harding, Simon; Musadiq, M; Yang, Yit; Talks, S J

doi:10.1016/j.ophtha.2007.03.057

Cited by 71 publications

(26 citation statements)

References 5 publications

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“…The additional endpoints which attempted to identify a potential mechanism for the improvement seen in our study, which included assessment of macular thickness with OCT, the foveal avascular zone, rhodopsin mRNA and changes in retinopathy grading, did not show any significant differences. This result is perhaps not unexpected, as previous studies have shown that the correlation of BCVA and retinal thickness is poor [24]. However, it is possible that improvement in vision is not occurring as a result of visible structural improvements in the retina.…”

Section: Discussionsupporting

confidence: 59%

Visual Improvement following Continuous Positive Airway Pressure Therapy in Diabetic Subjects with Clinically Significant Macular Oedema and Obstructive Sleep Apnoea: Proof of Principle Study

Mason

Kiire²,

Groves³

et al. 2011

Respiration

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Background: Diabetic retinopathy and diabetic macular oedema are more prevalent in patients with coexistent obstructive sleep apnoea (OSA). Objectives: We assessed if treatment of OSA with continuous positive airway pressure (CPAP) might improve visual acuity (VA). Methods: A total of 35 patients with clinically significant macular oedema (CSMO) and OSA [oxygen desaturation index (ODI) ≥10 or apnoea-hypopnoea index (AHI) ≥15] were identified and agreed to be studied. VA (expressed as the logarithm of the minimum angle of resolution, logMAR), macular thickness, fundal photographs, glycosylated haemoglobin (HbA1c) and rhodopsin mRNA were measured twice at baseline and at 3 and 6 months post-CPAP. Fluorescein angiography and the Epworth Sleepiness Scale (ESS) were obtained once at baseline and at 6 months. Results: Three patients withdrew before the first trial visit. Thus, a total of 32 patients (17 males) entered the study, and 4 subsequently withdrew; thus 28 completed 6 months of follow-up. Baseline characteristics of the subjects were as follows [mean (SD or inter-quartile range)]: age 66.2 (7.1) years, body mass index 31.7 (6.3), HbA1c 7.4% (1.44) [57.1 (15.7) mmol/mol], AHI 16.5 (11–25), ODI 16.0 (12–25), ESS 6.5 (4.0–12.0) and duration of diabetes 9.5 years (5.0–16.5). Participants were divided into 13 high and 15 low CPAP compliers (≥ and <2.5 h/night over the 6 months, respectively). At 6 months, the adjusted treatment effect on VA of high compliance versus low compliance was 0.11 (95% confidence interval 0.21 to –0.002; p = 0.047), equivalent to a one-line improvement on the logMAR chart. There was no significant improvement in macular oedema or fundal photographs. Conclusions: This hypothesis-generating, uncontrolled study suggests that ≥2.5 h/night CPAP usage over 6 months in individuals with CSMO and OSA may be associated with improvement in VA. This provides justification for a randomised controlled trial of CPAP therapy in such patients.

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Section: Discussionsupporting

confidence: 59%

Visual Improvement following Continuous Positive Airway Pressure Therapy in Diabetic Subjects with Clinically Significant Macular Oedema and Obstructive Sleep Apnoea: Proof of Principle Study

Mason

Kiire²,

Groves³

et al. 2011

Respiration

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“…Despite promising results with the stabilisation of vision in the short-term, longer follow-up demonstrated a progressive loss of visual acuity. [9][10][11] One study reported a limitation of visual loss after 1 year, particularly in those with subfoveal lesions; however, further follow-up at 2 years showed progressive visual decline. 9,10 The natural history of AS-associated CNV has a tendency towards disease progression and poor visual outcomes, which makes treatment difficult.…”

Section: Discussionmentioning

confidence: 99%

“…2,8 Photodynamic therapy (PDT) has been used as an alternative treatment method for both juxtafoveal and subfoveal CNV; however, longterm visual outcomes have generally remained poor. [9][10][11] Recently, ranibizumab, a humanised Fab fragment of a monoclonal antibody that binds to and inhibits the action of all isoforms of vascular endothelial growth factor (VEGF) A, was licensed for the treatment of CNV secondary to age-related macular degeneration (AMD), and became the only anti-VEGF recommended by the National Institute of Health and Clinical Excellence in the UK for the treatment of CNV secondary to AMD. 12 Recent studies have suggested that the use of intravitreal ranibizumab is efficacious in the treatment of CNV secondary to causes other than AMD, such as pathologic myopia or ocular histoplasmosis.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal ranibizumab for the treatment of choroidal neovascularisation secondary to angioid streaks

Shah

Amoaku

2012

Eye

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Aims To assess the medium to long-term efficacy and safety of intravitreal ranibizumab for the treatment of choroidal neovascularisation (CNV) secondary to angioid streaks (AS). Methods A total of 12 eyes of nine patients treated with intravitreal ranibizumab (0.5 mg in 0.05 ml) for CNV secondary to AS were retrospectively identified. Efficacy of treatment was determined by changes in best-corrected LogMAR visual acuity (BCVA) and optical coherence tomography. Changes with respect to baseline BCVA were defined as improved or reduced with a gain or loss of more than 10 letters, respectively, or stable if remaining within 10 letters. Results Over a mean follow-up of 21.75 months (range: 1-54), patients received mean 5.75 (range: 2-15) intravitreal ranibizumab injections per affected eye. BCVA improved in three eyes (25%), stabilised in eight eyes (66.67%), and deteriorated in one eye (8.33%). There was no significant change in central retinal thickness (CRT) over the follow-up period (P ¼ 0.1072). No drug-related systemic side effects were recorded. Conclusion The long-term treatment of CNV secondary to AS with intravitreal ranibizumab showed a stabilisation in CRT and an improvement or stabilisation of BCVA. The absence of systemic side effects was reassuring. Further long-term prospective studies are required to validate these findings.

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“…[4][5][6][7][8][9][10][11] Several strategies have been proposed to control CNV secondary to angioid streaks, such as argon laser photocoagulation, transpupillary thermotherapy, photodynamic therapy (PDT), surgical removal, and intravitreal bevacizumab and intravitreal ranibizumab (IVR) injections. [7][8][9][10][11][12][13][14][15][16][17][18] The effectiveness of PDT alone in stabilizing vision and decreasing recurrence of CNV secondary to angioid streaks remains questionable; hence, most eyes show poor long-term visual outcomes. [7][8][9][10][11][12][13][14] The poor natural history of many CNV lesions and the limitations of PDT for these lesions have prompted the search for alternative treatment modalities.…”

mentioning

confidence: 99%

“…19,20 Standard fluence PDT (sfPDT) is approved for treatment of predominantly classic CNV using 50 J/cm 2 delivered as 600 mW for more than 83 seconds. 7,8,[10][11][12][13][14] Standard fluence PDT has been found to be associated with choroidal hypoperfusion. 19,20 It results in an increase in vascular endothelial growth factor (VEGF) in normal tissue.…”

mentioning

confidence: 99%

Combination Treatment With Intravitreal Injection of Ranibizumab and Reduced Fluence Photodynamic Therapy for Choroidal Neovascularization Secondary to Angioid Streaks

Artunay

Yüzbaşıoğlu²,

Rasier³

et al. 2011

Retina

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The preliminary results of this prospective study indicate that combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks seems to be effective in reducing or eliminating retinal edema, regression of neovascularization, and improving or stabilizing visual acuity without any complications. Large controlled studies are needed to evaluate the long-term effects of this combination regimen.

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Photodynamic Therapy for Angioid Streaks

Cited by 71 publications

References 5 publications

Visual Improvement following Continuous Positive Airway Pressure Therapy in Diabetic Subjects with Clinically Significant Macular Oedema and Obstructive Sleep Apnoea: Proof of Principle Study

Visual Improvement following Continuous Positive Airway Pressure Therapy in Diabetic Subjects with Clinically Significant Macular Oedema and Obstructive Sleep Apnoea: Proof of Principle Study

Intravitreal ranibizumab for the treatment of choroidal neovascularisation secondary to angioid streaks

Combination Treatment With Intravitreal Injection of Ranibizumab and Reduced Fluence Photodynamic Therapy for Choroidal Neovascularization Secondary to Angioid Streaks

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