Photodynamic therapy for inflammatory choroidal neovascularisation unresponsive to immunosuppression

Abstract

Aim: To report on visual and angiographic outcomes of a consecutive series of patients with inflammatory choroidal neovascular membranes (CNV) unresponsive to systemic immunosuppression treated with photodynamic therapy (PDT). Methods: The medical records of six consecutive patients with inflammatory CNVs that failed to respond to systemic immunosuppression and that later underwent PDT were retrospectively reviewed. Patient demographics, visual acuity, and fluorescein angiographic findings were evaluated.Results: There were five females and one male with a mean age of 40.8 years (range 35-58 years). Four patients had clinical features consistent with punctate inner choroidopathy and two with presumed ocular histoplasmosis. In all cases clinical signs of CNV activity, including subretinal fluid, subretinal blood, hard exudates, and/or recent decrease in visual acuity were present prior to PDT. All patients had been treated with high dose systemic immunosuppressants, which failed to induce regression of the CNV and/or to improve vision. The CNVs were subfoveal in five patients and juxtafoveal in one; all were classified as predominantly classic. Following PDT an improvement in vision occurred in all cases (median improvement of 18 letters, range 3-42 letters). At last follow up, signs of decreased activity in the CNV were detected in all cases. Patients were followed for a median of 10 months (range 9-20 months). Conclusion: PDT appears to be a useful option in the management of patients with inflammatory CNVs unresponsive to immunosuppressive therapies.

Ocular Photodynamic Therapy – Standard Applications and New Indications (Part 1)

“…By a median follow-up of 15 months (range 10–31) VA improved by a median of 13 letters in 5 patients and remained stable (+/–1 letter) in 1 patient. Leslie et al [25] presented PDT in 6 eyes of patients who had been treated with a high dose of systemic immunosuppressive agents, which failed to induce regression of the CNV and/or to improve vision. Four patients had clinical features consistent with punctate inner choroidopathy and 2 with presumed ocular histoplasmosis syndrome.…”

Intravitreal bevacizumab for choroidal neovascularisation secondary to causes other than age-related macular degeneration

“…Eye fails, additional therapies have included laser photocoagulation, [58][59][60] PDT, 61,62 and submacular surgery, 63 with limited success.…”

Photodynamic therapy combined with systemic corticosteroids for choroidal neovascularisation secondary to punctate inner choroidopathy

“…14 The use of PDT in the management of subfoveal CNV in PIC has been reported by several authors. [9][10][11][12][13] A literature review reveals a total of 56 cases of CNV caused by inflammatory chorioretinal disease treated with PDT. Of these, 37 cases (66%) had PIC.…”

“…11 The selection of each treatment would depend on the stage of development of the CNV. Early lesions should respond well to immunosuppression, whereas formed CNV will require PDT.…”

“…3 Photodynamic therapy (PDT) was first shown to be of benefit in the treatment of subfoveal CNV secondary to age-related macular degeneration 8 Since then, several positive reports on its use in treatment of subfoveal CNV secondary to inflammatory chorioretinal diseases have been published. [9][10][11][12][13] However, all these studies were retrospective reviews of a variety of cases including PIC, POHS, multifocal choroiditis with panuveitis, and serpiginous choroiditis. Some of the cases had been previously treated with laser photocoagulation or systemic immunosuppression before PDT was performed.…”