Photodynamic Therapy-Induced Acute Exudative Maculopathy (PAEM): Prevalence, Impact and Management Strategies

Abstract

Photodynamic therapy (PDT) has a niche role in treating various choroidal pathologies. PDT-induced acute exudative maculopathy (PAEM) is an uncommon complication of PDT that results in exudative retinal detachment and mild to severe decrease in vision. Successful management strategies include observation, local or systemic corticosteroids, and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Most cases return to visual acuity near baseline. This review summarizes what is known about PAEM to date including etiology, prevalence, management strategies, and outcomes. We conclude that management of PAEM must take into consideration various patient-specific factors. Treatment with corticosteroids or anti-VEGF agents may expedite time to recovery, though lack of randomized controlled trials preclude firm conclusions regarding a standardized approach to managing this complication of PDT.

Photodynamic acute exudative maculopathy in a case series of circumscribed choroidal hemangioma.

“…As transient choroidal ischemia and inflammation resulting in excessive vascular permeability could be responsible for the development of PAEM, [10][11][12] it should not be surprising that CCH, because of the intrinsic vascular nature of this choroidal tumor, has a higher rate of this phenomenon than other pathologies. It is noteworthy that in the present study, the appearance or increase of IRF as the clinical presentation of PAEM was common (5/7 eyes).…”

“…Regarding the management of PAEM, as Sumnicht et al 11 explained, treatment with corticosteroids or anti-VEGF agents may reduce the time till recovery, although the lack of randomized controlled trials precludes a standardized approach to managing this condition. Moreover, the management strategy done in different studies is not directly comparable because several factors, such as the symptoms of the patient, the severity or the duration of it, could influence the physician's decision.…”

“…Breakdown of the blood–retinal barrier, retinal pigment epithelium (RPE) pump dysfunction, and the inflammatory surge of vascular endothelial growth factor occurring after PDT are other commonly accepted theories. 11,12…”

“…Breakdown of the bloodretinal barrier, retinal pigment epithelium (RPE) pump dysfunction, and the inflammatory surge of vascular endothelial growth factor occurring after PDT are other commonly accepted theories. 11,12 Different groups have described PAEM in multiple entities such as neovascular age-related macular degeneration (nAMD), central serous chorioretinopathy (CSCR), or ocular tumors. 8,10,13,14 Bacillary layer detachment (BALAD) is a newly described optical coherence tomography (OCT) sign that is associated with exudation in the macula including PAEM and is characterized by a separation or detachment of the photoreceptor's inner and outer segments, which is caused by a split within the inner segment myoid.…”

Two-year Clinical Outcomes Following Photodynamic Acute Exudative Maculopathy in Patients with Chronic Central Serous Chorioretinopathy

“…5,6 Photodynamic therapy-induced acute exudative maculopathy (PAEM) is considered a transient increase in subretinal fluid (SRF) within the first days after treatment, being recently reported by different authors and thus attracted much attention. [7][8][9][10] However, there is no consensus on the criteria for its diagnosis. Photodynamic therapy-induced acute exudative maculopathy has been reported in different diseases treated with PDT.…”