26
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      Are you tired of sifting through news that doesn't interest you?
      Personalize your Karger newsletter today and get only the news that matters to you!

      Sign up

      • Record: found
      • Abstract: found
      • Article: found

      Photodynamic Therapy in Subfoveal and Juxtafoveal Myopic Choroidal Neovascularization: A 10-year Retrospective Analysis

      research-article

      Read this article at

      ScienceOpenPublisherPubMed
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The aim of this study was to evaluate and compare the effects of photodynamic therapy (PDT) in eyes with subfoveal and juxtafoveal choroidal neovascularization (CNV) secondary to pathological myopia. The study was a single-center, 10-year analysis on 19 eyes. Patients underwent best-corrected visual acuity (BCVA) measurement, slit-lamp examination, ophthalmoscopy and fluorescein angiography. Eyes with subfoveal CNV (7 eyes, 37%) progressively worsened during the 10-year follow-up from 0.68 ± 0.26 to 0.80 ± 0.47 logMAR, while in the eyes with juxtafoveal CNV (12 eyes, 63%) BCVA improved from 0.59 ± 0.42 to 0.33 ± 0.27 logMAR. Prevalence and extension of chorioretinal atrophy (CRA) were greater in eyes with subfoveal compared with juxtafoveal CNV (84 vs. 66%, respectively) and enlargement (10.05 ± 6.7 vs. 3.53 ± 4.7 mm<sup>2</sup>, respectively). Our results confirm the limited long-term effectiveness of PDT in myopic subfoveal CNV. Satisfactory results can be achieved in juxtafoveal CNV with a better visual outcome and a minor CRA extension.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes.

          To determine the effects of photodynamic therapy (PDT) on choroidal and retinal structures of human eyes. One eye from each of three patients with large malignant melanomas of the uvea destined for enucleation received PDT using verteporfin according to the approved treatment recommendations for patients with age-related macular degeneration. Two laser spots and two light doses (50 J/cm(2) and 100 J/cm(2)) were applied in unaffected chorioretinal areas. The effects of PDT were assessed by fluorescein and indocyanine-green angiography. The eyes were enucleated 1 week later, fixed in buffered paraformaldehyde/glutaraldehyde solution, bisected along the laser spots, and processed for light and electron microscopy. In agreement with the clinical angiographic findings of hypofluorescence, a rather selective occlusion of the choriocapillary layer was observed in the 50-J/cm(2) PDT areas, whereas the 100-J/cm(2) PDT areas additionally revealed closure of deeper choroidal vessels and focal alterations of the retinal pigment epithelium. The overlying neurosensory retina, including photoreceptors and retinal capillaries, was well preserved in all PDT areas. Electron microscopy showed that alterations of the choriocapillary endothelium comprised swelling, shrinkage and fragmentation of endothelial cells, detachment from their basement membrane up to complete degeneration of the endothelial lining, leading to platelet aggregation, degranulation, and thrombus formation. Complete occlusion of capillary lumina by fibrin, thrombocytes, and cellular debris was observed. Remaining intact endothelial cells appeared to be reorganized into novel smaller vascular channels within occluded lumina. PDT with verteporfin at a dosage used clinically induces selective occlusion of the physiological choriocapillaris without affecting deeper choroidal, retinal, and optic nerve vessels or the overlying retinal pigment epithelium and neurosensory retina. The main mechanism of action appears to be vascular thrombosis induced by cytotoxic damage of endothelial cells and platelet activation. An increase in light dose enhances the occlusive effect with thrombosis within deeper choroidal layers and damage to the retinal pigment epithelium. However, photoreceptors remained intact at all light doses used.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Sequence of early vascular events after photodynamic therapy.

            To identify early vascular changes in choroidal neovascularization (CNV) and in adjacent normal choroid, after photodynamic therapy (PDT). In a prospective study, 40 patients with predominantly classic CNV due to age-related macular degeneration (AMD) were treated with PDT performed with verteporfin. Verteporfin was administered intravenously at a dose of 6 mg/m(2) body surface area. A near infrared laser light dose of 50 J/cm(2), an irradiance of 600 mW/cm(2) and a wavelength of 692 nm was applied. A scanning laser system was used to perform confocal fluorescein angiography (FA) and indocyanine green angiography (ICGA) before treatment and regularly at 5 hours, 1 day, 1 week, and 3 months after PDT. Images were analyzed for CNV size and leakage area as seen by FA and ICGA. Collateral damage within the surrounding choroid was documented based on the hypofluorescence in early- and late-phase ICGA. No immediate occlusion of the CNV complex was found angiographically, but a dynamic change over time was observed in the early perfusion patterns and late-phase hyper- and hypofluorescence. At 5 hours after treatment, large portions of the CNV lesion were still perfused. One day after PDT, CNV size in early FA and early ICGA reached its minimum, at 0.49 mm(2) (15.7%) and 0.78 mm(2) (31.1%) of the initial area, respectively. In late-phase FA and ICGA, however, an immediate massive exudation with a continuous increase in hyperfluorescence originated from the CNV and surrounding choroid, with a maximum in leakage area at 1 day. At 1 week PDT-induced exudation slowly resolved. Eyes in 36 patients showed some choroidal hypofluorescence by ICGA before treatment. A progressive increase of the hypofluorescent area surrounding the CNV was observed, which correlated with the size of the laser spot. Maximum hypofluorescence was noted at 1 week with an average size of 11.1 mm(2) in early- and late-phase ICGA. In contrast to findings in experimental animals, PDT in humans with classic CNV did not induce immediate thrombosis, but primarily caused a breakdown of vascular barriers. A characteristic sequence of vascular changes was observed with early, enhanced leakage from the CNV and normal choroid followed by nonperfusion later. Occlusion of the CNV lesions occurred 1 day after treatment, but closure of the adjacent choroidal vessels proceeded slowly over as long as 1 week.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Laser photocoagulation, photodynamic therapy, and intravitreal bevacizumab for the treatment of juxtafoveal choroidal neovascularization secondary to pathologic myopia.

              To compare the effects on visual acuity of laser treatment (LT), photodynamic therapy (PDT) with verteporfin, and intravitreal bevacizumab treatment in patients with juxtafoveal choroidal neovascularization secondary to pathologic myopia.
                Bookmark

                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2014
                May 2014
                25 January 2014
                : 231
                : 4
                : 204-210
                Affiliations
                Fondazione G.B. Bietti-IRCCS, Rome, Italy
                Author notes
                *Mariacristina Parravano, Fondazione G.B. Bietti-IRCCS, Via Livenza 3, IT-00198 Rome (Italy), E-Mail criparra@tin.it
                Article
                357504 Ophthalmologica 2014;231:204-210
                10.1159/000357504
                24481122
                c6a2f75b-f6d3-4b47-a1f2-fdc3ddc95211
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 05 September 2013
                : 18 November 2013
                Page count
                Figures: 1, Tables: 6, Pages: 7
                Categories
                Original Paper

                Vision sciences,Ophthalmology & Optometry,Pathology
                Choroidal neovascularization,Myopia,Photodynamic therapy

                Comments

                Comment on this article