Subfoveal Retinal and Choroidal Thickness After Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

doi:10.1016/j.ajo.2010.10.030

American Journal of Ophthalmology

Volume 151, Issue 4, April 2011, Pages 594-603.e1

https://doi.org/10.1016/j.ajo.2010.10.030 Get rights and content

Purpose

To evaluate the morphologic retinal and choroidal changes after verteporfin photodynamic therapy (PDT) with and without ranibizumab for polypoidal choroidal vasculopathy using spectral-domain optical coherence tomography.

Design

Retrospective, comparative series.

Methods

The enhanced depth imaging optical coherence tomography technique was used in this retrospective, comparative series to measure the subfoveal retinal and choroidal thicknesses before and after treatment.

Results

Twenty-seven eyes with polypoidal choroidal vasculopathy were examined retrospectively. Sixteen eyes were treated with PDT monotherapy (PDT group). Eleven eyes were treated with PDT after intravitreal ranibizumab injection (ranibizumab plus PDT group). The polypoidal lesions regressed in all cases at 3 months. The mean retinal thickness, including the retinal detachment, increased from 401 ± 157 μm before treatment to 506 ± 182 μm 2 days after PDT (P < .001) and decreased to 365 ± 116 μm by 1 week after treatment (P = .03) and 265 ± 127 μm by 6 months after treatment (P < .001). The mean choroidal thickness increased from 269 ± 107 μm before treatment to 336 ± 96 μm 2 days after PDT treatment (P < .001 compared with baseline) and decreased to 262 ± 96 μm by 1 week after treatment (P = .24) and 229 ± 104 μm by 6 months (P < .001). Although the choroidal thickness showed a similar trend with both therapies, the retinal thickness in the ranibizumab plus PDT group remained thinner than that in the PDT group until 6 months after treatment.

Conclusions

PDT was associated with decreased retinal and choroidal thicknesses. Combination therapy reduced the transient exudation after PDT in some cases, and monthly intravitreal ranibizumab injections maintained retinal thinning and seemed to improve vision better than PDT monotherapy.

Section snippets

Methods

The clinical examinations for diagnosis of PCV included indirect ophthalmoscopy, slit-lamp biomicroscopy with a contact lens or noncontact lens, digital fluorescein angiography, and indocyanine green angiography (ICGA). We used a digital imaging system with an infrared camera and standard fundus camera (TRC-50 IX/IMAGEnet H1024 system; Topcon, Tokyo, Japan) and a confocal laser scanning system (HRA-2; Heidelberg Engineering, Dossenheim, Germany). The best-corrected visual acuity (BCVA) was

Results

Twenty-seven eyes of 27 consecutive patients with newly diagnosed PCV were included. Sixteen eyes of 16 patients (12 men, 4 women; mean age, 71.8 years) comprised the PDT group. Eleven eyes of 11 patients (6 men, 5 women; mean age, 71.0 years) comprised the ranibizumab plus PDT group. The lesion area included the fovea in all cases. The mean GLD for PDT was 3013 ± 1059 μm in the PDT group and 2905 ± 1122 μm in the ranibizumab plus PDT group. ICGA showed that the polypoidal lesions in all cases

Discussion

In the current study, PDT occluded the polypoidal lesions and decreased the retinal and choroidal thicknesses in eyes with PCV. The combination therapy of ranibizumab and PDT reduced the exudation just after PDT and maintained the retinal thinning until 6 months after treatment. Consequently, the BCVA after combination therapy was relatively better than that after PDT monotherapy.

PCV is more common in Asia than in white persons39, 40 and is thought to account for approximately half of patients

Ichiro Maruko, MD, was born and raised in Japan. He is a graduate of the Fukushima Medical University School of Medicine, Fukushima, Japan in 1999. He worked at College of Optometry, University of Houston, Houston, Texas, USA from 2002 to 2004. He received MD and PhD at Fukushima Medical University School of Medicine. His major interest includes retinal and choroidal imaging.

Dr Maruko is currently a Research Associate of the Department of Ophthalmology, Fukushima Medical University School of

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Differences in multimodal imaging features between Asian and Caucasian eyes may contribute to our understanding of the etiology of the polypoidal choroidal vasculopathy (PCV). The purpose of this study was to compare the multimodal imaging features of Asian and Caucasian eyes with PCV.
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Dr Maruko is currently a Research Associate of the Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan.

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Original articleSubfoveal Retinal and Choroidal Thickness After Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthalmology

Clin Ther

Ophthalmology

Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials—TAP Report 1

Arch Ophthalmol

Japanese age-related macular degeneration trial: 1-year results of photodynamic therapy with verteporfin in Japanese patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration

Am J Ophthalmol

Verteporfin Roundtable 2000 and 2001 Participants; Study Group Principal InvestigatorsGuidelines for using verteporfin (Visudyne) in photodynamic therapy to treat choroidal neovascularization due to age-related macular degeneration and other causes

Retina

Guidelines for using verteporfin (Visudyne) in photodynamic therapy for choroidal neovascularization due to age-related macular degeneration and other causes: update

Retina

Treatment of polypoidal choroidal vasculopathy with photodynamic therapy

Retina

Indocyanine green angiography: guided photodynamic therapy for polypoidal choroidal vasculopathy

Am J Ophthalmol

Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy

Retina

Photodynamic therapy with verteporfin for age-related macular degeneration or polypoidal choroidal vasculopathy: comparison of the presence of serous retinal pigment epithelial detachment

Br J Ophthalmol

Histopathological changes following photodynamic therapy in human eyes

Arch Ophthalmol

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

Graefes Arch Clin Exp Ophthalmol

Photodynamic effects on choroidal neovascularization and physiological choroid

Invest Ophthalmol Vis Sci

Original article
Subfoveal Retinal and Choroidal Thickness After Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy