Klin Monbl Augenheilkd 2009; 226(9): 725-739
DOI: 10.1055/s-0028-1109514
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Verschiedene Indikationen der photodynamischen Therapie in der Augenheilkunde

Different Indications of Photodynamic Therapy in OphthalmologyG. E. Lang1 , S. Mennel2 , G. Spital3 , J. Wachtlin4 , B. Jurklies5 , H. Heimann6 , B. Damato7 , C. H. Meyer8
  • 1Augenklinik, Universitätsklinikum Ulm
  • 2Augenklinik, Philips-Universtität Marburg
  • 3Augenpraxis, St.-Franziskus-Hospital, Münster
  • 4Augenabteilung, Sankt-Gertrauden-Krankenhaus, Berlin Wilmersdorf
  • 5Zentrum für Augenheilkunde, Universitätsklinikum Essen
  • 6St. Pauls Eye Unit, Royal Liverpool University Hospital, Großbritannien
  • 7Ocular Oncology Unit, Royal Liverpool University Hospital, Großbritannien
  • 8Augenklinik, Universität Bonn
Further Information

Publication History

Eingegangen: 31.3.2009

Angenommen: 8.5.2009

Publication Date:
14 July 2009 (online)

Zusammenfassung

Hintergrund: Die photodynamische Therapie (PDT) mit Verteporfin am Auge wurde als Therapie der neovaskulären Form der altersabhängigen Makuladegeneration (AMD) vor 10 Jahren eingeführt. Danach erfolgte die Zulassung der PDT für chorioidale Neovaskularisationen (CNV) im Rahmen der pathologischen Myopie. Die Therapieempfehlungen zur AMD basieren auf den Ergebnissen zweier prospektiver, multizentrischer Studien (TAP- und VIP-Studie). Material und Methoden: In der Zwischenzeit wurde die PDT am Auge auch bei zahlreichen anderen Erkrankungen mit zum Teil bemerkenswertem Erfolg angewandt. Sie ist minimalinvasiv und hat geringe Nebenwirkungen. Verschiedene Erkrankungen und ihre Behandlung mit der PDT werden dargestellt. Ergebnisse: Die Durchführung der PDT als Behandlungsmethode bei idiopathischer CNV, bei CNV im Rahmen von inflammatorischen Netzhaut-Aderhauterkrankungen, chorioidalen Hämangiomen, vasoproliferativen Tumoren der Netzhaut, beim Aderhautmelanom und der Chorioretinopathia centralis serosa wird beschrieben. Bei den meisten Patienten kann die Progredienz der Erkrankung aufgehalten werden und bei einem Teil der Patienten kommt es zu einer Visusverbesserung. Die Aussichten sind umso besser, je früher die Behandlung erfolgt und je kleiner die Läsion ist. Schlussfolgerung: Zahlreiche Netzhaut-Aderhauterkrankungen können erfolgreich mit einer PDT behandelt werden. Allerdings ist diese Therapieform außer bei AMD und pathologischer Myopie off-label.

Abstract

Background: Photodynamic therapy (PDT) in eye disease was approved 10 years ago for age-related macular degeneration (AMD). Thereafter it was approved for choroidal neovascularisation (CNV) in pathological myopia. The treatment regimen is based on two prospective, multicentre trials (TAP and VIP studies). Material and Methods: In the meantime PDT has been successfully used also in several other ocular diseases. PDT is minimally invasive and has an excellent side effect profile. Different diseases and their treatment with PDT are discussed. Results: The treatments of idiopathic CNV, secondary CNV in inflammatory diseases of the retina and choroid, choroidal haemangioma, vasoproliferative tumours, malignant melanoma of the choroid, and central serous chorioretinopathy with PDT are described. In most patients the disease progression can be stopped and in some the PDT treatment results in visual improvement. The prognosis is better in patients with early disease detection and small lesions. Conclusion: Several retinal and choroidal diseases can be treated successfully with PDT. Except for AMD and pathological myopia, PDT is an off label treatment.

Literatur

  • 1 Mennel S, Barbazetto I, Meyer C H. et al . Ocular photodynamic therapy – standard applications and new indications (part 1). Review of the literature and personal experience.  Ophthalmologica. 2007;  221 216-226
  • 2 Mennel S, Barbazetto I, Meyer C H. et al . Ocular photodynamic therapy – standard applications and new indications (Part 2). Review of the literature and personal experience.  Ophthalmologica. 2007;  221 282-291
  • 3 Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Study Group . Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials-TAP report No. 2.  Arch Ophthalmol. 2001;  119 198-207
  • 4 Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Study Group . Verteporfin therapy of subfoveal choroidal neovascularzation in patients with age-related macular degeneration. Additional information regarding baseline lesion composition’s impact on vision outcomes-TAP report No. 3.  Arch Ophthalmol. 2002;  120 1443-1454
  • 5 Verteporfin in Photodynamic Therapy (VIP) Study Group . Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin.  Ophthalmology. 2001;  108 841-852
  • 6 Blinder K J, Blumenkranz M S, Bressler N M. et al . Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial – VIP report no. 3.  phthalmology. 2003;  110 667-673
  • 7 Husain D, Miller J W, Michaud N. et al . Intravenous infusion of lipososmal benzoporphyrin derivative for photodynamic therapy of experimental choroidal neovascualrization.  Arch Ophtahlmol. 1996;  114 978-985
  • 8 Richter A W, Waterfield E, Jain A K. et al . Liposomal delivery of a photosensitizer, benzoporphyrin derivative monoacid ring A (BPD), in tumor tissue in a mouse tumor model.  Photochem Photobiol. 1993;  57 1000-1006
  • 9 Schmidt-Erfurth U, Hasan T, Gragoudas E. et al . Vascular targeting in photodynamic occlusion of subretinal vessls.  Ophthalmology. 1994;  101 1953-1961
  • 10 Miller J W, Walsh A W, Kramer M. et al . Photodynamic therapy of experimental choroidal neovascularization using lipoprotein-delivered benzoporphyrin.  Arch Ophthalmol. 1995;  113 810-818
  • 11 Kramer M, Miller J W, Michaud N. et al . Liposomal benzoporphyrin derivative verteporfin photodynamic therapy. Selective treatment of choroidal neovascularization in monkeys.  Ophthalmology. 1996;  103 427-438
  • 12 Fingar V H, Wilman T J, Wiehle S A. The role of microvascular damage in photodynamic therapy: the effect of treatment on vessel constriction permeability and leukocyte adhesion.  Cancer Res. 1992;  52 4914-4921
  • 13 Cohen S Y, Laroche A, Leguen Y. et al . Etiology of choroidal neovascularization in young patients.  Ophthalmology. 1996;  103 1241-1244
  • 14 Ho A C, Yannuzzi L A, Pisicano K. et al . The natural history of idiopathic subfoveal choroidal neovascularization.  Ophthalmology. 1995;  102 782-789
  • 15 Chan W M, Lam D S, Wong T H. et al . Photodynamic therapy with verteporfin for subfoveal idiopathic choroidal neovascularization: one-year results from a prospective case series.  Ophthalmology. 2003;  110 2395-2402
  • 16 Wachtlin J, Wehner A, Heimann H. et al . Photodynamic treatment with verteporfin for patients with idiopathic choroidal neovascularization. Two-year results.  Ophthalmologe. 2004;  101 489-495
  • 17 Su Z A, Yao K, Shen J. et al . Evaluation of photodynamic therapy in idiopathic choroidal neovascularization.  Zhonghua Yan Ke Za Zhi. 2007;  43 509-13
  • 18 Chan W M, Lai T Y, Lau T T. et al . Combined photodynamic therapy and intravitreal triamcinolone for choroidal neovascularization secondary to punctate inner choroidopathy or of idiopathic origin: one-year results of a prospective series.  Retina. 2008;  28 71-80
  • 19 Brown J Jr, Folk J C, Reddy C V. et al . Visual prognosis of multifocal choroiditis, punctate inner choroidopathy, and the diffuse subretinal fibrosis syndrome.  Ophthalmology. 1996;  103 (7) 1100-1105
  • 20 Spaide R F, Freund K B, Slakter J. et al . Treatment of subfoveal choroidal neovascularization associated with multifocal choroiditis and panuveitis with photodynamic therapy.  Retina. 2002;  22 (5) 545-9
  • 21 Shah G K, Blinder K J, Hariprasad S M. et al . Photodynamic therapy for juxtafoveal choroidal neovascularization due to ocular histoplasmosis syndrome.  Retina. 2005;  25 (1) 26-32
  • 22 Wachtlin J, Heimann H, Behme T. et al . Long-term results after photodynamic therapy with verteporfin for choroidal neovascularizations secondary to inflammatory Chororetinal diseases.  Graefes Arch Clin Exp Ophthalmol. 2003;  241 (11) 899-906
  • 23 Gerth C, Spital G, Lommatzsch A. et al . Photodynamic therapy for choroidal neovascularization in patients with multifocal choroiditis and panuveitis.  Eur J Ophthalmol. 2006;  16 (1) 111-118
  • 24 Saperstein D A, Rosenfeld P J, Bressler N M. et al . Verteporfin therapy for CNV secondary to OHS.  Ophthalmology. 2006;  113 (12) 2371 e1-3
  • 25 Rechtman E, Allen V D, Danis R P. et al . Intravitreal triamcinolone for choroidal neovascularization in ocular histoplasmosis syndrome.  Am J Ophthalmol. 2003;  136 (4) 739-741
  • 26 Macular Photocoagulation Study Group . Persistent and recurrent neovascularization after krypton laser photocoagulation for neovascular lesions of ocular histoplasmosis.  Arch Ophthalmol. 1989;  107 (3) 344-352
  • 27 Hawkins B S, Bressler N M, Bressler S B. et al . Surgical removal vs observation for subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or idiopathic: I. Ophthalmic findings from a randomized clinical trial: Submacular Surgery Trials (SST) Group H Trial: SST Report No. 9.  Arch Ophthalmol. 2004;  122 (11) 1597-1611
  • 28 Chan W M, Lai T Y, Liu D T. et al . Intravitreal bevacizumab (avastin) for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin.  Am J Ophthalmol. 2007;  143 (6) 977-983
  • 29 Bakri S J, Larson T A, Edwards A O. Intraocular inflammation following intravitreal injection of bevacizumab.  Graefes Arch Clin Exp Ophthalmol. 2008;  246 (5) 779-781
  • 30 Shields C L, Honavar S G, Shields J A. et al . Circumscribed choroidal hemangioma: clinical manifestations and factors predictive of visual outcome in 200 consecutive cases.  Ophthalmology. 2001;  108 2237-2248
  • 31 Schmidt-Erfurth U, Michels S, Kusserow C. et al . Photodynamic therapy for symptomatic choroidal hemangioma: Visual and anatomic results.  Ophthalmology. 2002;  109 2284-2294
  • 32 Michels S, Michels B, Simader C. et al . Verteporfin therapy for choroidal hemangioma: a long-term follow-up.  Retina. 2005;  25 697-703
  • 33 Jurklies B, Anastassiou G, Ortmans S. et al . Photodynamic therapy using Verteporfin in circumscribed choroidal hemangioma.  Br J Ophthalmol. 2003;  87 84-89
  • 34 Verbraak F D, Schlingemann R O, Keunen J E. et al . Longstanding symptomatic choroidal hemangioma managed with limited PDT as initial or salvage therapy.  Graefe’s Arch Clin Exp Ophthalmol. 2003;  241 891-898
  • 35 Singh A D, Kaiser P K, Sear J E. et al . Photodynamic therapy of circumscribed choroidal hemangioma.  Br J Ophthalmol. 2004;  11 1414-1418
  • 36 Verbraak F D, Schlingemann R O, de Smet M D. et al . Single spot PDT in patients with circumscribed choroidal hemangioma and near normal visual acuity.  Graefe’s Arch Clin Exp Ophthalmol. 2006;  244 1178-1182
  • 37 Bosch M M, Helbig H. Blackening of a choroidal hemangioma after photodynamic therapy.  Klin Monatsbl Augenheilkd. 2005;  22 258-260
  • 38 Damato B, Elizalde J, Heimann H. Vasoproliferative Retinal Tumor. Joussen AM, Gardner TW, Kirchhof B, Ryan SJ Retinal Vascular Disease Berlin, Heidelberg, New York; Springer-Verlag 2007: 766-770
  • 39 Damato B. Vasoproliferative retinal tumour.  Br J Ophthalmol. 2006;  90 399-400
  • 40 Heimann H, Bornfeld N, Vij O. et al . Vasoproliferative tumours of the retina.  Br J Ophthalmol. 2000;  84 1162-1169
  • 41 Shields C l, Shields J A, Barrett J. et al . Vasoproliferative tumors of the ocular fundus. Classification and clinical manifestations in 103 patients.  Arch Ophthalmol. 1995;  113 615-623
  • 42 Barbezetto I A, Smith R T. Vasoproliferative tumor of the retima treated with PDT.  Retina. 2003;  23 565-567
  • 43 Blasi M A, Scupola A, Tiberti A C. et al . Photodynamic therapy for vasoproliferative retinal tumors.  Retina. 2006;  26 404-409
  • 44 Osman S a, Aylin Y, Arikan G. et al . Photodynamic treatment of a secondary vasoproliferative tumour associated with sector retinitis pigmentosa and Usher syndrome type I.  Clin Experiment Ophthalmol. 2007;  35 191-193
  • 45 Rodriguez-Coleman H, Spaide R F, Yannuzzi L A. Treatment of angiomatous lesions of the retina with photodynamic therapy.  Retina. 2002;  22 228-232
  • 46 Saldanha M J, Edrich C. Treatment of vasoproliferative tumors with photodynamic therapy.  Ophthalmic Surg Lasers Imaging. 2008;  39 143-145
  • 47 Damato B. Developments in the management of uveal melanoma.  Clin Experiment Ophthalmol. 2004;  32 639-647
  • 48 Barbazetto I A, Lee T C, Rollins I S. et al . Treatment of choroidal melanoma using photodynamic therapy.  Am J Ophthalmol. 2003;  135 898-899
  • 49 Donaldson M J, Lim L, Harper C A. et al . Primary treatment of choroidal amelanotic melanoma with photodynamic therapy.  Clin Experiment Ophthalmol. 2005;  33 548-549
  • 50 Soucek P, Cihelkova I. Photodynamic therapy with verteporfin in subfoveal amelanotic choroidal melanoma (A controlled case).  Neuro Endocrinol Lett. 2006;  27 145-148
  • 51 Wachtlin J, Bechrakis N E, Foerster M H. Photodynamic therapy with verteporfin for uveal melanoma.  Ophthalmologe. 2005;  102 241-246
  • 52 Bruce R A Jr. Evaluation of hematoporphyrin photoradiation therapy to treat choroidal melanomas.  Lasers Surg Med. 1984;  4 59-56
  • 53 Tse D T, Dutton J J, Weingeist T A. et al . Hematoporphyrin photoradiation therapy for intraocular and orbital malignant melanoma.  Arch Ophthalmol. 1984;  02 833-838
  • 54 Gonzalez V H, Hu L K, Theodossiadis P G. et al . Photodynamic therapy of pigmented choroidal melanomas.  Invest Ophthalmol Vis Sci. 1995;  36 871-878
  • 55 Kim R Y, Hu L K, Foster B S. et al . Photodynamic therapy of pigmented choroidal melanomas of greater than 3-mm thickness.  Ophthalmology. 1996;  103 2029-2036
  • 56 Kitzmann A S, Pulido J SM, Diehl N N. et al . The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980 – 2002.  Ophthalmology. 2008;  115 169-173
  • 57 Valmaggia C, Niederberger H. Photodynamic therapy in the treatment of chronic central serous chorioretinopathy.  Klin Monatsbl Augenheilkd. 2006;  223 372-375
  • 58 Mennel S, Peter S, Meyer C H. et al . Effect of photodynamic therapy on the function of the outer blood-retinal barrier in an in vitro model.  Graefes Arch Clin Exp Ophthalmol. 2006;  244 1015-1021
  • 59 Chan W M, Lai T YY, Lai R YK. et al . Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy.  Retina. 2008;  28 85-93
  • 60 Chan W M, Lai T Y, Lai R Y. et al . Half-Dose Verteporfin Photodynamic Therapy for Acute Central Serous Chorioretinopathy One-Year Results of a Randomized Controlled Trial.  Ophthalmology. 2008;  115 1756-1765

Prof. Dr. Gabriele E. Lang

Augenklinik, Universitätsklinikum Ulm

Prittwitzstr. 43

89075 Ulm

Phone: ++ 49/7 31/50 05 90 01

Fax: ++ 49/7 31/50 05 90 02

Email: gabriele.lang@uniklinik-ulm.de

    >