Limits...
Oscillatory photodynamic therapy for choroidal neovascularization and central serous retinopathy; a pilot study.

Peyman GA, Tsipursky M, Nassiri N, Conway M - J Ophthalmic Vis Res (2011)

Bottom Line: No adverse events or recurrence were noted.OPDT was effective in treating CNV lesions and CSR.OPDT may be an improvement on standard PDT due to reduced side effects, thermal damage and scarring.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Tulane University, New Orleans, Louisiana, USA.

ABSTRACT

Purpose: To report the preliminary results of oscillatory photodynamic therapy (OPDT) for choroidal neovascularization (CNV) and central serous retinopathy (CSR).

Methods: This study included 7 eyes of 6 patients with CSR (2 eyes), idiopathic CNV (2 eyes), CNV due to age-related macular degeneration (AMD) (2 eyes), and peripapillary CNV secondary to presumed ocular histoplasmosis syndrome (1 eye). Intravenous verteporfin (6 mg/m(2) body surface area) was infused over 10 minutes followed by oscillating laser (wavelength 689 nm) covering slightly beyond the entire lesion. An Area Centralis lens was applied and laser was delivered (600 mW/cm(2) fluence rate and 50 J/cm(2) dose). Intravitreal bevacizumab and dexamethasone combination therapy was used with OPDT in 4 eyes with CNV; intravitreal dexamethasone and triamcinolone acetonide were injected in the other eye with CNV. Clinical examination, funduscopy, fluorescein angiography, and optical coherence tomography (OCT) were performed at baseline and after treatment.

Results: After mean follow-up of 7.1±5.1 months, visual acuity improved from 0.87±0.69 logMAR (20/160) to 0.60±0.65 logMAR (20/80) (P = 0.027); central foveal thickness decreased from 322±62.1 to 240.7±34.8 microns as measured by OCT (P = 0.018). Fluorescein angiography and OCT demonstrated cessation of vascular leakage, and resolution of hemorrhage and subretinal fluid in all eyes. No adverse events or recurrence were noted.

Conclusion: OPDT was effective in treating CNV lesions and CSR. OPDT may be an improvement on standard PDT due to reduced side effects, thermal damage and scarring.

No MeSH data available.


Related in: MedlinePlus

A 34-year-old female patient with idiopathic choroidal neovascular membrane (CNVM) in the left eye (case #3). Pre-treatment: Color fundus photograph shows deep subretinal hemorrhage associated with retinal thickening and lipid exudation in the nasal macula (a). Fluorescein angiography demonstrates multiple leakage sites from the CNVM in the nasal macula (b). OCT confirms retinal thickening in the nasal fovea with a hyper-reflective subretinal lesion (central subfoveal thickness 263 μm) (c). Post-treatment: Color fundus photograph (d), fluorescein angiography (e), and OCT (central subfoveal thickness 250 μm) (f) all show a consolidated subretinal scar without persistent leakage or associated retinal thickening, consistent with involution of CNVM. OCT from the adjacent area shows slightly disrupted but mostly preserved photoreceptor layer despite OPDT. The scar appears hyperfluorescent and there is a ring of hypofluorescence corresponding to blockage from pigment migration. There are two small areas of hyperfluorescence nasal to the fovea consistent with window defects.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3306098&req=5

f2-jovr-6-3-166: A 34-year-old female patient with idiopathic choroidal neovascular membrane (CNVM) in the left eye (case #3). Pre-treatment: Color fundus photograph shows deep subretinal hemorrhage associated with retinal thickening and lipid exudation in the nasal macula (a). Fluorescein angiography demonstrates multiple leakage sites from the CNVM in the nasal macula (b). OCT confirms retinal thickening in the nasal fovea with a hyper-reflective subretinal lesion (central subfoveal thickness 263 μm) (c). Post-treatment: Color fundus photograph (d), fluorescein angiography (e), and OCT (central subfoveal thickness 250 μm) (f) all show a consolidated subretinal scar without persistent leakage or associated retinal thickening, consistent with involution of CNVM. OCT from the adjacent area shows slightly disrupted but mostly preserved photoreceptor layer despite OPDT. The scar appears hyperfluorescent and there is a ring of hypofluorescence corresponding to blockage from pigment migration. There are two small areas of hyperfluorescence nasal to the fovea consistent with window defects.

Mentions: This 34-year-old lady had mild myopia and reduced visual acuity in her left eye. She presented with a grayish subretinal lesion in the nasal fovea associated with subretinal hemorrhage, exudation and retinal thickening extending into the center of the fovea. Leakage and retinal thickening in the nasal fovea were confirmed with fluorescein angiography and OCT (Figures 2a–c). She was diagnosed with idiopathic choroidal neovascular membrane, which did not respond to an injection of intravitreal bevacizumab. At baseline, visual acuity was 20/40 and central subfoveal thickness was 263 μm. She was treated with OPDT and verteporfin (800-μm spot size for 83 seconds) as well as adjunctive intravitreal bevacizumab/dexamethasone. After treatment the patient had a consolidated subretinal scar in the nasal fovea without persistent leakage on angiography, or fluid on OCT which demonstrated central subfoveal thickness of 250 μm (Figures 2d–f). The treated perifoveal retina showed relatively preserved photoreceptor structure on OCT. Visual acuity improved to 20/25 without metamorphopsia. There was no recurrence up to 5 months after treatment.


Oscillatory photodynamic therapy for choroidal neovascularization and central serous retinopathy; a pilot study.

Peyman GA, Tsipursky M, Nassiri N, Conway M - J Ophthalmic Vis Res (2011)

A 34-year-old female patient with idiopathic choroidal neovascular membrane (CNVM) in the left eye (case #3). Pre-treatment: Color fundus photograph shows deep subretinal hemorrhage associated with retinal thickening and lipid exudation in the nasal macula (a). Fluorescein angiography demonstrates multiple leakage sites from the CNVM in the nasal macula (b). OCT confirms retinal thickening in the nasal fovea with a hyper-reflective subretinal lesion (central subfoveal thickness 263 μm) (c). Post-treatment: Color fundus photograph (d), fluorescein angiography (e), and OCT (central subfoveal thickness 250 μm) (f) all show a consolidated subretinal scar without persistent leakage or associated retinal thickening, consistent with involution of CNVM. OCT from the adjacent area shows slightly disrupted but mostly preserved photoreceptor layer despite OPDT. The scar appears hyperfluorescent and there is a ring of hypofluorescence corresponding to blockage from pigment migration. There are two small areas of hyperfluorescence nasal to the fovea consistent with window defects.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3306098&req=5

f2-jovr-6-3-166: A 34-year-old female patient with idiopathic choroidal neovascular membrane (CNVM) in the left eye (case #3). Pre-treatment: Color fundus photograph shows deep subretinal hemorrhage associated with retinal thickening and lipid exudation in the nasal macula (a). Fluorescein angiography demonstrates multiple leakage sites from the CNVM in the nasal macula (b). OCT confirms retinal thickening in the nasal fovea with a hyper-reflective subretinal lesion (central subfoveal thickness 263 μm) (c). Post-treatment: Color fundus photograph (d), fluorescein angiography (e), and OCT (central subfoveal thickness 250 μm) (f) all show a consolidated subretinal scar without persistent leakage or associated retinal thickening, consistent with involution of CNVM. OCT from the adjacent area shows slightly disrupted but mostly preserved photoreceptor layer despite OPDT. The scar appears hyperfluorescent and there is a ring of hypofluorescence corresponding to blockage from pigment migration. There are two small areas of hyperfluorescence nasal to the fovea consistent with window defects.
Mentions: This 34-year-old lady had mild myopia and reduced visual acuity in her left eye. She presented with a grayish subretinal lesion in the nasal fovea associated with subretinal hemorrhage, exudation and retinal thickening extending into the center of the fovea. Leakage and retinal thickening in the nasal fovea were confirmed with fluorescein angiography and OCT (Figures 2a–c). She was diagnosed with idiopathic choroidal neovascular membrane, which did not respond to an injection of intravitreal bevacizumab. At baseline, visual acuity was 20/40 and central subfoveal thickness was 263 μm. She was treated with OPDT and verteporfin (800-μm spot size for 83 seconds) as well as adjunctive intravitreal bevacizumab/dexamethasone. After treatment the patient had a consolidated subretinal scar in the nasal fovea without persistent leakage on angiography, or fluid on OCT which demonstrated central subfoveal thickness of 250 μm (Figures 2d–f). The treated perifoveal retina showed relatively preserved photoreceptor structure on OCT. Visual acuity improved to 20/25 without metamorphopsia. There was no recurrence up to 5 months after treatment.

Bottom Line: No adverse events or recurrence were noted.OPDT was effective in treating CNV lesions and CSR.OPDT may be an improvement on standard PDT due to reduced side effects, thermal damage and scarring.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Tulane University, New Orleans, Louisiana, USA.

ABSTRACT

Purpose: To report the preliminary results of oscillatory photodynamic therapy (OPDT) for choroidal neovascularization (CNV) and central serous retinopathy (CSR).

Methods: This study included 7 eyes of 6 patients with CSR (2 eyes), idiopathic CNV (2 eyes), CNV due to age-related macular degeneration (AMD) (2 eyes), and peripapillary CNV secondary to presumed ocular histoplasmosis syndrome (1 eye). Intravenous verteporfin (6 mg/m(2) body surface area) was infused over 10 minutes followed by oscillating laser (wavelength 689 nm) covering slightly beyond the entire lesion. An Area Centralis lens was applied and laser was delivered (600 mW/cm(2) fluence rate and 50 J/cm(2) dose). Intravitreal bevacizumab and dexamethasone combination therapy was used with OPDT in 4 eyes with CNV; intravitreal dexamethasone and triamcinolone acetonide were injected in the other eye with CNV. Clinical examination, funduscopy, fluorescein angiography, and optical coherence tomography (OCT) were performed at baseline and after treatment.

Results: After mean follow-up of 7.1±5.1 months, visual acuity improved from 0.87±0.69 logMAR (20/160) to 0.60±0.65 logMAR (20/80) (P = 0.027); central foveal thickness decreased from 322±62.1 to 240.7±34.8 microns as measured by OCT (P = 0.018). Fluorescein angiography and OCT demonstrated cessation of vascular leakage, and resolution of hemorrhage and subretinal fluid in all eyes. No adverse events or recurrence were noted.

Conclusion: OPDT was effective in treating CNV lesions and CSR. OPDT may be an improvement on standard PDT due to reduced side effects, thermal damage and scarring.

No MeSH data available.


Related in: MedlinePlus