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Severe decrease in visual acuity with choroidal hypoperfusion after photodynamic therapy.

Figurska M, Wierzbowska J, Robaszkiewicz J - Med. Sci. Monit. (2011)

Bottom Line: Choroidal circulation disturbance after PDT is possible and has to be taken into account.Sporadically, it can lead to an acute decrease in visual acuity and local state.After stabilization of AF and optical coherence tomography imaging, further treatment of neovascular AMD with intravitreal injections of anti-VEGF agents should be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Military Medical Institute, Warsaw, Poland. malgorzata-figurska@wp.pl

ABSTRACT

Background: Photodynamic therapy (PDT) is considered a selective method of treatment which works in areas of choroidal neovascularization (CNV); however, there are reports of choroidal hypoperfusion after PDT. This paper presents a clinical case of choroidal circulation disturbances caused by PDT, accompanied by CNV progression.

Case report: The patient, a 75-year-old woman, was qualified for PDT in the right eye--first treatment due to progression of occult CNV. Best corrected visual acuity (BCVA) in the right eye at baseline was +0.3 logMAR. After PDT, a rapid decrease in visual acuity to +0.7 logMAR in the right eye was observed, central choroidal hypoperfusion in fluorescein angiography (FA) with subretinal fluid appeared and, as a consequence, progression of neovascular age-related macular degeneration (AMD). After stabilizing the local state through conservative therapy, a decision was made to treat the right eye with intravitreal injections of vascular endothelial growth factor (VEGF) inhibitor. During a 12-month period of observation, 7 doses of ranibizumab were administered. A regression in activity of wet AMD was observed, with visual acuity of +0.6 logMAR.

Conclusions: Choroidal circulation disturbance after PDT is possible and has to be taken into account. Sporadically, it can lead to an acute decrease in visual acuity and local state. After stabilization of AF and optical coherence tomography imaging, further treatment of neovascular AMD with intravitreal injections of anti-VEGF agents should be considered.

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Related in: MedlinePlus

OCT before PDT (fovea scan): foveal contour is preserved, the highly reflective complex of RPE and choriocapillaries is irregular and thickened, subretinal fluid is observed.
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f1-medscimonit-17-6-cs75: OCT before PDT (fovea scan): foveal contour is preserved, the highly reflective complex of RPE and choriocapillaries is irregular and thickened, subretinal fluid is observed.

Mentions: In December 2008 the patient, a 75-year-old woman, was qualified for photodynamic therapy in the right eye – first treatment due to progression of occult choroidal neovascularization. Best corrected visual acuity (BCVA) at baseline, tested with the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart, was: right eye +0.3 logMAR (72 letters), left eye +1.0 logMAR (34 letters). Ophthalmoscopic examination of the right eye showed a grayish, elevated focus of wet AMD in the macula (Figures 1–3), and in the macula of the left eye a PDT scar was visible (3 treatments without complications in 2007). General diseases reported by the patient were arterial hypertension and stroke in the previous year. Fluorescein angiography (FA) was performed using the Heidelberg Engineering HRA 2 device, optical coherence tomography (OCT) with SOCT Copernicus HR and OCT SLO OTI. In photodynamic therapy of the right eye, the following parameters were employed: laser focus diameter 4900 μm (including a margin of healthy retina – 1000 μm), BSA 1.7, 10-minute infusion of verteporfin solution (2 mg/ml, 6 mg/m2). The procedure began, as recommended by the standards, 15 minutes after start of the infusion; a 689 nm laser was used (Opal Photoactivator, Coherent), exposure time 83 seconds, energy 50 J/cm2.


Severe decrease in visual acuity with choroidal hypoperfusion after photodynamic therapy.

Figurska M, Wierzbowska J, Robaszkiewicz J - Med. Sci. Monit. (2011)

OCT before PDT (fovea scan): foveal contour is preserved, the highly reflective complex of RPE and choriocapillaries is irregular and thickened, subretinal fluid is observed.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539547&req=5

f1-medscimonit-17-6-cs75: OCT before PDT (fovea scan): foveal contour is preserved, the highly reflective complex of RPE and choriocapillaries is irregular and thickened, subretinal fluid is observed.
Mentions: In December 2008 the patient, a 75-year-old woman, was qualified for photodynamic therapy in the right eye – first treatment due to progression of occult choroidal neovascularization. Best corrected visual acuity (BCVA) at baseline, tested with the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart, was: right eye +0.3 logMAR (72 letters), left eye +1.0 logMAR (34 letters). Ophthalmoscopic examination of the right eye showed a grayish, elevated focus of wet AMD in the macula (Figures 1–3), and in the macula of the left eye a PDT scar was visible (3 treatments without complications in 2007). General diseases reported by the patient were arterial hypertension and stroke in the previous year. Fluorescein angiography (FA) was performed using the Heidelberg Engineering HRA 2 device, optical coherence tomography (OCT) with SOCT Copernicus HR and OCT SLO OTI. In photodynamic therapy of the right eye, the following parameters were employed: laser focus diameter 4900 μm (including a margin of healthy retina – 1000 μm), BSA 1.7, 10-minute infusion of verteporfin solution (2 mg/ml, 6 mg/m2). The procedure began, as recommended by the standards, 15 minutes after start of the infusion; a 689 nm laser was used (Opal Photoactivator, Coherent), exposure time 83 seconds, energy 50 J/cm2.

Bottom Line: Choroidal circulation disturbance after PDT is possible and has to be taken into account.Sporadically, it can lead to an acute decrease in visual acuity and local state.After stabilization of AF and optical coherence tomography imaging, further treatment of neovascular AMD with intravitreal injections of anti-VEGF agents should be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Military Medical Institute, Warsaw, Poland. malgorzata-figurska@wp.pl

ABSTRACT

Background: Photodynamic therapy (PDT) is considered a selective method of treatment which works in areas of choroidal neovascularization (CNV); however, there are reports of choroidal hypoperfusion after PDT. This paper presents a clinical case of choroidal circulation disturbances caused by PDT, accompanied by CNV progression.

Case report: The patient, a 75-year-old woman, was qualified for PDT in the right eye--first treatment due to progression of occult CNV. Best corrected visual acuity (BCVA) in the right eye at baseline was +0.3 logMAR. After PDT, a rapid decrease in visual acuity to +0.7 logMAR in the right eye was observed, central choroidal hypoperfusion in fluorescein angiography (FA) with subretinal fluid appeared and, as a consequence, progression of neovascular age-related macular degeneration (AMD). After stabilizing the local state through conservative therapy, a decision was made to treat the right eye with intravitreal injections of vascular endothelial growth factor (VEGF) inhibitor. During a 12-month period of observation, 7 doses of ranibizumab were administered. A regression in activity of wet AMD was observed, with visual acuity of +0.6 logMAR.

Conclusions: Choroidal circulation disturbance after PDT is possible and has to be taken into account. Sporadically, it can lead to an acute decrease in visual acuity and local state. After stabilization of AF and optical coherence tomography imaging, further treatment of neovascular AMD with intravitreal injections of anti-VEGF agents should be considered.

Show MeSH
Related in: MedlinePlus