Objective To evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of bevacizumab for choroidal neovas cularization (CNV) caused by age-related macular degeneration (AMD). Methods A total of 21 eyes of 21 patients with AMD, which was diagnosed by examination of visual acuity, intraocular pressure, ocular fundus, fundus color photography, fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and optic coherence tomography(OCT), were underwent PDT combined with intravitreal injection of Bevacizumab. The patients, 15 males (15 eyes) and 6 females (6 eyes), aged from 56 to 78 years, with the average of 68.6 years. The best corrected visual acuity：counting fingers/10cm0.9, logMAR was 1.04 plusmn; 0.41.CNV located in below or side central fovea of macula. There was obvious leakage of fluorescein which examined by FFA and ICGA. The average of retinal thickness of macular foveal was （258.91 plusmn; 78.66）mu;m. The treatment method of PDT has to according to the way of PDT for TAP and Verteporfin PDT for VIP. Intravitreal infection with 1.5mg bevacizumab was performed after three days under surface anesthesia. Follow-up time was 1, 3, 6, 12 months after the treatment. Results At last visit, the best-corrected visual acuity：counting fingers/10 cm 1.5, logMAR was 1.04plusmn;0.41, and the differences are statistically significant compared with before. The BCVA improved four or more lines in 6 eyes (28.57%), improved two to four lines in 9 eyes (42.86%), stabilized (plusmn;1 line or no change) in 6 eyes (28.57%) and decreased in none. The average intraocular pressure was （15.20plusmn;2.41）mmHg after surgery, and the differences was not statistically significant compared with before（P＞0.05）. FFA and ICGA showed CNV complete closure in 13 eyes (61.90 %), partial closure in 8 eyes (38.10%). The average of retinal thickness of mac ular foveal was（127.38plusmn;20.14） mu;m (P＜0.01). Conclusion Combining treatment with PDT and intravitreal injection of Bevacizumab is safe and effective for CNV which caused by AMD. It has significant improvement in BCVA, leakage of CNV and retinal edema. (Chin J Ocul Fundus Dis,2008,24:164-167)
ObjectiveTo observe the efficacy and safety of combined photodynamic therapy (PDT) with intravitreal ranibizumab injection in patients with polypoidal choroidal vasculopathy (PCV). MethodsTwenty-four PCV patients (24 eyes) were enrolled in this retrospective case study.All patients were assessed by the examinations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart, color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT). The mean visual acuity was (33.41±19.43) letters; the mean macular retinal thickness was (343.63±88.60) μm. Patients received PDT first, and intravitreal injected ranibizumab 0.5 mg (0.05 ml) 72 hours later. Treatments were repeated as a single intravitreal injection of ranibizumab combined with or without PDT if the monthly follow-up indicated that it was necessary. The average follow-up period was 13.1 months. The average treatment times were analyzed for each eye. Systemic and ocular adverse events were observed. Visual acuity, macular retinal thickness and leakage of PCV before and after the treatment were analyzed. ResultsIntravitreal ranibizumab injections was repeated (2.8±1.6) times per eye on average, and intravitreal injection of ranibizumab combined with PDT was repeated (0.4±0.5) times per eye on average. No systemic and ocular adverse effects were found during and after combined therapy. In the last follow-up, the mean visual acuity of ETDRS was (44.21±17.24) letters, improved by 10.8 letters (t=-4.77, P<0.01).Visual acuity was improved in 11 eyes (45.8%) and stable in 13 eyes (54.2%). FFA and ICGA showed complete closed PCV in 17 eyes (70.8%), partial closed PCV in 7 eyes (29.2%). OCT image showed that the retinal edema was disappeared in 19 eyes (79.2%) and alleviated in 5 eyes (20.8%). The mean macular retinal thickness was (171.33±38.06) μm, which was 172.30 μm less than that of pre-treatment values (t=11.96, P<0.05). ConclusionPhotodynamic therapy combined with intravitreal ranibizumab injections for PCV is safe and effective, with visual acuity improvement, reduction of retinal edema and PCV leakage.
Objective To observe the clinical effect of half-dose photodynamic therapy (PDT) for chronic central serous chorioretinopathy. Methods Thirty-two eyes of 27 patients (22 males and 5 females) with chronic central serous chorioretinopathy, diagnosed by best corrected visual acuity (BCVA) of logMAR, direct ophthalmoscope, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography, were enrolled. The age was ranged from 31 to 63 years old, with a mean of 45 years. The course of the disease was ranged from 6 to 32 months, with a mean of 16.2 months. The logMAR BCVA was 1.6 -0.1. The serous neuroepithelium detachment was found in 28 eyes, and serous neuroepithelium detachment combined with retinal pigment epithelium detachment (PED) was found in 4 eyes. The central retinal thickness was ranged from 184 to 465 mu;m, with a mean of 318.6 mu;m. All of the patients were treated with half dose PDT according to the methods in literatures. The above examinations were performed every 3 months after the treatment to observe the BCVA, subretinal fluid and retinal thickness. Results OCT showed that subretinal fluid were absorbed completely and retina remained attached in 25 of 28 eyes (89.3%) and 2 of 4 eyes (50.0%) with PED, while subretinal fluid were absorbed partly and retina attached incompletely in 3 of 28 eyes (10.7%) and 2 of 4 eyes (50.0%) with PED at the last visit. Twenty-seven eyes with retina remained attached, the mean central retinal thickness (CRT) decreased from (321.4plusmn;88.2) to (150.4plusmn;22.3) mu;m (t=9.09, P＜0.05); the mean logMAR BCVA improved from 0.68plusmn;0.09 to 0.44plusmn;0.07 (t=2.65,P＜0.05). Among those, logMAR BCVA within 0.32 were found in 12 eyes. There was a significant positive association between the CRT and BCVA (r=0.96, P＜0.01）. No recurrence or side effect was observed at the last visit. Conclusion Half-dose PDT is a safe and effective approach for chronic central serous chorioretinopathy, especially for those without PED.
ObjectiveTo evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT. Best-corrected visual acuity(BCVA), central macular thickness (CMT) were measured before and after treatment (1, 3 and 6 months). The mean BCVA was 0.28±0.22, mean CMT was(384.5±85.0)μm. The situation of subretinal fluids (SRF) absorption was observed. ResultsIn 35 eyes, SRF of 29 eyes (82.9%) completely absorbed and 6 eyes (17.1%) not completely absorbed after one month of treatment. SRF of all eyes (100.0%) completely absorbed after three months of treatment. After 6 months of treatment, SRF of 3 eyes (8.6%) were recurrence, which might be completely absorbed when a half-dose maintenance therapy PDT was used again. The mean BCVA significantly improved to 0.14±0.13 at 1 months, 0.05±0.11 at 3 months and 0.05±0.12 at 6 months after PDT (t=5.410, 7.830, 7.758; P < 0.05). The mean CMT decreased to (224.3±61.4) μm at 1 months, (199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856, 11.781, 11.900; P < 0.05). The mean CMT of controlled 32 eyes after treatment was (198.5±33.9) μm, much lower than the fellow eyes(232.3±17.5) μm (t=-3.988, P < 0.05). ConclusionsHalf-dose verteporfin PDT was safe and effective in treating chronic CSC, but may cause thinning of CMT.
ObjectiveTo evaluate the 3-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). MethodsThis is a retrospective, uncontrolled case series study. Thirty-two eyes of 29 patients with PCV were enrolled. All patients were primarily treated with the first conventional PDT. For the eye with active polypoida, residual or exudative lesions in 6 month after PDT, PDT combined with intravitreal anti vascular endothelial growth factor (VEGF)or simple vitreous injection of anti VEGF therapy were used. All the patients were followed up for at least 3 years with the mean follow-up duration of 43.64±10.84 months. The best-corrected visual acuity (BCVA) in 1, 3, 6, 12, 24 and 36 months after the primary PDT, PCV recurrence rates and number of treatments were followed and analyzed. The BCVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. ResultsDuring the 1, 3, 6, 12 months after the primary PDT, the mean BCVA were all improved with statistically significant difference(t=2.27, 4.57, 3.77, 2.37; P<0.05). During the 24 and 36 months after PDT, the mean BCVA was decreased without statistically significant difference(t=-1.29, -0.81; P>0.05). On the final evaluation at 36 months, the mean BCVA was improved in 6 eyes(18.75%), stable in 14 eyes(43.75%), and decreased in 12 eyes(37.50%). During the follow-up time, recurrence of PCV in 24 eyes (75.00%), no recurrence in 8 eyes (25.00%). There was 1 recurrence in 12 eyes (50.00%), 2 recurrences in 9 eyes (37.50%), 3 recurrences in 3 eyes (12.50%). Initial recurrences were noted in 4 eyes (16.67%) within 12 months of baseline PDT treatment; in 11 eyes (45.83%) between 13 and 24 months; in 9 eyes (37.50%) between 25 and 36 months. The mean number of PDT and anti-VEGF was 1.86±1.04 and 4.95±3.92 in all patients, respectively. ConclusionThe 3-year efficacy of PDT in patients with PCV was poor with low improvement of visual acuity and high recurrence rate of PCV.
ObjectiveTo summarize the clinical results and safety of photodynamic therapy (PDT) through 4 years after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration(AMD). MethodsClinical data of 73 AMD cases (95 eyes) diagnosed through fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT), treated with PDT were reviewed and analyzed in this hospital from June 2000 to June 2004. The changes of best corrected visual acuity (BCVA), fundus pictures, FFA, ICGA and OCT were compared before and after PDT. Follow-up time varied from 3 months to 4 years (mean, 2 years). ResultsThe mean age of 73 patients was 67.8 years old. The BCVA was from CF/10 cm to 1.0. At the final follow up, the BCVA was improved (increase≥2 lines) in 39 eyes (41.1%), stabilized (±1 line) in 51 eyes (53.7 %) and decreased 2 lines in 5 eyes (5.3%). Fundus hemorrhage and exudation reduced after PDT. FFA and ICGA showed CNV complete closure in 58 eyes (61.05%), partial closure in 6 eyes (6.32%), CNV incomplete closure in 22 eyes (23.16% ) and recurrence in 9 eyes (9.47%). After once PDT of 12 eyes with early-stage AMD, the BCVA improved (from 0.6 to 1.5), CNV completely closed, and the OCT showed disappearance of macular edema and neursensory retinal deta chment. No CN V recurred in our four years follow-up observation and the BCVA of the patients remained stable. The mean number of PDT treatment was 1.8 per eye in 95 cases. No serious local or systemic complications were encountered. ConclusionsSingle or multiple sessions of PDT can acheive long-term safety and efficacy. For early-stage AMD patients with minimally classic CNV, PDT can completely make CNV closed and reduce the risk of visual loss.(Chin J Ocul Fundus Dis，2004，20：275-279)