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[Photodynamic therapy: extended indication].

R Müller-Velten·St Michels·U Schmidt-Erfurth·H Laqua
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Abstract

OBJECTIVE: Evaluation of efficacy of photodynamic therapy (PDT) for classic choroidal neovascularization (CNV) beyond the common indication. METHODS: A group of 256 patients was treated with photodynamic therapy from January to December 2000. Ten of these patients had a predominantly classic CNV due to angioid streaks (5), parafoveal telangiectasia (2), or chorioretinitis (3). In two patients an idiopathic origin of the CNV was presumed. Another 21 patients showed a juxtafoveal classic membrane (12) or a recurrence after laser photocoagulation (9). Visual acuity was evaluated, also in correlation to age and CNV size. Continuous follow-up of CNV and leakage size was performed with fluorescein angiography. RESULTS: Overall 85% of the patients showed visual stabilization or improvement during an average observation period of 10.5 months. A correlation was found between age and visual improvement favoring younger patients; however, no correlation was found between visual improvement and CNV size. CNV and leakage size decreased moderately over the 9-month follow-up from 1.81/3.45 mm(2) to 1.61/2.60 mm(2). CONCLUSION: PDT shows efficacy for classic choroidal neovascularization beyond the common indication.

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Choroidal NeovascularizationEpiretinal MembraneFluorescein AngiographyFollow-Up StudiesHematoporphyrin PhotoradiationHumansPhotosensitizing AgentsPorphyrinsRetrospective StudiesTreatment OutcomeVerteporfinVisual AcuityJournal Article

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R Müller-Velten, St Michels, U Schmidt-Erfurth, H Laqua. 2003. [Photodynamic therapy: extended indication].. https://doi.org/10.1007/s00347-002-0723-9

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Quantitative fluorescein angiographic analysis of choroidal neovascular membranes: validation and correlation with visual function.

PURPOSE: To compare computerized analysis with traditional grading methods in the analysis of fluorescein angiograms from patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) and to examine the clinical relevance of parameters generated by computerized analysis by testing their relationships with clinical measures of vision. METHODS: Custom quantitative fluorescein analysis (QFA) software was used to analyze 62 angiograms from patients with CNV for whom distance visual acuity (DVA) data were available. On applying QFA, we obtained three mathematical parameters for each lesion component: pixel area (PA), integrated intensity (II), and positive fluorescence (PF). Quotients (Q) were derived for the latter two parameters by correcting against background (b) or optic nerve (o) fluorescence (IIQ(b), IIQ degrees , PFQ(b), and PFQ degrees ). The new metrics were compared with traditional grading parameters of classic CNV and lesion area. The relationships of both sets of angiographic data with measures of vision were explored by regression analyses. RESULTS: Weighted kappa between QFA and traditional grading for lesion subtype assessment was high (kappa = 0.7). Regression analyses with PA, IIQ(b), IIQ degrees , PFQ(b), and PFQ degrees for each lesion descriptor (leakage, classic CNV, occult CNV, total lesion) as independent variables and DVA as the dependent variable showed that in every case PFQ(b) exhibited the most significant relationship with vision (adjusted r(2) = 0.26). Parameter estimates showed that for a change of 30 units on the PFQ(b) for classic CNV, a loss of 20 letters of DVA may be expected. No parameters from traditional grading methods showed statistically significant relationships with DVA. CONCLUSIONS: The markers of dynamic change in area and intensity of fluorescence exhibited stronger relationships with visual function than did area measurements alone.

Choroidal Neovascularization↗
PubMed2006

Photodynamic therapy vs limited macular translocation in the management of subfoveal choroidal neovascularization in pathologic myopia: a two-year study.

PURPOSE: To compare the results of limited macular translocation and photodynamic therapy (PDT) in subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia with a 24-month follow-up. DESIGN: Retrospective analysis of nonrandomized interventional clinical study. METHODS: Retrospective review of 66 consecutive patients: 34 myopic eyes with subfoveal neovascularization treated by PDT and 32 operated on with the translocation technique. Translocation was considered principally when the lesion size was adequate (nasal inferior margin of the membrane less than half a disk diameter away from the center of the fovea) with duration of symptoms of less than four months. Main outcome measure was the postoperative change in visual acuity. RESULTS: In the translocation group, mean gain in visual acuity was greater than in the PDT group (+2.8 lines and -1.8 line, respectively, P = .001). In the translocation group, 55% of eyes gained 3 lines or more at two years compared with 10% in the PDT group. Sixty percent of eyes in the translocation group vs 40% in the PDT group had an improvement of at least five letters. Mean foveal displacement after translocation was 906 mum; postoperative complications included retinal detachment (three eyes), macular fold (one eye), and transient diplopia (four eyes). In young patients, the postoperative gain was better in both groups. In the translocation group, mean survival time for choroidal neovascularization recurrence was 40 months for patients younger than 40 years and 20 months for older patients. CONCLUSIONS: Translocation showed better results than PDT at two years. Further studies are required to confirm these findings.

Choroidal Neovascularization↗