Abstract
Purpose
To evaluate the efficacy of photodynamic therapy (PDT) in cases of classic choroidal neovascularization caused by age-related macular degeneration by using optical coherence tomography (OCT)
Methods
Thirty eyes of 30 patients diagnosed with predominantly classic-type choroidal neovascularization from age-related macular degeneration in the Department of Ophthalmology between March 1, 2004 and March 31, 2005 were treated with PDT. The efficacy of PDT was evaluated with OCT. From OCT findings, changes of the foveal contour, subretinal fluid, retinal pigment epithelial detachment (PED), and highly reflective external bands were analyzed and compared with findings from fluorescein angiography.
Results
After PDT, the foveal contour on OCT was recovered in 24 of 30 abnormal eyes (80%), subretinal fluid on OCT was absorbed in 18 of 26 abnormal eyes (69%), PED on OCT was reattached in 16 of 22 abnormal eyes (72%), and thick highly reflective external bands on OCT were thinned in 16 of 26 abnormal eyes (62%). The leakage on fluorescein angiography resolved in 20 of 30 abnormal eyes (67%).
Conclusions
Recovery of the foveal contour, reabsorption of subretinal fluid, reattachment of PED, and thinning of highly reflective external bands on OCT findings were achieved with PDT. The changes of foveal contour and highly reflective external band were correlated with signs of fluorescein leakage.
References
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Figure 1.
Fluorescein angiograph of predominantly classic choroidal neovascularization due to age-related macular degeneration. Classic choroidal neovascularization is occupying over 50% of entire lesion area.
![jkos-49-274f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-274f1.gif)
Figure 2.
Optical coherence tomographs from the eye with age-related macular degeneration. Abnormal foveal contour was seen. Sensory retinal detachment with subretinal fluid (A), retinal pigment epithelial detachment (B), and thickened high reflective external band (C) was detected.
![jkos-49-274f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-274f2.gif)
Figure 3.
Optical coherence tomographs with abnormal foveal contour before photodynamic therapy (A) and improved foveal contour after the second photodynamic therapy (B).
![jkos-49-274f3.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-274f3.gif)
Figure 4.
Optical coherence tomographs with pigment epithelial detachment and sensory retinal detachment. Before treatment, pigment epithelial detachment with sensory retinal detachment was prominent (A). After treatment, only small pigment epithelial detachment was detected (B).
![jkos-49-274f4.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-274f4.gif)
Figure 5.
Optical coherence tomographs of thick high reflective external band before photodynamic therapy (A) and thinner high reflective external band after the second photodynamic therapy (B).
![jkos-49-274f5.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-274f5.gif)
Table 1.
Abnormal OCT findings in ARMD
OCT findings | Number (n=30) |
---|---|
Foveal contour loss (intraretinal fluid) | 30 (100%) |
Serous RD | 26 (87%) |
Thickened high reflective external band | 26 (87%) |
PED | 22 (73%) |
Table 2.
Improved OCT findings
OCT findings | After 1 st PDT | After 2 nd PDT | N |
---|---|---|---|
Foveal contour loss (intraretinal fluid) | 9 (30%) | 24 (80%)* | 30 |
Serous RD | 13 (50%) | 18 (69%)* | 26 |
Thickened high reflective external band | 8 (31%) | 11 (42%)* | 26 |
PED | 12 (54%) | 16 (72%)* | 22 |
Table 3.
FAG findings before and after PDT (n=30)
FAG findings | Before PDT | 10 weeks after 1 st PDT | 10 weeks after 2 nd PDT |
---|---|---|---|
Leakage (+) | 30 (100%) | 25 (83%) | 10 (33%) |
Leakage (−) | 0 (0%) | 5 (17%) | 20 (67%) |
Table 4.
Relationship between leakage on FAG and foveal contour on OCT
After 1 st PDT |
|||
---|---|---|---|
Abnormal foveal contour | Improved foveal contour | Total | |
Leakage | 20 (67%) | 5 (17%) | 25 (83%) |
No leakage | 1 (3%) | 4 (13%) | 5 (17%) |
Total |
21 (70%) |
9 (30%) |
30 (100%) |
p*=0.009. |
|||
After 2 nd PDT |
|||
|
Abnormal foveal contour |
Improved foveal contour |
Total |
Leakage | 5 (17%) | 5 (17%) | 10 (33%) |
No leakage | 1 (3%) | 19 (63%) | 20 (67%) |
Total | 6 (20%) | 24 (80%) | 30 (100%) |
Table 5.
Relationship between leakage on FAG and serous retinal detachment (RD) on OCT
After 1 st PDT |
|||
---|---|---|---|
Serous RD (+) | Serous RD (−) | Total | |
Leakage | 12 (46%) | 11 (42%) | 23 (88%) |
No leakage | 1 (4%) | 2 (8%) | 3 (12%) |
Total |
13 (50%) |
13 (50%) |
26 (100%) |
p*>0.99. |
|||
After 2 nd PDT |
|||
Serous RD (+) | Serous RD (−) | Total | |
Leakage | 5 (19%) | 3 (12%) | 8 (31%) |
No leakage | 3 (12%) | 15 (57%) | 18 (69%) |
Total | 8 (31%) | 18 (69%) | 26 (100%) |
Table 6.
Relationship between leakage on FAG and thickness of high reflective external band (HREB) on OCT
After 1 st PDT |
|||
---|---|---|---|
HREB↑ | HREB↓ | Total | |
Leakage | 17 (66%) | 4 (15%) | 21 (81%) |
No leakage | 1 (4%) | 4 (15%) | 5 (19%) |
Total |
18 (70%) |
8 (30%) |
26 (100%) |
p*=0.020. |
|||
After 2 nd PDT |
|||
|
HREB↑ |
HREB↓ |
Total |
Leakage | 4 (15%) | 4 (15%) | 8 (30%) |
No leakage | 1 (4%) | 17 (66%) | 18 (70%) |
Total | 5 (19%) | 21 (81%) | 26 (100%) |
Table 7.
Relationship between leakage on FAG and pigment epithelial detachment (PED) on OCT
After 1 st PDT |
|||
---|---|---|---|
|
PED (+) |
PED (−) |
Total |
Leakage | 10 (45%) | 9 (41%) | 19 (86%) |
No leakage | 0 | 3 (14%) | 3 (14%) |
Total |
10 (45%) |
12 (55%) |
22 (100%) |
p*=0.221. |
|||
After 2 nd PDT |
|||
|
PED (+) |
PED (−) |
Total |
Leakage | 5 (23%) | 1 (4%) | 6 (27%) |
No leakage | 1 (4%) | 15 (69%) | 16 (73%) |
Total | 6 (27%) | 16 (73%) | 22 (100%) |