The Efficacy of Verteporfin Photodynamic Therapy in Age-Related Macular Degeneration

Woo Seok Choi; Hyun Woong Kim

doi:10.3341/jkos.2008.49.2.274

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Choi and Kim: The Efficacy of Verteporfin Photodynamic Therapy in Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2008;49(2):274-281.

Published online: 31 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.2.274

The Efficacy of Verteporfin Photodynamic Therapy in Age-Related Macular Degeneration

Woo Seok Choi, M.D., Hyun Woong Kim, M.D.

Department of Ophthalmology, Pusan Paik Hospital, College of Medicine, Inje University, Pusan, Korea

Address reprint requests to Hyun Woong Kim, M.D., Department of Ophthalmology, Pusan Beak Hospital, College of Medicine, Inje University #633-165 Kekum-dong, Pusanjin-gu, Pusan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: maekbak@hanmail.net

Received 6 September 2006 Accepted 12 December 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Choroidal neovascularization, OCT, Phododynamic therapy

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.

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.

Figure 3.

Optical coherence tomographs with abnormal foveal contour before photodynamic therapy (A) and improved foveal contour after the second photodynamic therapy (B).

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).

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).

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%)

OCT=optical coherence tomography; RD=retinal detachment; PED=pigment epithelial detachment.

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

OCT=optical coherence tomography; RD=retinal detachment; PED=pigment epithelial detachment

^* Accumulative average.

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%)

PDT=photodynamic therapy; FAG=fluorescence angiography.

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%)

p^*=0.009

^* Fisher's exact test.

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%)

p^*=0.060

^* Fisher's exact test.

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%)

p^*=0.020

^* Fisher's exact test.

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%)

p^*=0.001

^* Fisher's exact test.

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