The Efficacy of Photodynamic Therapy With Verteporfin for Polypoidal Choroidal Vasculopathy: Retrospective Multi-Center Case Study

Jae Pil Shin; Hyoung Jun Koh; Oh Woong Kwon; Si Yeol Kim; Ha Kyoung Kim; Dong Heun Nam; Woo Ho Nam; Kyu Hyung Park; Boo Sup Oum; Jae Ryung Oh; Seung Young Yu; Ill Han Yoon; Hee Sung Yoon; Sung Chul Lee; Eun Goo Lee; Jae Heung Lee; Jeong Hee Lee; In Young Chung; Hee Seung Chin; Kuhl Huh; Hyung Woo Kwak

doi:10.3341/jkos.2009.50.3.365

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Shin, Koh, Kwon, Kim, Kim, Nam, Nam, Park, Oum, Oh, Yu, Yoon, Yoon, Lee, Lee, Lee, Lee, Chung, Chin, Huh, and Kwak: The Efficacy of Photodynamic Therapy With Verteporfin for Polypoidal Choroidal Vasculopathy: Retrospective Multi-Center Case Study

Original Article

J Korean Ophthalmol Soc 2009;50(3):365-375.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.3.365

The Efficacy of Photodynamic Therapy With Verteporfin for Polypoidal Choroidal Vasculopathy: Retrospective Multi-Center Case Study

Jae Pil Shin, MD¹, Hyoung Jun Koh, MD², Oh Woong Kwon, MD², Si Yeol Kim, MD¹, Ha Kyoung Kim, MD³, Dong Heun Nam, MD^4,⁸, Woo Ho Nam, MD^3,⁹, Kyu Hyung Park, MD^5,¹⁰, Boo Sup Oum, MD^6,², Jae Ryung Oh, MD^7,^2,¹¹, Seung Young Yu, MD⁸, Ill Han Yoon, MD⁹, Hee Sung Yoon, MD¹⁰, Sung Chul Lee, MD², Eun Goo Lee, MD¹¹, Jae Heung Lee, MD¹², Jeong Hee Lee, MD¹³, In Young Chung, MD¹⁴, Hee Seung Chin, MD¹⁵, Kuhl Huh, MD⁷, Hyung Woo Kwak, MD⁸

¹Department of Ophthalmology, Kyungpook National University, College of Medicine, Daegu, Korea

²Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea

³Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Korea

⁴Department of Ophthalmology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea

⁵Department of Ophthalmology, Seoul National University, College of Medicine, Seoul, Korea

⁶Department of Ophthalmology, Pusan National University, College of Medicine, Pusan, Korea

⁷Department of Ophthalmology, Korea University, College of Medicine, Seoul, Korea

⁸Department of Ophthalmology, Kyunghee University, College of Medicine, Seoul, Korea

⁹Department of Ophthalmology, Inje University, College of Medicine, Pusan, Korea

¹⁰Sungmo Eye Hospital, Pusan, Korea

¹¹Kong Eye Center, Seoul, Korea

¹²Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Seoul, Korea

¹³Department of Ophthalmology, Ewha Womans University, College of Medicine, Seoul, Korea

¹⁴Department of Ophthalmology, Gyeongsang National University, College of Medicine, Chinju, Korea

¹⁵Department of Ophthalmology, Inha University, College of Medicine, Incheon, Korea

Address reprint requests to Hyung Woo Kwak, MD, Department of Ophthalmology, KyungHee University College of Medicine #1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea Tel: 82-2-958-8451, Fax: 82-2-966-7340, E-mail: hwkwak@khmc.or.kr

Received 1 August 2008 Accepted 9 December 2008

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) with verteporfin for polypoidal choroidal vasculopathy (PCV) in Korean patients.

Methods

Clinical data of patients who were treated with PDT for PCV and followed up for more than 6 months were collected from 14 hospitals around the country. The changes in the best corrected visual acuity, angiographic outcome, retinal thickness measured by optical coherence tomography (OCT), and adverse effects of treatment were evaluated.

Results

Eighty six patients (86 eyes) were recruited (male: 75.6%, age: 65.9±8.3 years, mean follow-up: 14.8±10.2 months). The mean logMAR visual acuity at baseline was 0.55±0.32 and did not show any statistically significant difference from the final mean logMAR visual acuity (0.53±0.54) (p =0.639). The mean treatment session number of PDT was 2±1.2. Visual acuity stabilized or improved in 70.9% of patients. Visual acuity improved by more than 2 lines in 33 eyes (38.4%) and worsened by more than 2 lines in 21 eyes (24.4%) of patients. Vascular leakage decreased in 62.5% of patients in fluorescein angiography and polypoidal lesions disappeared or were reduced in 57.3% of patients in indocyanine green angiography. There was no systemic adverse effect of PDT, but increased subretinal hemorrhage after PDT occurred in 10 eyes (11.6%).

Conclusions

In polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin is safe and effective for preserving visual acuity and reducing vascular leakage and retinal thickness.

Keywords: Photodynamic therapy, Polypoidal choroidal vasculopathy, Verteporfin

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Figure 1.

Changes of visual acuity after photodynamic therapy in polypoidal choroidal vasculopathy. V.A=visual acuity.

Figure 2.

Proportion of moderate (more than 3 lines) and severe (more than 6 lines) visual loss after photodynamic therapy in polypoidal choroidal vasculopathy. V.A=visual acuity.

Figure 3.

Fluorescein angiographic outcomes of polypoidal choroidal vasculopathy after photodynamic therapy.

Figure 4.

Final activities of polyp in indocyanine green angiography after photodynamic therapy in polypoidal choroidal vasculopathy.

Figure 5.

Changes of central macular thickness (CMT) and total macular volume (TMV) in optical coherent tomogram after photodynamic therapy in polypoidal choroidal vasculopathy.

Table 1.

Demographics and baseline characteristics of patients

No. of patients (n)	86
Age (years)	65.9±8.3
Male/Female (%)	65/21 (75.6%/24.4%)
Right/Left eye (%)	45/41 (52.3%/47.7%)
Follow up (months)	14.8±10.2
Location of polyp (%)	Subfovea-33 (38.4%), Juxtafovea-53 (61.6%)
Number of polyps	3.7±2.4 (range 1-15)
Status of fellow eye	ARMD: 22, PCV: 4, Disciform scar: 1,
	Retinal detachment: 1, ERM: 1, POAG: 1
Systemic disease	HTN: 18, DM: 9, Angina:1, Tbc: 1,
	Allergy:1, Stomach ca.: 1
Number of PDT treatment	2.0±1.2 (range 1-8)
Baseline GLD (μm)	2814.5±1194.8
Laser spot size at 1st PDT (μm)	3706.3±1099
Bseline BCVA (mean± SD/median)	0.55±0.32 LogMAR/0.5 LogMAR
Final BCVA (mean± SD/median)	0.53±0.54 LogMAR/0.395 LogMAR (p=0.693^*)

^*by paired t-test

ARMD=age-related macular degeneration

ERM=epiretinal membrane

POAG=primary open-angle glaucoma

HTN=hypertension

Stomach ca.=stomach cancer

GLD=greatest linear dimension

BCVA=best corrected visual acuity.

Table 2.

Comparison between subfoveal and juxtafoveal polypoidal choroidal vasculopthy

	subfovea	juxtafovea	p^*
No. of Patients (n)	33	53
Age (years)	68.2±8.2	64.6±8.2	0.053
Right/Left (eyes)	17/16	28/25	0.905
Male/Female (eyes)	28/5	37/16	0.13
Follow up (months)	15.8±9.1	14.2±10.8	0.479
No. of Polyp	4±2.96	3.5±2.15	0.396
No. of Retreatment	2.24±1.28	1.87±1.19	0.172
Baseline BCVA (LogMAR)	0.55±0.26	0.56±0.36	0.812
Final BCVA (LogMAR)	0.61±0.61	0.48±0.49	0.282
Changes of BCVA (LogMAR)	−0.06±0.62	0.08±40.47	0.226
Baseline GLD (μm)	2879.2±1090.8	2774.2±1263.8	0.694
Laser spot size at 1st PDT (μm)	3792.9±1123.8	3652.4±1090.6	0.567
Final FAG activity (n)	n=32	n=48	0.245
Complete regression	3 (9.4%)	13 (27.1%)
Partial regression	13 (40.6%)	21 (43.8%)
Stationary	8 (25%)	6 (12.5%)
Progression	6 (18.8%)	6 (12.5%)
Conversion to CNV	2 (6.3%)	2 (4.2%)
Final ICG activity of polyp (n)	n=22	n=39	0.438
Complete regression	6 (27.3%)	13 (33.3%)
Partial regression	5 (22.7%)	11 (28.2%)
Stationary	6 (27.3%)	8 (20.5%)
Progression or new polyp	3 (13.6%)	5 (12.8%)
Conversion to CNV	2 (9.1%)	2 (5.1%)

^*statistically significant in p<0.05 by Mann-Whitney U test

BCVA=best corrected visual acuity

GLD=greatest linear dimension

PDT=photodynamic therapy

CNV=choroidal neovascularization.

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