Ocular Photodynamic Therapy – Standard Applications and New Indications (Part 1)

Abstract

Ocular photodynamic therapy (PDT) was introduced as a novel treatment for neovascular forms of age-related macular degeneration and choroidal neovascularization (CNV) secondary to pathologic myopia in the mid/end 1990s. The current treatment recommendations are based on the results of two large, prospective, multicenter, randomized clinical trials (Treatment of Age-Related Macular Degeneration with Photodynamic Therapy and Verteporfin in Photodynamic Therapy Studies) and thousands of patients have been treated worldwide over the last years. Meanwhile, PDT has been performed in several other ocular pathologies with some remarkable results, however, with most reports being case reports and small case series without statistical significance. These extended applications include CNV secondary to choroiditis and retinochoroiditis, angioid streaks, central serous chorioretinopathy, retinal angiomatous proliferation, parafoveal telangiectasia or CNV associated with macular dystrophy and idiopathic CNV, as well as diseases without CNV, such as choroidal hemangioma, retinal hamartoma, choroidal melanoma, chronic central serous chorioretinopathy, angiomatous lesions secondary to systemic diseases, rubeosis iridis or neovascular glaucoma. To date, with the introduction of anti-VEGF therapy, the role of PDT will certainly change. However, it is reasonable to believe that it will maintain an important role in combination therapy due to its unique properties of selective vascular targeting. Therefore, it is essential for the ophthalmologist to be familiar with the extended applications and their modifications of treatment parameters. This review will summarize the standard and experimental applications of PDT based on our own results and the literature.

Photodynamic therapy for central serous chorioretinopathy

“…These have included pharmacologic therapy, laser photocoagulation, photodynamic therapy (PDT) and most recently anti-vascular endothelial growth factor (anti-VEGF). 4,5,[7][8][9][10][11][12][13] Each study with different treatment modalities has had its own drawbacks-small population size, treatment efficacy, and adverse event occurrence. In this review, we assess the studies that evaluated the use of PDT in the treatment of CSCR.…”

Alternative approach to laser methods of treating vascular pathologies of the eye

“…5) and an increased concentration of the angiogenic growth factor VEGF is noted for a week after the PDT. 33 The hyper-and hypofluorescence of the CNV after PDT results from a combination of damage of the microvessels and the pathophysiological reactions stimulated by them. 34 Clinical studies of V-PDT show a short-term reduction of the leakage from the CNV and resorption of the subretinal fluid.…”

Photodynamic therapy: Dermatology and ophthalmology as main fields of current applications in clinic

“…The main advantage of PDT over conventional laser treatment is the selective thrombosis of new vessels while preserving adjacent neuroretinal structures. PDT has been performed with some remarkable results in several other ocular pathologies involving CNV (retinal angiomatous proliferation, choroiditis and idiopathic CNV) and diseases without CNV such as choroidal hemangioma [17].…”