Photodynamic therapy combined with systemic corticosteroids for choroidal neovascularisation secondary to punctate inner choroidopathy

Abstract

Aim To report on visual acuity (VA) and angiographic outcomes in patients presenting with subfoveal choroidal neovascular membranes (CNV) secondary to punctate inner choroidopathy (PIC), treated with photodynamic therapy (PDT) with verteporfin combined with systemic corticosteroids. Methods A prospective case series of patients with subfoveal CNV secondary to PIC was analysed. All patients were treated with PDT combined with oral prednisolone (1 mg/kg body weight/day) which was started 5 days before PDT. Fluorescein angiography was performed at baseline and every 3 months post-treatment to establish the size, position, and activity of the CNV. Visual acuity was measured using the ETDRS scale. Further PDT treatment was carried out at follow-up visits if there was angiographic evidence of ongoing CNV activity. Results Five female patients with a mean age of 30.4 years (range 25-43 years) were treated over a 12-month period. The mean greatest linear diameter (GLD) of the CNV was 1.66 mm (range 0.46-3.28 mm). A mean improvement in vision of nine ETDRS letters (range À15-20 letters) after treatment was found, which was maintained at final followup. The mean follow-up time was 12 months (range 10-14 months). The mean number of PDT treatments was two (range 1-3). Conclusions: The vaso-occlusive effect of PDT combined with the vasostatic and antiinflammatory effect of systemic oral prednisolone appears to be a safe and effective option in the primary treatment of subfoveal CNV in patients with PIC.

Surgical management and ultrastructural study of choroidal neovascularization in punctate inner choroidopathy after bevacizumab

“…Small retrospective series have suggested that PDT may be effective [10]. More recent small prospective studies of PDT in combination with either systemic steroids or 4 mg intravitreal triamcinolone of five and four eyes, respectively, showed decreased activity of CNV lesions [11, 12]. Larger lesions though did not respond.…”

Choroidal neovascularization due to punctate inner choroidopathy: long-term follow-up and review of literature

“…Further reports on small cohorts of patients with PIC by Wachtlin et al,12 Chatterjee and Gibson,13 Postelmans et al,14 Lim et al,15 and Coco et al16 substantiate a general trend toward favorable results with PDT. Fong et al21 and Chan et al22 reported encouraging results on combined PDT with oral or intravitreal steroid. Finally, Vossmerbaeumer et al17 reported the successful outcome in a case of CNV secondary to PIC with intravitreal anti-VEGF treatment (bevacizumab), and Leung et al18 reported favorable results in a case with intravitreal ranibizumab after a short-term follow-up.…”

Photodynamic therapy for choroidal neovascularization in young adult patients

“…Similarly, others also reported a good experience with combination therapy of steroids and PDT in patients with inflammatory CNV. Fong et al [8] reported their results in 5 patients with PIC with a mean age of 30 years, treated with systemic steroids and PDT, and found a mean improvement of 9 letters with only 1 eye having a decrease in VA. In addition, Leslie et al [18] reported improvement in VA in all patients with PIC, or presumed ocular histoplasmosis syndrome (POHS) unresponsive to immunosuppressive therapy, following PDT.…”

“…Since no randomized clinical trials were performed for non-AMD-related CNV, treatment strategies are based on extrapolation from the AMD results, and on clinical data collected from small clinical series. Previous studies have demonstrated a more favorable effect of PDT in inflammatory lesions compared to AMD [5,8] as well as in young myopic patients with CNV [9].…”