Photodynamic Therapy for Age-Related Macular Degeneration Treatment: Epidemiological and Clinical Analysis of a Long-Term Study

Mataix, Jorge; Desco, M Carmen; Palacios, E.; García-Pous, Maria

doi:10.3928/15428877-20090430-09

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Delivering PDT to the polypoidal lesions will result in occlusion of the polypoidal lesions and focal choroidal ischemia at the treated areas [35, 36], which may result in further VEGF secretion from the surrounding intact branching vascular network and subsequent recurrence of serosanguinous exudation causing further visual deterioration. Hence, the benefits of combining PDT with intravitreal injections of anti-VEGF agents were strongly emphasized [20].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom

et al. 2017

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Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom.MethodsFundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count.ResultsEighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities.ConclusionsBased on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom

et al. 2017

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“…23 We speculated that changes resulting from PDT treatment, such as photoreceptor degeneration, fibrosis and atrophic changes, might attenuate the visual acuity improvement even if the lesion is inactivated.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy

Inoue

Arakawa

Yamane

et al. 2013

Eye

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“…Even if demographic and clinical predictors, such as age of patient, baseline best-corrected visual acuity (BCVA) and baseline CNV dimension, have been evaluated to explain the remarkable heterogeneity of PDT-V outcomes in patients with neovascular AMD 51–53 , no unequivocal data were recorded also after the differentiation between different CNV subtypes which are traditionally categorized by fluorescein angiography (FA) in: (i) classic CNV (C-CNV), characterized by a well-demarcated hyperfluorescent area with an hypofluorescent margin in FA early phase and dye leakage obscuring the boundaries of the neovascular lesion during the late phase; (ii) predominantly classic CNV (PC-CNV), with the classic component occupying 50% or more of the entire neovascular lesion that includes occult CNV and all the fluorescence-blocking constituents; (iii) minimally classic CNV (MC-CNV), with the classic component occupying less than 50% of the neovascular complex; (iv) occult CNV (O-CNV), with no classic component 22–25 . In fact, within patients treated with PDT-V for AMD-related CNV, other factors appear to be implicated in those differences of therapeutic responsiveness, which are clearly noticeable reviewing the final outcomes of both randomized controlled trials 22–26 and real-life clinical studies 54–56 . Focusing on a pharmacogenetic predictive approach, our previous investigations have pointed out the role of thrombophilic and anti-thrombophilic single nucleotide polymorphisms (SNPs) in modifying the result of PDT-V in Caucasian patients with neovascular macular degenerations 57–60 .…”

Section: Introductionmentioning

confidence: 99%

Impact of methylenetetrahydrofolate reductase C677T polymorphism on the efficacy of photodynamic therapy in patients with neovascular age-related macular degeneration

Parmeggiani

Gallenga

Costagliola

et al. 2019

Sci Rep

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The most severe visual impairments due to age-related macular degeneration (AMD) are frequently caused by the occurrence of choroidal neovascularization (CNV). Although photodynamic therapy with verteporfin (PDT-V) is currently a second-line treatment for neovascular AMD, it can be conveniently combined with drugs acting against vascular endothelial growth factor (anti-VEGF) to reduce the healthcare burden associated with the growing necessity of anti-VEGF intravitreal re-injection. Because the common 677 C > T polymorphism of the methylenetetrahydrofolate reductase gene (MTHFR-C677T; rs1801133) has been described as predictor of satisfactory short-term responsiveness of AMD-related CNV to PDT-V, we retrospectively examined the outcomes of 371 Caucasian patients treated with standardized, pro-re-nata, photodynamic regimen for 24 months. Responder (R) and non-responder (NR) patients were distinguished on the basis of the total number of scheduled PDT-V (TN-PDT-V) and change of best-corrected visual acuity (∆-BCVA). The risk for both TN-PDT-V and ∆-BCVA to pass from R to NR group was strongly correlated with CT and TT genotypes of MTHFR-C677T variant resulting, respectively, in odd ratios of 0.19 [95% CI, 0.12–0.32] and 0.09 [95% CI, 0.04–0.21] (P < 0.001), and odd ratios of 0.24 [95% CI, 0.15–0.39] and 0.03 [95% CI, 0.01–0.11] (P < 0.001). These pharmacogenetic findings indicate a rational basis to optimize the future clinical application of PDT-V during the combined treatments of AMD-related CNV, highlighting the role of thrombophilia to be aware of the efficacy profile of photodynamic therapy.

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Photodynamic Therapy for Age-Related Macular Degeneration Treatment: Epidemiological and Clinical Analysis of a Long-Term Study

Abstract: PDT is a safe, long-term treatment for exudative age-related macular degeneration, but it is not definitive because this treatment cannot stop the initial growth of the choroidal neovascularization lesion.

Cited by 11 publications

References 22 publications

Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom

Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom

Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy

Impact of methylenetetrahydrofolate reductase C677T polymorphism on the efficacy of photodynamic therapy in patients with neovascular age-related macular degeneration

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