Photodynamic therapy for peripapillary pachychoroid syndrome—a case report

Abstract

A 76-year-old man presented with reduced visual acuity in both eyes, more severe in the right eye. His previous medical history included anti–vascular endothelial growth factor treatment, with multiple intravitreal injections in both eyes, and repeated focal laser in the left eye. His best-corrected visual acuity was 20/200 in the right eye and 20/40 in the left eye. Based on fundus examination and multimodal imaging, the patient was diagnosed with pachychoroid disease with peripapillary pachychoroid syndrome in the right eye and nasal macular scarring with late cystoid degeneration in the left eye. He underwent low-fluence photodynamic therapy in both eyes. At 6 months’ follow-up, best-corrected visual acuity improved to 20/120 in the right eye and was maintained at 20/40 in the left eye, with good anatomical outcome.

Pachychoroid Spectrum Disorders: An Updated Review

“…The efficacy of anti-VEGF injections is mixed; some have reported favorable outcomes after aflibercept injections, [ 61 ] while others reported cases of PPS that were recalcitrant to multiple anti-VEGF medications. [ 56 , 62 , 63 ] Recalcitrant cases have recently shown improved BCVA after low-fluence PDT. [ 63 ] Investigations of PDT have also shown long-term significant decreases in both SRF and CSFT, [ 58 ] but with complete resolution in fewer patients than seen in CSCR populations.…”

“…[ 56 , 62 , 63 ] Recalcitrant cases have recently shown improved BCVA after low-fluence PDT. [ 63 ] Investigations of PDT have also shown long-term significant decreases in both SRF and CSFT, [ 58 ] but with complete resolution in fewer patients than seen in CSCR populations. [ 64 ] Xu et al investigated long-term treatment outcomes and found that eyes receiving anti-VEGF injections exhibited decreases in choroidal and retinal thickness, but no significant change in best-corrected visual acuity (VA).…”

“…Studies have suggested that vPDT may induce choroidal vascular remodeling. [ 63 , 111 , 112 ] By occluding the involved anastomosis, PDT would remove the shunt that is contributing to overload and hyperpermeability. [ 90 ] Recent analysis has suggested that although PDT can stop the choroidal leakage, the underlying venous outflow obstruction still remains.…”