Three-Year Results of Polypoidal Choroidal Vasculopathy Treated With Photodynamic Therapy

Wong, Chee Wai; Cheung, Chui Ming Gemmy; Mathur, Ranjana; Li, Xiang; Chan, Choi Mun; Yeo, Ian; Wong, Edmund; Lee, Shu Yen; Wong, Doric; Wong, Tien Yin

doi:10.1097/iae.0000000000000499

Cited by 65 publications

(54 citation statements)

References 63 publications

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“…Additionally, Unlike PDT, PUT do not require the injection of exogenous agents. Therefore, most of the conditions that can be treated by PDT and laser ablation, including superficial tumors such as head and neck cancer59, melanoma60, and capillary malformation such as port-wine stain61, and retinal diseases such as polypoidal choroidal vasculopathy, choroidal neovascularization, and central serous chorioretinopathy62, could potentially benefit from the development and application of PUT. In addition, current clinical applications which involve focal laser therapy of the macula, such as diabetic macular edema and branch retinal vein occlusions, would be other potential clinical applications.…”

Section: Discussionmentioning

confidence: 99%

High-precision, non-invasive anti-microvascular approach via concurrent ultrasound and laser irradiation

Zhang

Mordovanakis

et al. 2017

Sci Rep

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Antivascular therapy represents a proven strategy to treat angiogenesis. By applying synchronized ultrasound bursts and nanosecond laser irradiation, we developed a novel, selective, non-invasive, localized antivascular method, termed photo-mediated ultrasound therapy (PUT). PUT takes advantage of the high native optical contrast among biological tissues and can treat microvessels without causing collateral damage to the surrounding tissue. In a chicken yolk sac membrane model, under the same ultrasound parameters (1 MHz at 0.45 MPa and 10 Hz with 10% duty cycle), PUT with 4 mJ/cm2 and 6 mJ/cm2 laser fluence induced 51% (p = 0.001) and 37% (p = 0.018) vessel diameter reductions respectively. With 8 mJ/cm2 laser fluence, PUT would yield vessel disruption (90%, p < 0.01). Selectivity of PUT was demonstrated by utilizing laser wavelengths at 578 nm or 650 nm, where PUT selectively shrank veins or occluded arteries. In a rabbit ear model, PUT induced a 68.5% reduction in blood perfusion after 7 days (p < 0.001) without damaging the surrounding cells. In vitro experiments in human blood suggested that cavitation may play a role in PUT. In conclusion, PUT holds significant promise as a novel non-invasive antivascular method with the capability to precisely target blood vessels.

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Section: Discussionmentioning

confidence: 99%

High-precision, non-invasive anti-microvascular approach via concurrent ultrasound and laser irradiation

Zhang

Mordovanakis

et al. 2017

Sci Rep

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“…on the long-term visual outcome of PCV treated PDT, visual acuity deteriorated at the 3-year mark. (85) Two prospective studies (3- and 5-year follow-up) have demonstrated similar results. (96,97) Adverse events with PDT include sub-retinal hemorrhage, choroidal ischemia, RPE tears and microrips at the margin of the PED, and massive-suprachoroidal hemorrhage.…”

Section: Management Of Pcvmentioning

confidence: 68%

“…(84,85) Younger age, smaller lesion size, better baseline vision, and less baseline hemorrhage, are predictive measures of favorable one year visual outcomes following PDT monotherapy. (86) Numerous studies have evaluated PDT monotherapy for short and mid-term results and concluded that visual acuity remains stable or improved, while polyp regression occurs in 80–95% of treated eyes.…”

Section: Management Of Pcvmentioning

confidence: 99%

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Polypoidal Choroidal Vasculopathy

Kim

Nirwan

Kuriyan

2017

Curr Ophthalmol Rep

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Purpose of Review The goal of this paper is to review the recent literature of polypoidal choroidal vasculopathy (PCV) and provide an update on the epidemiology, pathophysiology, clinical findings, and management. Recent Findings Although indocyanine-green angiography (ICGA) is still the gold standard for diagnosis of PCV, the use of en face optical coherence tomography (OCT) and OCT angiography are useful tools in the diagnosis of PCV. Studies demonstrate superior treatment outcomes with combination photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) therapy. Summary PCV is a disease most commonly in Asians and African-Americans and presents with an orange-red nodule in the macula or the peripapillary region. While ICGA remains the most accurate method to diagnose PCV, newer non-invasive imaging modalities (eg. OCT-A and en face OCT) can be used to identify PCV lesions. The combination of PDT and anti-VEGF therapy is superior to either monotherapy. Future studies of OCT modalities and other anti-VEGF agents will be important in guiding PCV diagnosis and management, respectively.

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“…Currently, PDT is widely regarded as effective in the treatment of PCV due to the regression of polyp‐like dilations in spite of the relative lack of visual improvement within 2 years . Wong et al also reported that the visual outcome in eyes with PCV was stable until 2 years, while the outcome at 3 years worsened, particularly in eyes that experienced recurrence.…”

Section: Introductionmentioning

confidence: 99%

Polypoidal choroidal vasculopathy treatment options: A meta‐analysis

Qian

Zhao

et al. 2017

Eur J Clin Investigation

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BackgroundCombined treatment with intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) and verteporfin photodynamic therapy (PDT) is widely used for patients with polypoidal choroidal vasculopathy (PCV), although clinical evidence regarding the therapeutic efficacy and safety of such treatment remains lacking.Design/MethodsWe performed a meta‐analysis of previously reported studies comparing combination treatment, PDT monotherapy, and anti‐VEGF monotherapy. Primary outcome measures included changes in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT). The proportion of patients with polyp regression was regarded as the secondary outcome measure.ResultsTwenty studies (three RCTs and 19 retrospective studies) involving 1,178 patients with PCV were selected. Significant differences in the proportion of patients with polyps were observed between the PDT and anti‐VEGF monotherapy groups at 3 and ≥6 months (P < .00001; and P = .0001, respectively). Significantly greater reductions in CRT were observed in the anti‐VEGF than in the PDT group at the 3‐month follow‐up (P = .04). Significantly greater improvements in BCVA were observed in the combined therapy group than in the PDT monotherapy group at 3, 6, 12, and 24 months (P = .03; P = .005; P = .02; and P < .00001, respectively). Combined treatment also resulted in significantly greater improvements in BCVA than monotherapy with anti‐VEGF at 6 and 24 months (P = .001; P < .00001, respectively), and significantly greater polyp regression than that observed following anti‐VEGF treatment at 3 and ≥6 months (P < .00001; P < .0001, respectively).ConclusionsCombined therapy involving anti‐VEGF agents and PDT may be more effective in improving long‐term outcomes for patients with PCV than monotherapy.

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Three-Year Results of Polypoidal Choroidal Vasculopathy Treated With Photodynamic Therapy

Abstract: The visual outcome in eyes with PCV was stable until 2 years, but the outcome at 3 years worsened, particularly in eyes that experienced recurrence.

Cited by 65 publications

References 63 publications

High-precision, non-invasive anti-microvascular approach via concurrent ultrasound and laser irradiation

High-precision, non-invasive anti-microvascular approach via concurrent ultrasound and laser irradiation

Polypoidal Choroidal Vasculopathy

Polypoidal choroidal vasculopathy treatment options: A meta‐analysis

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