Treatment of Rubeosis iridis with Photodynamic Therapy with Verteporfin – A New Therapeutic and Prophylactic Option for Patients with the Risk of Neovascular Glaucoma?

Abstract

Patients with ischaemic retinopathy who show iris neovascularization despite panretinal laser photocoagulation (PRP) very often develop a neovascular glaucoma. Photodynamic therapy (PDT) has been shown to occlude neovascularization without damage to physiologic vessels or adjacent tissue in the treatment of choroidal neovascularization (CNV) and might also be of value for patients with neovascular glaucoma who did not benefit from the PRP. First results of a monocentre, open label, intra-individual controlled, pilot phase I/II, dose-finding study demonstrate that PDT with verteporfin is capable of occluding neovascular vessels for a defined period of time without damaging adjacent tissue or physiologic iris vessels. Whether this vessel occlusion will have an impact on the progression of rubeosis or neovascular glaucoma will be the subject of further investigation.

Ocular Photodynamic Therapy – Standard Applications and New Indications (Part 2)

“…However, subsequent reopening of the angle neovascularization was detectable after 1 month. Similar results were reported by Muller et al [48] in a pilot phase I/II, dose-finding study, demonstrating that PDT is capable to occlude iris proliferations for a defined period of time without damaging adjacent tissue or physiologic iris vessels.…”

Photodynamic therapy for recurrent hyphema after proton beam radiotherapy of iris melanoma

“…PDT has also been used as experimental treatment for uveal melanoma in animal models [4]. We identified one small case series of four patients with iris melanoma who were primarily treated with photodynamic therapy [5], and two reports on PDT for iris neovascularisation secondary to posterior segment ischaemia [6,7]. To our knowledge, this is the first reported case in which PDT successfully treated recurrent hyphema caused by abnormal intralesional blood vessels after proton beam radiotherapy of iris melanoma.…”

Verteporfin photodynamic therapy for anterior segment neovascularization secondary to ischaemic central retinal vein occlusion

“…Thus, we decided to administer PDT following the same setting used for treatment of the choroidal neovascolarization. In previous studies, the use of the PDT has been shown to be effective in the obliteration of the iris new vessel without altering or to damage the healthy iris tissue 10–12 …”

“…Photodynamic therapy (PDT) with several photosensitizers was tried in experimental models in an attempt to obliterate iris neovascularization (INV) with encouraging results 7–9 . An experimental study on humans has shown that PDT with verteporfin can determine occlusion of INV 10 . Recently, PDT was successfully employed in the treatment of early‐phase NVG, obtaining a partial obliteration of anterior segment neovascularization (ASNV) and lowering of intraocular pressure (IOP) 11,12 …”