Photodynamic therapy – classic applications and new indications. Own Experience and Review of the Literature Part 2

Department of Ophthalmology, Philipps University, Marburg, Germany.
Ophthalmologica (Impact Factor: 1.68). 02/2007; 221(5):282-91. DOI: 10.1159/000104757
Source: PubMed


Photodynamic therapy (PDT) has become a well-established treatment for vascular forms of age-related macular degeneration (AMD). The implementation of evidence-based medicine principles into the treatment regimen of AMD seems to be immensly important, since AMD continues to be the most frequent cause of blindness among patients older than 65 years in industrialized countries. Numerous randomized prospective studies demonstrated high levels of evidence for the efficacy of various treatment approaches such as laser photocoagulation, PDT, subretinal surgery or novel anti-angiogenic drugs [Arch Ophthalmol 2006;124:597-599]. The high evidence shown by these studies supported the rationale to use PDT also in additional, less frequent, vasoproliferative diseases. Although these 'case series' and 'individual case control studies' have a low level of evidence, they give us important information for treatment decisions in these rare conditions. The goal of this survey is to review the current literature regarding PDT in vasoproliferative and exudative ocular diseases outside AMD. Many studies modified the treatment parameters of PDT to address the specific pathology of the underlying disease. Table 1 summarizes the diseases and treatment parameters that are described in this part 2, the entire table of this review is included in part 1 ( 000101922).

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  • M. Stur ·
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    ABSTRACT: Nach Einführung der intravitrealen Therapie ist es zu einem deutlichen Rückgang der Anwendung der photodynamischen Therapie (PDT) mit Verteporfin gekommen, weil die Resultate nach PDT schlechter sind als nach intravitrealer Applikation von Bevacizumab oder Ranibizumab. Ob in Zukunft die PDT – in Kombination mit intravitrealer Therapie – noch eine Rolle bei der Therapie der neovaskulären altersbedingten Makuladegeneration spielen wird, wird derzeit im Rahmen mehrerer randomisierter Multizenterstudien untersucht. Für die Behandlung der akuten und chronischen Chorioretinopathia centralis serosa, von retinalen und choroidalen Hämangiomen und von polypoidaler choroidaler Vaskulopathie ist die PDT mit Verteporfin aber nach wie vor als Therapie der ersten Wahl indiziert. The introduction of intravitreal therapy resulted in a significant decrease in the use of photodynamic therapy (PDT) with verteporfin due to the superior results of the intravitreal application of Bevacizumab and Ranibizumab. The question whether PDT – in combination with intravitreal therapy – will have a role in the future for management of cases with neovascular macular degeneration is currently investigated by several randomized controlled multicenter trials. Nevertheless, PDT with verteporfin is still the first choice for the treatment of acute or chronic central serous chorioretinopathy, of retinal and choroidal hemangiomas and of polypoidal choroidal vasculopathy.
    Spektrum der Augenheilkunde 12/2008; 22(6):340-347. DOI:10.1007/s00717-008-0294-5 · 0.18 Impact Factor
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    ABSTRACT: Hintergrund Wir berichten über die Anwendung der Kombinationstherapie aus photodynamischer Therapie (PDT) und intravitrealer Eingabe von Bevacizumab als Therapieoption bei 9 Patienten mit chronischer Chorioretinopathia centralis serosa (CCS). Patienten und Methoden Neun männliche Patienten mit chronischer CCS wurden wie folgt behandelt: Standard PDT-Lasertherapie mit Verteporfin und anschließender intravitrealer Eingabe von Bevacizumab innerhalb von 24 h. Präoperativ sowie 1, 3, 6, 9 und 12 Monate postoperativ wurden Visus, Fluoreszenzangiographie (FLA) und optische Kohärenztomographie (OCT) dokumentiert. Ergebnisse Bei allen Patienten kam es zu einer Verbesserung der Sehschärfe von 1–4 ETDRS-Zeilen. Der mittlere Visus stieg von 0,5 präoperativ auf 0,8 postoperativ nach 3 Monaten. FLA und OCT zeigten in allen Fällen eine Rückbildung der Leckagen und der subretinalen Flüssigkeit. Die Verlaufsbeobachtung von 8 Patienten über 9–12 Monate ergab einen stabilen Visus ohne CCS-Rezidiv. Schlussfolgerung PDT kombiniert mit Bevacizumab zeigt sich in unserer Fallserie als wirkungsvolle und sichere Kombinationstherapie, die als Therapieoption für Patienten mit chronischer CCS ohne Besserungstendenz geeignet ist.
    Der Ophthalmologe 11/2011; 108(11). DOI:10.1007/s00347-011-2419-5 · 0.50 Impact Factor
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    ABSTRACT: To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to chronic central serous chorioretinopathy (CSC). Twelve patients were treated with intravitreal injections of 2.5 mg bevacizumab at 6- to 8-week intervals until intraretinal or subretinal fluid resolved. Observation procedures were Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT), performed at 6- to 8-week intervals. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Multivariate analysis of variance with repeated measures was used to calculate a statistical significance of change in BCVA and mean central retinal thickness, which were the main outcome measures. SAS statistical software was used for analyses. Patients received 2-/+1 intravitreal injections of bevacizumab on average during a follow-up of 24-/+14 weeks. Mean BCVA increased by 2-/+2 lines; the change in BCVA (logMAR) was significant (p<0.02). Mean central retinal thickness decreased significantly over follow-up (p<0.05), with 6 patients (50%) showing complete resolution of subretinal fluid. Anatomic and functional improvement following intravitreal bevacizumab injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSC. The results suggest a possible role for anti-VEGF agents in the treatment of chronic CSC. Further evaluation of intravitreal bevacizumab for chronic CSC in controlled randomized studies is warranted.
    European journal of ophthalmology 11/2008; 19(4):613-7. · 1.07 Impact Factor
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