Session Title: Free Paper Session 14: AMD IV
Session Date/Time: Friday 08/09/2017 | 16:30-18:00
Paper Time: 16:36
Venue: Room 111
First Author: : E.Pedanova RUSSIA
Co Author(s): : A. Doga P. Volodin A. Mayorova
Polypoidal choroidal vasculopathy (PCV) is the rare subtype of age-related macular degeneration (AMD). The main reason of separation PCV from other subtypes of AMD is an inadequate efficacy of anti-VEGF therapy. Photodynamic therapy with Verteporfin demonstrates encouraging results in management of PCV. Chlorine e6 is an alternative photosensitizer for PDT that has already shown efficacy in neovascular AMD treatment. The aim of this study is to evaluate the first results of photodynamic therapy with chlorine e6 in treatment of polypoidal choroidal vasculopathy
“The academic Fyodorov Eye Microsurgery Complex” of the Ministry of Health of Russia”
Twelve patients (13 eyes) with PCV were included in the study. They underwent ophthalmological examination completed with best corrected visual acuity (BCVA) measurement, microperimetry, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein and indocyanine green angiography (FA and ICGA), OCT-Angiography. Photodynamic therapy with chlorine e6 (Photolon) was performed with the standard dose photosensitizer (6mg/m2) and standard-fluence PDT (50 J/cm2) over 83 seconds from a 662 nm laser. Patient were followed up for the period of 3 months. PDT retreatment was performed after 3 months in cases of disease recurrence. To determine difference between baseline and post-treatment values t-test for repeated measurements was used with significance corresponding to a p-value of <0.05.
At 1 month after treatment angiography and OCT-Angiography revealed that all polyps had been closed completely, but branching vascular network (BVN) had been persisted in all cases. Mean central retinal thickness decreased from 406.11 ± 98.74 to 312.84 ± 91.43 microns (p<0.05). Mean central sensitivity improved from 15.91 ± 8.13 to 25.43 ± 11.82 dB (p<0.05). At 3 month follow up choroidal architectonics didn`t change in most patients. Further anatomical and functional impairment were detected. Central retinal thickness decreased from 312.84 ± 91.43 to 293.94 ± 87.81 microns, central sensitivity increased from 25.43 ± 11.82 to 26.17 ± 10.07 dB. The recurrence of PCV occurred in two cases (2 eyes) and new polyps were found in 1 subject (1 eye). These eyes were retreated with PDT.
PDT with chlorine e6 photosensitizer have demonstrated to be an effective treatment modality regarding the polyps obliteration and decrease of exudation from modified choroidal vessels, but have not influenced on BVN closure. BVN persistence apparently is the cause of exudation recurrence and new polyp formation in some cases. These findings reduce clinical and functional results of PDT and require additional treatment methods.