Session Title: Free Paper Session 18: New Drug & Treatment Technology
Session Date/Time: Saturday 09/09/2017 | 14:30-16:00
Paper Time: 14:30
Venue: Room 120
First Author: : A.Kennedy UK
Co Author(s): : E. Hughes
Veteporfin PDT is a well-established treatment for persistent or recurring CSCR. However, full dose PDT can cause atrophy of the retinal pigment epithelium, ischaemia of the choriocapillaris and choroidal neovascularisation. To address this “safety enhanced” half-dose verterporfin and half-fluence PDT have been shown to restore normal retinal anatomy and improve visual symptoms without adverse event. Young patients can develop an isolated serous PED associated with choroidal hyperpermeability. This condition is considered to be a variant of CSCR. There is no established treatment protocol for these cases. We present three patients with isolated PEDs secondary to CSCR treated with half-fluence PDT.
Sussex Eye Hospital, Brighton
Single centre retrospective interventional case series. All patients who had received half-fluence PDT regimen in our ophthalmology unit were analysed. Of the 40 patients, 3 had predominant or isolated PEDs and were selected for the study. Prior to treatment, all patients had a history taken, a Snellen best corrected visual acuity (BCVA) tested, were subjected to a full slit lamp examination and were investigated with an enhanced depth macula optical coherence tomography scan (OCT), a standard fundus fluorescein angiogram (FFA) and a standard indocyanine green angiogram (ICG). Following a full dose of Visudyne (veteporfin (Bausch & Lomb)), each patient was treated using 83 seconds exposure at 25J/cm2 with a light dose rate of 300mW. The spot size was calculated to cover the entirety of the lesion to be treated. Patients were then seen at 1 month, 5 months and at least 14 months post-treatment in clinic where their visual symptoms were assessed, their BCVA was obtained, they were examined clinically and investigated with OCT.
Case 1: 47 year old man with distortion in the left eye for two years and BCVA of 6/15. OCT demonstrated a sub-foveal PED. Angiography confirmed CSCR. The patient was treated with half-fluence PDT. At one month, his distortion had greatly improved and his BCVA was 6/7.5. The PED had resolved. This was maintained at 18 months. Case 2: 49 year old man with chronic bilateral CSCR for 11 years. He had a paracentral scotoma which started to progress and his BCVA dropped to 6/36 in the right eye. OCT demonstrated two PEDs and paramacular chorioretinal atrophy. He was treated with half-fluence PDT to the right eye. At 1 month the patient's symptoms improved but his BCVA was 6/60. Both PEDs had resolved on OCT. At 2 years his BCVA was 6/24 and his right OCT was dry. Case 3: 42 year old man with distortion in his right eye for one month. BCVA was 6/6. OCT revealed a PED confirmed as CSCR following angiography. He was treated with half-fluence PDT. At 1 month, his distortion had gone, his BCVA was 6/5 in both eyes and his PED had resolved on OCT. This was maintained at 14 months.
In conclusion, half-fluence PDT is an effective treatment for CSCR manifesting with a PED in isolation. Similar results have been reported with other PDT regimens and further study is required to identify the most effective and safest protocol.