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Verteporfin photodynamic therapy induced apoptosis in choroidal neovascular membranes
  1. K Petermeier1,*,
  2. O Tatar1,*,
  3. W Inhoffen1,
  4. M Völker1,
  5. B A Lafaut2,
  6. S Henke-Fahle1,
  7. F Gelisken1,
  8. F Ziemssen1,
  9. S Bopp3,
  10. K U Bartz-Schmidt1,
  11. S Grisanti1
  1. 1University Eye Clinic at the Centre for Ophthalmology, Eberhard-Karls University Tuebingen, Germany
  2. 2Department of Ophthalmology, AZ StJan, Bruges, Belgium
  3. 3Eye Clinic Universitätsallee, Bremen, Germany
  1. Correspondence to: Professor Salvatore Grisanti Department of Ophthalmology I, Division of Vitreoretinal Surgery, Eberhard-Karls University of Tuebingen, Schleichstrasse 12-16, 72076 Tuebingen, Germany; salvatore.grisanti{at}med.uni-tuebingen.de

Abstract

Aim: To evaluate the impact of verteporfin photodynamic therapy (PDT) on the induction of apoptosis in choroidal neovascular membranes (CNV) secondary to age related macular degeneration.

Methods: Retrospective review of 22 surgically excised CNV. 12 of these patients had been treated with PDT 3–146 days previously. Apoptotic cells were detected with the TUNEL technique and compared to the expression of CD34 (endothelial cells, EC), CD105 (activated endothelial cells), Ki-67 (proliferation marker), and cytokeratin18 (retinal pigment epithelial cells, RPE).

Results: CNV excised 3 days after PDT were characterised both by collapsed and patent vessels. The EC displayed a statistical significant positive TUNEL reaction when compared to the remaining treated CNV (p<0.001) and untreated CNV (P = 0.002). The proliferative activity was reduced. CNV excised 1–5 months after PDT displayed a patent vascularisation and high proliferative activity. All membranes either treated or untreated disclosed only sporadic TUNEL positive cells within the stroma and the RPE.

Conclusions: Verteporfin PDT leads to selective and effective damage of EC within CNV. Both patent and occluded vessels were lined by apoptotic EC. This finding and the increased expression of proliferation marker at later time points suggest that revascularisation after PDT is caused by angiogenesis rather than recanalisation.

  • AMD, age related macular degeneration
  • CNV, choroidal neovascular membranes
  • EC, endothelial cells
  • FA, fluorescein angiography
  • PDT, photodynamic therapy
  • RPE, retinal pigment epithelium
  • TUNEL, TdT mediated dUTP nick end labelling
  • verteporfin
  • age related macular degeneration
  • apoptosis
  • choroidal neovascular membranes
  • photodynamic therapy
  • AMD, age related macular degeneration
  • CNV, choroidal neovascular membranes
  • EC, endothelial cells
  • FA, fluorescein angiography
  • PDT, photodynamic therapy
  • RPE, retinal pigment epithelium
  • TUNEL, TdT mediated dUTP nick end labelling
  • verteporfin
  • age related macular degeneration
  • apoptosis
  • choroidal neovascular membranes
  • photodynamic therapy

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Footnotes

  • * These authors contributed equally to the work and should be considered equivalent first authors.

  • This work was supported by the Grimmke Foundation, Jung Foundation and Vision 100 Foundation.

  • The authors have no competing interests related to the manuscript.

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