Original article
Long-term Results of Photodynamic Therapy for Choroidal Neovascularization in Japanese Patients With Pathologic Myopia

https://doi.org/10.1016/j.ajo.2010.06.046Get rights and content

Objective

To determine the results of photodynamic therapy (PDT) in highly myopic eyes with choroidal neovascularization (CNV).

Design

Open-label, consecutive, interventional case series.

Methods

Forty-eight eyes of 46 consecutive Japanese patients with a myopic CNV were studied. The eyes were treated with PDT and were followed up from 1 to 4 years. The best-corrected visual acuities (BCVAs) at the baseline and after the PDT were compared. Multivariate regression analyses were used to determine the factors that were significantly associated with the BCVA at 3 or 4 years.

Results

The mean follow-up period was 3.2 years. Sixty-nine percent of the patients obtained angiographic closure by a single PDT treatment, and the average number of PDT treatments was 1.4. Chorioretinal atrophy developed in 61% of the eyes at 3 years and in 70% of the eyes at 4 years. The BCVA did not change significantly after the PDT. Multivariate regression analyses showed that the BCVA at 3 years was significantly correlated with the baseline BCVA and area of chorioretinal atrophy. Analyses of the 20 patients at 4 years or more showed that in 5 of 7 (71.4%) patients with juxtafoveal CNV, chorioretinal atrophy did not develop and that all had BCVA of 0.5 or better. However, in 12 of the 13 patients with a subfoveal CNV, chorioretinal atrophy developed at 4 years, and 10 of these patients had BCVA of 0.1 or worse.

Conclusions

In highly myopic patients, 69% obtained angiographic closure by a single PDT treatment, and recurrence was rare. These findings indicate that PDT is still a good option for treating CNVs in highly myopic patients.

Section snippets

Methods

This was a prospective, interventional case series of 60 eyes of 57 consecutive patients with myopic CNV who were treated with PDT between October 2004 and November 2006. Before the approval of the use of an intravitreous injection of bevacizumab (IVB) was obtained from the Ethics Committee of the Tokyo Medical and Dental University, we treated all of the eligible patients with myopic CNV with PDT alone. After December 2006, we switched the treatment for myopic CNV to IVB in all of the eligible

Results

The clinical characteristics of the patients at the initial examination (baseline) are shown in Table 1. Their average age was 53.1 ± 15.9 years, with a range of 19 to 81 years, and the average refractive error (spherical equivalent) of the eyes that were not pseudophakic was −11.6 ± 3.5 D, with a range of −6.5 to −21.0 D. The average axial length was 28.5 ± 1.5 mm, with a range of 26.1 to 32.4 mm. The baseline BCVA was 0.63 ± 0.44 logMAR units, with a range of 0 to 2.0 logMAR units. Thirty-two

Discussion

We studied 48 eyes with myopic CNV: 22 eyes with subfoveal CNV, and 16 eyes with nonsubfoveal CNV. All of the eyes were treated with PDT alone and were followed up for at least 1 year. The mean number of PDT sessions in the 38 eyes was 1.4, with a mean follow-up of 3.2 years. Seventy percent of these eyes obtained angiographic closure by a single PDT. In an earlier study, we reported that patients received an average of 1.4 PDT sessions with a mean follow-up of 15.0 ± 7.0 months.18 These data

Kengo Hayashi, MD, graduated from Okayama University, Japan in 2002, and is now a core member of High Myopia Clinic at Tokyo Medical and Dental University. Dr. Hayashi's interest is on the treatment of myopic choroidal neovascularization.

References (27)

  • I. Krebs et al.

    Choroidal neovascularization in pathologic myopia: three-year results after photodynamic therapy

    Am J Ophthalmol

    (2005)
  • D.S. Lam et al.

    Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up

    Br J Ophthalmol

    (2004)
  • A. Pece et al.

    Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization secondary to pathologic myopia: long-term study

    Retina

    (2006)
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    Kengo Hayashi, MD, graduated from Okayama University, Japan in 2002, and is now a core member of High Myopia Clinic at Tokyo Medical and Dental University. Dr. Hayashi's interest is on the treatment of myopic choroidal neovascularization.

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