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Photodynamische Therapie mit Verteporfin bei Rezidiven choroidaler Neovaskularisationen (CNV) nach primärer Argonlaserkoagulation

Photodynamic therapy with verteporfin for recurrent choroidal neovascularisation following prior argon laser coagulation

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Zusammenfassung

Hintergrund

Die photodynamische Therapie (PDT) mit Verteporfin wurde erfolgreich zur Behandlung von ≥50% der klassischen choroidalen Neovaskularisationsmembranen (CNV) bei exsudativer altersabhängiger Makuladegeneration (AMD) und anderer Genese eingeführt. Unklar ist z. Z. jedoch, ob Patienten mit subfovealen CNV-Rezidiven nach vorangegangener Laserkoagulation einer CNV ebenfalls von der PDT profitieren.

Methode

Retrospektiv wurden der Visusverlauf und die fluoreszeinangiographischen Befunde nach Standard-PDT subfovealer Rezidive nach vorangegangener Argonlaserkoagulation einer extra- oder juxtafovealen CNV bei AMD oder anderer Genese analysiert.

Ergebnisse

Insgesamt wurden 20 konsekutive Augen von 19 AMD-Patienten ausgewertet. Nach 12 Monaten konnte ein Visusverlust von 3 oder mehr ETDRS-Linien bei 14 der 20 Augen (70%) und nach 24 Monaten bei 7 von 16 Augen (44%) vermieden werden. Nach dem ersten Jahr zeigten 5 der 7 Augen (71%) mit einem subfovealen Rezidiv nach Laserkoagulation einer myopen, postentzündlichen oder idiopathischen CNV einen Visusverlust von weniger als 3 Zeilen oder eine Visusverbesserung.

Schlussfolgerungen

Trotz der kleinen Patientenzahl sehen wir eine Indikation zur PDT bei subfovealen Rezidiven nach vorangegangener Argonlaserkoagulation extra- oder juxtafovealer CNVs. Beim Vorliegen einer anderen CNV-Ursache als der AMD besteht eine bessere Visusprognose.

Abstract

Background

Photodynamic therapy (PDT) with verteporfin has been successfully introduced to treat choroidal neovascularisations (CNV) that have more than 50% classic CNV components due to exudative age-dependent macular degeneration (AMD) and other diagnoses. However, what is still unclear is if patients with recurrent subfoveal CNV who have had prior laser coagulation can also profit from PDT for CNV.

Methods

The course of visual acuity (ETDRS) and the fluorescein angiographic findings were retrospectively analysed after standard PDT of recurrent subfoveal CNV after prior argon laser coagulation of an extrafoveal or juxtafoveal CNV in AMD or other diagnoses.

Results

A total of 20 consecutive eyes from 19 AMD patients were evaluated. After 12 months in 14 of the 20 eyes (70%) deterioration in visual acuity of 3 or more ETDRS lines could be avoided and likewise in 7 of 16 eyes (44%) after 24 months. After the 1st year, 5 of the 7 eyes (71%) with recurrent subfoveal CNV after laser coagulation of a myopic, postinflammatory or idiopathic CNV had deterioration of visual acuity of less than three lines or an improvement in visual acuity.

Conclusions

Despite the low number of patients examined, we could see an indication for PDT in recurrent subfoveal CNV after prior argon laser coagulation of extrafoveal or juxtafoveal CNV. When the patient presented with a CNV cause other than AMD, a better prognosis for visual acuity was achieved.

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Correspondence to A. Gabel-Pfisterer.

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Teile der Arbeit wurden auf der 101. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft 2003 in Berlin vorgestellt.

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Gabel-Pfisterer, A., Wehner, A., Heimann, H. et al. Photodynamische Therapie mit Verteporfin bei Rezidiven choroidaler Neovaskularisationen (CNV) nach primärer Argonlaserkoagulation. Ophthalmologe 102, 592–596 (2005). https://doi.org/10.1007/s00347-004-1146-6

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  • DOI: https://doi.org/10.1007/s00347-004-1146-6

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