Original article
Optical coherence tomography findings following photodynamic therapy of choroidal neovascularization

https://doi.org/10.1016/S0002-9394(02)01566-0Get rights and content

Abstract

PURPOSE: To develop an optical coherence tomography (OCT) classification system that monitors the response of eyes treated with photodynamic therapy (PDT) with verteporfin for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD).

DESIGN: Retrospective interventional case series.

METHODS: Ninety eyes (88 patients) with AMD and predominantly classic subfoveal CNV treated with PDT using verteporfin were identified by a laser log and retrospectively reviewed. Optical coherence tomography and fluorescein angiography (FA) were performed before treatment and at subsequent follow-up examinations in all eyes. Optical coherence tomography findings were evaluated and compared with corresponding FA.

RESULTS: A five-stage OCT classification of eyes treated with PDT was created from the evaluation of 79 total eyes (77 patients). Stage I (two eyes) is recognized within the first week of treatment and demonstrates an acute inflammatory response with increased subretinal fluid. Stage II (28 eyes) represents the restoration of a near-normal fovea contour with diminished subretinal fluid occurring 1 to 4 weeks after treatment. Stage III (79 eyes) occurs between 4 to 12 weeks following treatment and is subdivided into two categories based on the amount of subretinal fibrosis and fluid present. Stage IIIa (15 eyes) contains a greater subretinal fluid to fibrosis ratio indicating an active CNV process. Lesions in stage IIIb (64 eyes) less actively leak and have more prominent fibrosis with minimal intraretinal fluid. Cystoid macular edema defines a stage IV lesion (11 eyes). In stage V lesions (19 eyes) the subretinal fluid resolves with thinning of the retina as well as fibrosis merging with the retinal pigment epithelial layer (RPE).

CONCLUSION: Optical coherence tomography appears to be useful in monitoring the retinal changes that occur following PDT of CNV and may assist in understanding the changes observed on angiography.

Section snippets

Methods

All eyes treated with PDT at the New England Eye Center in Boston, Massachusetts, between November 1999 and December 2000 were identified from a manually recorded laser log. Fluorescein angiography and charts of all eyes that had undergone treatment were retrospectively reviewed. Choroidal neovascularization secondary to non-AMD etiologies including inflammatory, idiopathic, pathologic myopia, angioid streaks, and presumed ocular histoplasmosis were excluded. For inclusion in the study, eyes

Stage I: acute inflammatory response

: Immediately following PDT, both OCT and FA demonstrated evidence of an acute inflammatory response. This was confirmed on imaging modalities at 1 hour and up to 1 week following photoactivation of verteporfin. Fluorescein angiography revealed hyperfluorescence of both the CNV and treatment area, with later frames of the angiogram demonstrating increased leakage of fluorescein in the treatment zone. The OCT demonstrated increased accumulation of intraretinal fluid in a circular distribution

Discussion

Optical coherence tomography is a sensitive tool that provides cross-sectional images and reproducible measurements of the macula.11 When scanning eyes with AMD, CNV is imaged in the intraretinal space as a highly reflective red signal. Histologic studies of laser-induced CNV confirm that RPE cells arising from the RPE/choriocapillaris layer envelop CNV, creating the highly reflective band in the retina.12, 13 Retinal fluid collections appear as hyporeflective black spaces either in the

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