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Three-dimensional Imaging of Photodynamic Effects in Choroidal Neovascularization and Choroid
1Ahlswede W., 1Michels S., 2Reginald B., 1Laqua H., 1Schmidt-Erfurth U.,
1Medizinische Universität zu Lübeck, Klinik für Augenheilkunde (Lübeck)
2Medizinische Universität zu Lübeck, Medizinisches Laserzentrum (Lübeck)
Purpose: Photodynamic therapy (PDT) induces occlusive and regenerative effects in choroidal neovascularization (CNV) and physiological choroid. The process of vascular alteration is documented quantitatively and qualitatively bei three-dimensional angiography.
Method: In a prospective, randomized trial 60 patients with subfoveal CNV due to age-related macular degeneration (AMD) were treated with PDT or placebo. Verteprofin in a drug dose of 6 mg/m2 body surface and a light dose of 50 J/cm2 were used for verum therapy and glucose solution for placebo treatments. Retreatments were indicated whenever persistent leakage was seen by fluorescein angiography at 3 months intervals. Caufocal indocyannin green angiography (ICGA) was performed before and continously at each control visit during two years. Flourescence series with 32 tomographic images over a 4 mm depth were analyzed topographically and reproduced in a three-dimensional display.
Results: At initial presentation CNV lesions were documented as a well-defined prominence in each patient. In the verteporfin group CNV height was continously decreased with each interval. The reduction was 10% after 3 months, 25% after 6, 50% after 12 and 60% compared to the initial value after 24 months. In the placebo group CNV slightly increased in height during the first 6 months and remained stable at about 90% of the initial prominence at long-term follow-up. The CNV diameter decreased from 2,8 to 1,9 disc areas (DA) within 12 months in the verteporfin group and reached a mean diameter of 1,6 DA at 24 months. However, an increase from 2,5 to 3,7 DA within 6 months was found in the placebo group which remained unchanged over 24 months. Perfusion defects within the physiological choroid were observed in 50% of PDT-treated eyes reaching a maximum at 12 month with long-term persistence until 24 months.
Conclusions: Three-dimensional angiography offers a reliable documentation of CNV progression and regression during PDT as well as during the spontaneous course of the disease. A decrease in CNV size is associated with an increase in choroidal perfusion defects.