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M. Prakash, D.P. Han; Acute Recurrent Exudative Macular Detachments Associated With Photodynamic Therapy in a Patient With Idiopathic Polypoidal Choroidal Vasculopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):328.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Photodynamic therapy (PDT) using verteporfin has shown positive results in the treatment of patients with subfoveal idiopathic polypoidal choroidal vasculopathy (IPCV) [Spaide et. al., Retina 2002;22(5):529–535]. This study describes a previously unreported clinical observation of acute recurrent serous macular detachments associated with photodynamic therapy in a patient with IPCV. Methods: An 84 year–old Caucasian woman with IPCV received two PDT treatments with verteporfin within a four month interval. Two days after each treatment, she presented with sudden, painless loss of vision in the treated eye. Complete ocular examination and fluorescein angiography (FA) were performed. Results: Visual acuity (VA) at presentation was 20/50. FA demonstrated macular leakage hyperfluorescence. PDT with verteporfin was performed using an application of 689 nm laser, 6.3 mm spot diameter, 600 mw/cm2, begun 15 minutes after initiation of verteporfin injection (dosage: 6mg/m2). Two days after treatment, VA was 20/400. Posterior segment examination demonstrated shallow subretinal fluid involving the inferior four clock hours including the foveal region. A scleral buckle procedure was performed empirically for rhegmatogenous detachment, but no breaks were identified intraoperatively. Subretinal fluid resolved by the 22nd post–operative day and VA returned to baseline. Four months later, VA measured 20/60. Repeat FA showed persistent leakage hyperfluorescence in the same eye. PDT with verteporfin was repeated using the same treatment parameters. Two days after treatment, VA was 20/200. Posterior segment examination demonstrated a recurrent exudative macular and inferior retinal detachment associated with shifting subretinal fluid. The detachment resolved spontaneously over 14 days. Three months after the second PDT treatment, VA had returned to 20/50. Conclusions: To our knowledge, this is the first report of acute recurrent exudative macular detachments associated with PDT for IPCV. Patients with IPCV who develop exudative detachment after initial PDT treatment may be at risk for subsequent episodes. In such cases, modification of initial treatment parameters may be appropriate. The natural history of PDT–associated exudative macular detachments appears to include that of spontaneous resolution and return of VA.
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