Photodynamic Therapy of Subfoveal and Juxtafoveal Choroidal Neovascularization Secondary to Nongranulomatous Uveitis

Abstract

Abstract: : Purpose: Photodynamic therapy (PDT) of secondary choroidal neovascularization (CNV) due to nongranulomatous uveitis may prevent loss of visual function. This report presents the results of the application of PDT to subfoveal and juxtafoveal CNV in three symptomatic young adult patients; two with multifocal choroiditis and one with Reiter's syndrome, and as such, serves as an initial evaluation of the potential of this therapy. Methods: The patients (aged 21 to 31 years old) presented to the uveitis and retina services at the University of Wisconsin Department of Ophthalmology and Visual Sciences with acute unilateral visual loss. Presenting visual acuity in the affected eye ranged from 20/200 to 20/400. All patients received serial fluorescein angiography (FA) and optical coherence tomography (OCT-1 and OCT-3) to evaluate and follow the neovascular lesions and to determine the areas for treatment. PDT was administered within 1 week to 1 month following the occurrence of symptomatic vision loss. The patients received from 1 to 3 treatments of PDT. Lesions were judged to be stabilized if they did not enlarge, or diminished in size, and if leakage ceased as detected by FA. Results: All 3 patients were found to have classic, type II CNV lesions with subretinal leakage. Follow-up periods after PDT ranged from 1 to 13 months. A patient with juxtafoveal CNV secondary to Reiter's syndrome (2.3 mm diameter lesion) and pretreatment visual acuity of 20/200, received two rounds of PDT within one month, and was observed to have a stabilized lesion, and an improvement of visual acuity to 20/60 at 6 months. A patient with multifocal choroiditis and subfoveal CNV (2.2 mm diameter lesion) and pretreatment visual acuity of 20/400, received 3 rounds of PDT over 4 months, and was observed to have a stabilized lesion, and improvement of the visual acuity to 20/200 at 13 months. A third patient presented with multifocal choroiditis and a subfoveal CNV (0.7 mm diameter lesion) with a visual acuity of 20/400. This patient received one course of PDT, and has had stabilization of both the CNV lesion and visual acuity. Conclusions: PDT treatment can stabilize secondary subfoveal and juxtafoveal CNV due to nongranulomatous uveitis. Stabilization of these lesions is correlated with reduction of subretinal leakage and improved visual acuity. Longer-term follow up will be necessary to determine the full efficacy of this treatment for this type of condition.

Keywords: choroid: neovascularization • photodynamic therapy • visual acuity