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Sumeet Jindal, Scott W Cousins, Priyatham S Mettu; Indocyanine Green Angiography-Directed Verteporfin Photodynamic Therapy for Treatment of Serous Pigment Epithelium Detachments in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1941.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the efficacy of indocyanine green angiography (ICGA)-directed verteporfin photodynamic therapy (PDT) for the treatment of persistent disease activity (PDA) in spite of anti-vascular endothelial growth factor (VEGF) therapy, in patients with serous pigment epithelium detachments (SPED) in neovascular age-related macular degeneration (NV AMD).
Retrospective, observational, single-site study of patients with SPED and NV AMD and with PDA in spite of anti-VEGF therapy (minimum of three consecutive monthly treatments), undergoing ICGA-directed PDT (enrolling single eye of eligible subjects). ICGA allowed identification of the neovascular lesion and targeted application of PDT with minimum necessary spot size. Clinical response to PDT was assessed using a categorical disease activity scale (Fig. 1), at multiple time points through 1-year post-PDT.
Among the total study population (n=49 eyes of 49 subjects) of individuals with PDA in spite of anti-VEGF therapy, 61.2% achieved disease quiescence, defined as PED flattening with resolution of subretinal and intraretinal fluid, following ICGA-directed PDT. An additional 10.2% had a significant reduction to trivial disease activity post-PDT, defined as a significant two-category reduction in SPED height with resolved subretinal fluid and intraretinal fluid, 16.3% had reduced but significant PDA, while 12.2% showed no clinical response to ICGA-directed PDT. Among the subgroup with significant response to PDT (defined as quiescent or trivial disease), ICGA-directed PDT facilitated extension of anti-VEGF treatment interval, without PDA recurrence, in 45.7% of subjects. Though rate of PDA recurrence in this subgroup was 40%, repeat ICGA-directed PDT successfully restored quiescent or trivial disease activity in 11.4%.
ICGA-directed verteporfin PDT is an effective adjunctive treatment option for persistent disease activity in patients with SPED in the setting of NV AMD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1 - Disease Activity Scale
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