Problems with and pitfalls of photodynamic therapy.
OBJECTIVE
To delineate the various factors that may influence the outcome of photodynamic therapy of the retina and choroid.


METHODS
Experimental animal study.


METHODS
Pigmented and nonpigmented rabbits; rhesus monkeys.


METHODS
The hydrophilic photosensitizer, mono-L-aspartyl chlorin e6, which is maximally activated at 664 nm, was studied after intravenous injection into pigmented and nonpigmented rabbits and rhesus monkeys. Laser light was supplied by a red diode laser coupled to a modified slit-lamp biomicroscope and delivered to the ocular fundus after passing through a standard fundus contact lens. Standard photodynamic parameters were used. The effects of fundus pigmentation, intraocular pressure, spot focus and defocus, region of fundus treated, equivalent fluence, and retreatment were observed in the different animal species.


METHODS
Slit-lamp biomicroscopy, fluorescein angiography, light and transmission electron microscopy.


RESULTS
Fundus pigmentation appeared to be a factor only at the lowest fluence level tested, where only 4 of 12 lesions attempted in pigmented fundi were noted on fluorescein angiography, compared with 12 of 12 lesions in albino rabbits. At normal intraocular pressures and a given fluence, 10 of 10 lesions were fully manifested on fluorescein angiography, compared with 4 of 10 at 30 mmHg and 0 of 10 at pressures sufficient to blanch the optic nerve (>60 mmHg). For laser spots either focused or defocused, there were 6 of 6 lesions that were fully manifested on fluorescein angiography for each of the parameters. Lesions treated in the fovea resulted in larger spots on fluorescein angiography. The fluence of 5 mW for 10 seconds resulted in a larger lesion on angiography than the equivalent fluence of 10 mW for 5 seconds. Areas of retreatment in rabbits demonstrated more thinning of the neurosensory retina and loss of photoreceptor outer segments and nuclei than corresponding areas receiving one treatment.


CONCLUSIONS
Photodynamic therapy results varied, depending on intraocular pressure, region of fundus treated, ocular pigmentation, and the total time of exposure to the photosensitizer. Retreatment resulted in progressive thinning of the neurosensory retina with loss of photoreceptor outer segments and nuclei in the rabbit eye.
Peyman
G A
GA
Louisiana State University Eye Center, Louisiana State University Medical Center and School of Medicine, New Orleans 70112-2234, USA.
Kazi
A A
AA
Unal
M
M
Khoobehi
B
B
Yoneya
S
S
Mori
K
K
Moshfeghi
D M
DM
D000818:Animals; D002829:Choroid / Q000187:drug effects* / Q000473:pathology / Q000648:ultrastructure; D005451:Fluorescein Angiography; D007429:Intraocular Pressure; D007834:Lasers; D008253:Macaca mulatta; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D010857:Pigment Epithelium of Eye / Q000187:drug effects; D011166:Porphyrins / Q000627:therapeutic use*; D011817:Rabbits; D012086:Reoperation; D012160:Retina / Q000187:drug effects* / Q000473:pathology / Q000648:ultrastructure; D012307:Risk Factors; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D011166:Porphyrins; C053434:Talaporfin