Kinetics of retinal lipoprotein precipitation and elimination after closure of subretinal new vessels.
OBJECTIVE
To study the kinetics of retinal precipitation and elimination of lipoprotein in relation to photodynamic therapy of subretinal new vessels.


METHODS
This was a retrospective observational study of subretinal precipitate before and after photodynamic therapy for subfoveal new vessels secondary to age-related macular degeneration in 14 eyes demonstrating precipitate at one or more visits, using digital red-free gray-scale fundus photography, intravenous fluorescein angiography, optical coherence tomography, and morphometric mapping.


RESULTS
In 14 eyes of 14 patients, the area covered by lipoprotein precipitate increased from a mean of 0.54 optic disc areas (range, 0-2.61) before treatment to a mean of 0.65 optic disc areas (range, 0.01-3.04) at 45 d after treatment (P = 0.18). Eyes with a serous detachment at baseline, before the initial treatment (n = 10) demonstrated more treatment-related precipitation than eyes without a serous detachment at baseline (n = 4; P = 0.034). Two eyes with a large amount of precipitate and a long follow-up demonstrated net elimination of precipitate from approximately 100 days after the initial treatment, with uniexponential precipitate half-lives of 43 and 32 days.


CONCLUSIONS
Photodynamic therapy for subfoveal new vessels may be associated with retinal precipitation of lipoprotein, presumably because early extraction of water and salts from the subretinal fluid increases the concentration of leaked plasma proteins. Despite reperfusion of the subretinal vessels, macromolecular leakage appears to cease within 100 days, indicating that functional maturation of the new vessels has occurred, with an associated decrease in pore size.
Taarnhøj
Nina Charlotte Bille Brahe
NC
Department of Ophthalmology, Herlev Hospital, University of Copenhagen, Denmark. loja@herlevhosp.kbhamt.dk
Kjeka
Ole
O
Larsen
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D011232:Chemical Precipitation; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007700:Kinetics; D008074:Lipoproteins / Q000378:metabolism*; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D012160:Retina / Q000378:metabolism*; D012171:Retinal Vessels / Q000378:metabolism* / Q000473:pathology; D012189:Retrospective Studies; D000077362:Verteporfin
D008074:Lipoproteins; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin