One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients.
OBJECTIVE
To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in Japanese patients presumed to have age-related macular degeneration (AMD) and compare 1-year outcomes after photodynamic therapy between PCV and choroidal neovascularization secondary to AMD.


METHODS
Prospective interventional study.


METHODS
Ninety-three consecutive patients (93 eyes) met the inclusion criteria: at least 50 years old, best-corrected visual acuity (VA) of 34 to 73 on the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart, a subfoveal lesion 5400 mum or smaller in greatest linear dimension (GLD) on fluorescein angiography (FA), and eligibility for photodynamic therapy.


METHODS
Indocyanine green angiography was performed in all participants, and PCV and AMD were differentiated, treated with photodynamic therapy, and the patients observed for 1 year. The GLD was determined by FA for AMD and by indocyanine green angiography for PCV, and the diameter of the laser spot size was chosen, with an extra 1000 microm added to the GLD. Photodynamic therapy was repeated if leakage occurred on FA at 3-month follow-up visits.


METHODS
Prevalence of PCV at baseline and visual and angiographic changes 1 year after photodynamic therapy in PCV and AMD.


RESULTS
Using indocyanine green angiography, 36 eyes (39%) were diagnosed with PCV and 54 eyes (58%) with choroidal neovascularization secondary to AMD. The median change in VA using the ETDRS letter score from baseline to 1 year was -7.0 in AMD eyes and +8.0 in PCV eyes (Mann-Whitney rank sum test; P<0.001). The VA improved (> or =15 letters) in AMD and PCV by 6% and 25%, respectively, and decreased (> or =15 letters) by 31% and 8%, respectively. Fluorescein leakage stopped at 1 year in 86% of PCV and 61% of AMD eyes (P = 0.031). Polypoidal choroidal vasculopathy recurred in 2 PCV eyes (5.6%), and a new PCV lesion developed in 1 PCV eye (2.8%) and 2 AMD eyes (3.7%) on indocyanine green angiography at 1 year.


CONCLUSIONS
The prevalence of PCV meeting the treatment criteria for photodynamic therapy for presumed AMD is high in Japanese patients. Photodynamic therapy is more efficacious for PCV than for AMD, which may explain the good results in Japanese patients. Further study should assess the long-term clinical results.
Gomi
Fumi
F
Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan. fgomi@ophthal.med.osaka-u.ac.jp
Ohji
Masahito
M
Sayanagi
Kaori
K
Sawa
Miki
M
Sakaguchi
Hirokazu
H
Oshima
Yusuke
Y
Ikuno
Yasushi
Y
Tano
Yasuo
Y
D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D007564:Japan / Q000208:ethnology; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D007208:Indocyanine Green