Photodynamic Therapy (PDT)
Therapeutic procedure
Utilizes the photosensitive intravenous drug, verteporfin (Visudyne)
With a low power, long duration infrared laser
In ophthalmology it is used to treat
Neovascular age related macular degeneration (AMD)
Polypoidal choroidal vasculopathy (PCV)
Haemangioma
Central serus retinopathy(CSR)
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Photodynamic therapy , A case series
1. Photodynamic Therapy (PDT)
A Case Series
RS Walpitagamage1, NP Costa1, , DMMAK Dissanayake2,
KH Wickramasinghe3, DHH Wariyapola4
1Post Graduate Trainee in Ophthalmology,2Registrar in Ophthalmology,
3Senior Registrar in Ophthalmology,4Consultant Ophthalmologist,
Sri Jayewardenepura General Hospital, Kotte.
2. Introduction
• Photodynamic Therapy (PDT)
– Therapeutic procedure
– Utilizes the photosensitive intravenous drug,
verteporfin (Visudyne)
– With a low power, long duration infrared laser
• In ophthalmology it is used to treat
– Neovascular age related macular degeneration (AMD)
– Polypoidal choroidal vasculopathy (PCV)
– Haemangioma
– Central serus retinopathy(CSR)
3. Introduction
• Photodynamic Therapy (PDT)
– lead to the closure of choroidal neovascular and
other active proliferating vessels
– leaving normal retinal tissue unharmed
• Used to treat sub foveal pathologies
5. Method
• Period from March 2016 to April 2017
• Number PDTs done at SJGH- 14
• Pre and post PDT(one month)
– Visual acuity - Snellen’s
– Central Macular thickness using Optical Coherence
Tomography (OCT)
6. Results
• One month after PDT
– Average reduction of macular thickness - 36.6%
– Stable VA -64% (9/14)
– One line improvement of VA -28%(4/14)
– VA and macular oedema worsen in one patient
• 93%(13/14) patients responded to PDT
• One patient did not respond to PDT
7. Case 1
• A 64 years old female
• OD VA - 6/24
• Found to have wet AMD with CNV
11. • After 1 month of PDT
• 44.2% reduction of
central macular
thickness
• One line improvement
of VA- 6/18
PDT done on 19/04/2017
Followed by
IV Bevacizumab
Before PDT After 1 month of PDT
12. After 3 doses of Bevacizumab and 3 months of PDT
Before PDT
No SRF, small amount of intra retinal fluid
13. Case2
• 66 years old female
• OS wet AMD with CNV - 8 doses of IV Bevacizumab
• Patient defaulted for 8 months, presented with reduction of
vision
• VA- 6/36
15. ICGA done on 9/11/2016
Polyps
Abnormal
vascular
network
16. PDT done on 16/11/2016
Followed by
IV Bevacizumab
• After 1 month of PDT
• 44.6% reduction of
central macular
thickness
• One line improvement
of VA- 6/24
Before PDT After 1 month of PDT
17. After 3 doses of Bevacizumab and 3 months of PDT
Before PDT
No SRF, PED has gone off
18. Case 3
• 56 years old female
• OS wet AMD with CNV
• Treated with 10 doses of IV Bevacizumab
• VA- 6/18
Multiple
Hemorrhagic PEDs
21. PDT done on 16/03/2016
Followed by
IV Bevacizumab
• After 1 month of PDT
• 22.7% reduction of
central macular
thickness
• One line improvement
of VA 6/12
Before PDT After 1 month of PDT
22. Before PDT After PDT, 4 doses of Bevacizumab given
Now one year without Anti VEGF
23. Conclusion
• PDT is effective in treating PCV when
Bevacizumab has failed
• Always review the diagnosis when anti VEGF
does not give the expected results
• Arrange ICG to confirm PCV and offer PDT
for that patient
Notas del editor
Exudates and Maculae oedema
No SRF, small amount of intra retinal fluid due to VMT