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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 6  |  Page : 552-553

Disadvantages of photodynamic therapy for polypoidal choroidal vasculopathy


Shiley Eye Center, University of California, San Diego, La Jolla, CA 92093, USA

Date of Web Publication16-Oct-2010

Correspondence Address:
Jay Kumar Chhablani
Shiley Eye Center, University of California, San Diego, 9415 Campus, Point Drive, Rm 217B, La Jolla, CA 92093
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.71691

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How to cite this article:
Chhablani JK. Disadvantages of photodynamic therapy for polypoidal choroidal vasculopathy. Indian J Ophthalmol 2010;58:552-3

How to cite this URL:
Chhablani JK. Disadvantages of photodynamic therapy for polypoidal choroidal vasculopathy. Indian J Ophthalmol [serial online] 2010 [cited 2019 Oct 22];58:552-3. Available from: http://www.ijo.in/text.asp?2010/58/6/552/71691

Dear Editor,

We read the article by Mitamura et al. [1] with interest. The article compares the short-term therapeutic effects of intravitreal bevacizumab (IVB) to those of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV).

We would like to comment about the application of PDT in PCV. PDT is associated with several disadvantages. First, PCV often presents as multiple widely distributed lesions, so it might be difficult to treat all lesions, including multiple polyps and interconnecting vessels, with a single beam of PDT. Treatment of leaking polypoidal dilations only without treating the entire vascular complex can result in persistence or worsening of exudation. Second, it can be difficult to treat nodules in the peripapillary area with a round PDT beam. Third, features commonly associated with PCV such as a large PED or a large submacular hemorrhage are not usually amenable to PDT treatment. Fourth, PCV tends to recur repeatedly so multiple PDT treatments are often necessary, which can increase the risk of long-term choroidal atrophy. Cases of massive subretinal/suprachoroidal hemorrhage have been reported soon after PDT. [2] Even 50% reduced light fluence PDT can produce a retinal pigment epithelial tear in pigment epithelial detachment. [3]

Recently, Kokame et al. [4] reported stabilization of vision at 6 months, with monthly intravitreal injection of ranibizumab in PCV. Lai et al. reported stabilization of vision and reduction in exudative detachment with IVB but its limited role in regression of polypoidal lesions in indocyanine green angiography (ICGA). [5] Complete regression of polypoidal lesions in ICGA may not be the therapeutic target but the close follow-up is mandatory. Polyps showing "washout phenomenon" on ICGA can be watched. Considering the disadvantages and economic burden associated with PDT, anti-VEGF drugs alone could be the preferred treatment for symptomatic PCV.

 
  References Top

1.
Mitamura Y, Kitahashi M, Kubota-Taniai M, Yamamoto S. Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: Short-term results. Indian J Ophthalmol 2010;58:291-6.   Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Lee SY, Kim JG, Joe SG, Chung H, Yoon YH. The therapeutic effects of bevacizumab in patients with polypoidal choroidal vasculopathy. Korean J Ophthalmol 2008;22:92-9.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Kim SW, Oh J, Oh IK, Huh K. Retinal pigment epithelial tear after half fluence PDT for serous pigment epithelial detachment in central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging 2009;40:300-3.  Back to cited text no. 3
[PUBMED]    
4.
Kokame GT, Yeung L, Lai JC. Continuous anti-VEGF treatment with ranibizumab for polypoidal choroidal vasculopathy: 6-month results. Br J Ophthalmol 2010;94:297-301.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.
Lai TY, Chan WM, Liu DT, Luk FO, Lam DS. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Br J Ophthalmol 2008;92:661-6.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  



This article has been cited by
1 Asian Age-Related Macular Degeneration
Laurence Shen Lim,,Chui Ming Gemmy Cheung,Tien Yin Wong
Asia-Pacific Journal of Ophthalmology. 2013; 2(1): 32
[Pubmed] | [DOI]
2 Authorsę reply
Mitamura, Y., Kitahashi, M., Kubota-Taniai, M., Yamamoto, S.
Indian Journal of Ophthalmology. 2010; 58(6): 553-554
[Pubmed]



 

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