Der Ophthalmologe

, Volume 101, Issue 7, pp 675–681 | Cite as

Dreidimensionale Darstellung photodynamischer Effekte und des Spontanverlaufs bei chorioidalen Neovaskularisationen

  • W. Ahlswede
  • S. Michels
  • R. Birngruber
  • U. Schmidt-Erfurth
Originalien

Zusammenfassung

Hintergrund

Die photodynamische Therapie (PDT) induziert okklusive und regenerative Effekte in chorioidalen Neovaskularisationen (CNV) und in physiologischer Aderhaut. Mittels dreidimensionaler Angiographie wird der Gefäßumbau qualitativ und quantitativ darstellbar.

Methode

In einer prospektiven, randomisierten Studie wurden 30 Patienten mit subfovealer CNV bei altersbedingter Makuladegeneration (AMD) mit PDT oder Placebo behandelt. Aufeinanderfolgende Angiographieserien mit 32 tomographischen Bildern wurden topographisch analysiert und dreidimensional reproduziert.

Ergebnisse

Bei der Erstvorstellung war die CNV bei allen Patienten als scharf begrenzte Prominenz dokumentierbar. In der Verteporfingruppe nahm die Höhe der Membran mit jedem Intervall kontinuierlich ab. In der Placebogruppe nahm sie zunächst über 6 Monate gering zu und blieb langfristig bei 90% der Originalhöhe stabil. In der Verteporfingruppe entwickelte sich bei 44% der Patienten nach 12 Monaten ein zusätzlicher Aderhautdefekt.

Schlussfolgerung

Die dreidimensionale Angiographie stellt Wachstum und Rückgang der CNV unter photodynamischer Behandlung präzise dar. Einem Rückgang der CNV steht bei PDT eine Zunahme von Aderhautdefekten gegenüber.

Schlüsselwörter

Photodynamische Therapie Chorioidale Neovaskularisation Altersbedingte Makuladegeneration Dreidimensionale topographische Angiographie 

Three-dimensional imaging of photodynamic effects and spontaneous course in choroidal neovascularization

Abstract

Purpose

Photodynamic therapy (PDT) induces occlusive and regenerative effects in choroidal neovascularization (CNV) and physiological choroid. The process of vascular alteration is documented quantitatively and qualitatively by three-dimensional angiography.

Method

In a prospective, randomized trial 30 patients with subfoveal CNV due to age-related macular degeneration (AMD) were treated with PDT or placebo. Fluorescence series with 32 tomographic images over a 4-mm depth were analyzed topographically and reproduced in a three-dimensional display.

Results

At initial presentation CNV lesions were documented as a well-defined prominence in all patients. In the verteporfin group CNV height continuously decreased with each interval. In the placebo group CNV slightly increased in height during the first 6 months and remained stable at about 90% of the initial prominence at long-term follow-up. After 12 months 44% of the patients in the verteporfin group developed an additional choroidal defect.

Conclusion

Three-dimensional angiography offers a reliable documentation of CNV progression and regression during PDT. A decrease in CNV size is associated with an increase in choroidal perfusion defects.

Keywords

Photodynamic therapy Age-related macular degeneration Choroidal neovascularization Three-dimensional topographic angiography 
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Notes

Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: U. Schmidt-Erfurth is Coauthor auf einem Patent für Verteporfin über das Patentoffice der Harvard Medical School.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • W. Ahlswede
    • 1
  • S. Michels
    • 1
  • R. Birngruber
    • 2
  • U. Schmidt-Erfurth
    • 1
    • 3
  1. 1.AugenklinikUniversitätsklinikum Schleswig-HolsteinLübeck
  2. 2.Medizinisches Laserzentrum GmbHLübeck
  3. 3.AugenklinikUniversität Schleswig-Holstein Campus LübeckLübeck

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