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Dreidimensionale Darstellung photodynamischer Effekte und des Spontanverlaufs bei chorioidalen Neovaskularisationen

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

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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.

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.

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Literatur

  1. Chang TS, Freund KB, de la Cruz Z (1994) Clinicopathologic correlation of choroidal neovascularisation demonstrated by indocyanine green angiography in a patient with retention of good vision for almost four years. Retina 14:114–124

    CAS  PubMed  Google Scholar 

  2. Ferris F, Fine S, Hyman L (1984) Age-related macular degeneration and blindness due to neovascular maculopathy. Arch Ophthalmol 102:265–273

    Google Scholar 

  3. Gal D, McDonald PC, Porter JC, Simpson ER (1981) Cholesterol metabolism in cancer cells in monolayer culture. Int J Cancer 28:315–319

    CAS  PubMed  Google Scholar 

  4. Gibson JM, Lavery JR, Rosenthal AR (1986) Blindness and partial sight in an eldery population. Br J Ophthalmol 70:700–705

    CAS  PubMed  Google Scholar 

  5. Jori G, Beltramini M, Reddi E, Pagnan A, Tomio L, Tsanov T (1984) Evidence for a major role of plasma lipoproteins as hematoporphyrin carriers in vivo. Cancer Lett 24:291–297

    CAS  PubMed  Google Scholar 

  6. Klein R, Klein B, Linton KLP (1992) Prevalence of age-related maculopathy: the Beaver Dam Study. Ophthalmology 99:933–943

    CAS  PubMed  Google Scholar 

  7. Leibowitz H, Krueger DE, Maunder LR et al (1980) The Framingham eye study monograph; an ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in general population of 2631 adults, 1973–1975. Surv Ophthalmol 24:335–610

    CAS  PubMed  Google Scholar 

  8. Michels S, Barbazetto I, Schmidt-Erfurth U (2002) Veränderungen neovaskulärer Membranen und normaler Aderhautgefäße nach mehrfacher photodynamischer Therapie. Ophthalmologe 99:96–100

    Article  CAS  PubMed  Google Scholar 

  9. Michels S, Schmidt-Erfurth U(2002) Sequence of early vascular brents following photodynamic threrapy. Invest Ophthalmol Vis Sci, im Druck

  10. Schlötzer-Schrehardt U, Viestenz A, Naumann GOH, Laqua H, Michels, Schmidt-Erfurth U (2002) Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes. Graefes Arch Clin Exp Ophthalmol 240:748–757

    PubMed  Google Scholar 

  11. Schmidt-Erfurth U, Baumann W, Gragoudas E, Flotte TJ, Michaud NA, Birngruber R, Hasan T (1994) Photodynamic therapy of experimental choroidal melanoma using lipoproteindelivered benzoporphyrin. Ophthalmology 101:89–99

    CAS  PubMed  Google Scholar 

  12. Schmidt-Erfurth U, Michels S, (2002) Long-term changes in confocal indocyanine green angiography following photodynamic therapy. Invest Ophthalmol Vis Sci 44:2147–2154

    Google Scholar 

  13. Schmidt-Erfurth U, Noack J, Teschner S, Birngruber R (1999) Confocal indocyanin green angiography with three-dimensional topography: results in choroidal neovascularisation (CNV). Ophthalmologe 96:797–804

    Article  CAS  PubMed  Google Scholar 

  14. Schmidt-Erfurth U, Schlötzer-Schrehardt U, Viestenz A, Naumann GOH, Laqua H (2002) Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol 120:835–844

    PubMed  Google Scholar 

  15. Schmidt-Erfurth U, Teschner S, Noack J, Birngruber R (2001) Three-dimensional topographic angiography in chorioretinal vascular disease. Invest Ophthalmol Vis Sci 42:2386–2394

    CAS  PubMed  Google Scholar 

  16. Teschner S, Noack J, Birngruber R, Schmidt-Erfurth U (2002) Threedimensional characterization of leakage-activity in chorioretinal disease. Ophthalmology, im Druck

  17. Weishaupt K, Gorner CJ, Dougherty T (1976) Identification of singlet oxygen as the cytotoxic agent in photoinactivation of a murine tumor. Cancer Res 36:2326–2329

    CAS  PubMed  Google Scholar 

  18. Yanuzzi LA, Slakter JS, Sorenson JA (1992) Digital indocyanine green videoangiography and choroidal neovascularization. Retina 12:191–223

    CAS  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Augenklinik, Universitätsklinikum Schleswig-Holstein, Lübeck

    W. Ahlswede, S. Michels &  U. Schmidt-Erfurth

  2. Medizinisches Laserzentrum GmbH, Lübeck

    R. Birngruber

  3. Augenklinik, Universität Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23562 , Lübeck

    U. Schmidt-Erfurth

Authors
  1. W. Ahlswede
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  2. S. Michels
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  3. R. Birngruber
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  4. U. Schmidt-Erfurth
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Corresponding author

Correspondence to U. Schmidt-Erfurth.

Additional information

Teile dieser Arbeit wurden auf der 100. Tagung der Deutschen Ophthalmologischen Gesellschaft vorgetragen.

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Ahlswede, W., Michels, S., Birngruber, R. et al. Dreidimensionale Darstellung photodynamischer Effekte und des Spontanverlaufs bei chorioidalen Neovaskularisationen. Ophthalmologe 101, 675–681 (2004). https://doi.org/10.1007/s00347-003-0943-7

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  • DOI: https://doi.org/10.1007/s00347-003-0943-7

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