Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

  • Patrycja Nowak-Sliwinska
  • Michel Sickenberg
  • Hubert van den Bergh
Chapter
First Online:

Abstract

Photodynamic therapy (PDT) with Visudyne® was the first successful therapy for wet age-related macular degeneration (AMD). Clinical tests of PDT for wet AMD surprisingly showed a significantly better outcome for patients from Japan, Singapore, and China as compared to the results obtained on Caucasian patients. These differences pointed to the fact that patients with polypoidal choroidal vasculopathy (PCV), which is encountered more frequently in people with darker skin, had inadvertently been included among the AMD patients. As these two diseases are difficult to distinguish with the fluorescein angiography used in these trials, the switch to indocyanine green angiography (ICGA) then permitted the more specific and detailed study of PCV with Visudyne® therapy. The results of PCV treated with PDT turned out to be very good indeed, even though on the time scale of 1 year or more retreatment was needed in some patients. Anti-VEGF therapy by itself, however, did not show anywhere near the same benefit for treating PCV as was the case for the treatment of wet AMD. Recently, triple therapy with Visudyne®-PDT combined with anti-VEGF therapy and a steroid was found to give the best results for the visual acuity of patients with PCV. This chapter summarizes the data on PDT of PCV, and the effect of different combination therapies. Some of the pathological and genetic similarities and differences between PCV and wet AMD are also discussed.

Keywords

Age-related macular degeneration Antiangiogenic Choroidal neovascularization Optical coherence tomography Polypoidal choroidal vasculopathy Visudyne®-photodynamic therapy 

Abbreviations

AMD

Age-related macular degeneration

AREDS

Age-related eye disease study

BCVA

Best-corrected visual acuity

BPDMA

Benzoporphyrin derivative monoacid ring A

CNV

Choroidal neovascularization

ELN

Elastin gene

ETDRS

Early treatment diabetic retinopathy study

ICGA

Indocyanine green angiography

IVTA

Intra-vitreal triamcinolone acetonide

OCT

Optical coherence tomography

PCV

Polypoidal choroidal vasculopathy

PED

Pigment epithelial detachment

pO2

Partial pressure of oxygen

RPED

Retinal pigmented epithelium detachement

TTA

Triamcinolone acetonide

VDA

Vascular disrupting agent

VEGF-A

Vascular endothelial growth factor A

V-PDT

Visudyne®-photodynamic therapy

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Notes

Acknowledgments

The authors are grateful for financial support from Dr. J. Jacobi (to PNS).

Conflict of Interest

The authors declare no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Patrycja Nowak-Sliwinska
    • 1
  • Michel Sickenberg
    • 1
  • Hubert van den Bergh
    • 1
  1. 1.Department of ChemistryEcole Polytechnique Fédérale De LausanneLausanneSwitzerland

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