Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up

Abstract

Aims: To evaluate the visual and fluorescein angiographic outcomes of photodynamic therapy (PDT) with verteporfin in patients with subfoveal choroidal neovascularisation (CNV) caused by pathologic myopia in the Chinese.

Methods: Prospective, non-comparative, two centre interventional study. Patients with CNV secondary to pathologic myopia of Chinese ethnicity were recruited and treated with a standard regimen of PDT with verteporfin. Results of this study in Chinese eyes with pigmented retinal pigment epithelium were compared with those from the Verteporfin in Photodynamic Therapy (VIP) Study of predominantly white eyes.

Results: Thirty one and 22 eyes that completed the 12 month and 24 month follow up studies respectively were analysed. The mean and median best corrected visual acuities (BCVA) could be maintained at the baseline level at the 12 month and 24 month visits. Fourteen (63.6%) eyes had stable or improved BCVA at 24 months and six (27.3%) of them had a moderate gain in vision (improved by three or more lines). Visual results were comparable with that of the VIP study, but the average accumulative PDT treatments required in one and two years were 1.7 and 2.3 respectively, which were significantly less than 3.4 and 5.1 treatments in VIP study. Mean logMAR BCVA of the younger age group (<55 years) at 24 months was 0.41 (SD 0.29), which was significantly better than the older age group (>/= = 55 years) of 0.82 (SD 0.40) (Mann-Whitney U test, p = 0.029).

Conclusions: PDT using the predetermined treatment protocol has achieved similar visual outcomes in the Chinese population as in white people with subfoveal myopic CNV over a 2 year study period. The complete cessation of CNV leakage can be accomplished, on average, with fewer PDT retreatments than reported in the VIP study. The disparity may be due to ethnic differences in these two populations.

Figure 1

Scatter plot showing the change in visual acuities at one and two year visits with photodynamic therapy

Figure 2

Changes in the mean logMAR BCVA with time over the 24 month follow up

Figure 3

Left eye of a 56 year old Chinese woman with myopia of −8.00 diopters (D) manifesting as choroidal neovascularisation (CNV). The baseline best corrected visual acuity (BCVA) was 20/200. (A) Fundus photography showing CNV of 1 disc diameter at subfoveal region together with a rim of subretinal haemorrhage. (B, C) Early phase fluorescein angiography (FA) showing a well delineated classic membrane with early hyperfluorescence and profuse angiographic leakage in the late phase. (D) Fundus photography at 3 months after photodynamic therapy (PDT) showing a CNV of the same size. The adjacent haemorrhage was partially reabsorbed. (E, F) Early and late phase of FA showing a CNV with mild angiographic leakage with time as shown by increasing hyperfluorescence, an ill defined border, and increasing in size of hyperfluorescence in late phase compared with early phase. Retreatment with PDT was required in accordance with angiographic manifestations. (G) The CNV becoming a fibrotic scar and associated with atrophy of adjacent retinal pigment epithelium. (H, I) No vasacular leakage was revealed in subsequent follow ups and the early and late phase of the FA at 2 years showed a non-leaking scar. The BCVA remained at 20/200.

Figure 4

Right eye of a 44 year old Chinese man with myopia of −11.00 D. (A) Fundus photograph revealing a small subfoveal lesion with subretinal haemorrhage. The baseline best corrected visual acuity (BCVA) was 20/100. (B) Early phase fluorescein angiography (FA) showing a tiny well defined choroidal neovascularisation (CNV). (C) Late phase FA showing profuse angiographic leakages from the CNV. (D) Fundus photograph at 3 months after PDT, revealing a small contracting lesion together with a rim of hyperplastic retinal pigment epithelium. (E) Early phase FA showing a circumscribed lesion with hyperfluorescence. (F) Late phase FA showing same level and same dimension of hyperfluorescence. The edge of the lesion remained sharp and clear and it was compatible with scar staining. No repeated PDT was offered and the angiographic morphology remained the same in the subsequent follow ups together with a stable BCVA at the level of 20/70 at the 2 year visit.