Early anatomical changes and association with photodynamic therapy induced acute exudative maculopathy in patients with macular diseases

Abstract

The purpose of this study was to investigate the occurrence rate and predictors of photodynamic therapy (PDT) induced acute exudative maculopathy (PAEM). This retrospective study included 39 eyes of 39 patients (32 males and 7 females), who were treated with initial PDT. PAEM was defined as an increase in central retinal thickness (CRT) of 15% or more measured by OCT on day 3 after PDT compared with baseline. Sixteen of 39 eyes (41%) were classified in the PAEM+ group. CRT and central choroidal thickness (CCT) were significantly increased at 3 days in the PAEM+ group and significantly decreased at 1 month after PDT in the PAEM- group. In a multiple comparison, neovascular age-related macular degeneration (nAMD) had a significantly higher incidence of PAEM compared to polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC). The incidence of PAEM was lower in PCV and CSC, and higher in nAMD. BCVA at 1 month was significantly worse in the PAEM group, which may be related to visual prognosis after PDT. Since both CRT and CCT decrease at 1 month, the detection of PAEM needs to be assessed a few days after PDT.

Figure 1

This is a representative case of PAEM-. Fluorescein angiography (a), indocyanine green angiography (b), and horizontal line of optic coherence tomography images of patients at baseline (c), 3 days follow-up (d) and 1 month follow-up (e) after photodynamic therapy (PDT). 60-year-old-male with central serous chorioretinopathy in the left eye. Central retinal thickness was 358 µm at baseline, 364 µm (+ 1.7%) at 3 days, 122 µm (− 65.9%) at 1 month after PDT. Central choroidal thickness was 338 µm at baseline, 341 µm (+ 0.9%) at 3 days, 255 µm (− 24.6%) at 1 month after PDT. Complete resolution of sub retinal fluid was seen at 1 month follow-up.

Figure 2

This is a representative case of PAEM+. Fluorescein angiography (a), indocyanine green angiography (b), and horizontal (c, e, g) and vertical (d, f, h) line of optic coherence tomography images of patients at baseline (c, d), 3 days follow-up (e, f) and 1 month follow-up (g, h) after photodynamic therapy (PDT). 82-year-old-female with polypoidal choroidal vasculopathy in the light eye. Central retinal thickness was 361 µm at baseline, 538 µm (+ 49.0%) at 3 days, 334 µm (− 7.5%) at 1 month after PDT. Central choroidal thickness was 135 µm at baseline, 270 µm (+ 100.0%) at 3 days, 126 µm (− 6.7%) at 1 month after PDT. The subretinal fluid increased at 3 days follow-up, with complete resolution at 1 month follow-up. The bacillary detachment was also seen only at 3 days follow-up.

Figure 3

Change in central retinal thickness (CRT) (a) and central choroidal thickness (CCT) (b) from baseline. In the comparison between the two groups, the rate of change in CRT and CCT was significantly increased in the PAEM group at 3 days after PDT, with no significant difference at 1 month (CRT and CCT: 3 days, p < 0.05 and p < 0.05; 1 month, p = 0.17 and p = 0.21).

Figure 4

Incidence of PAEM by disease subtype. The incidence of PAEM was 79% in nAMD, 21% in PCV, and 18% in CSC. In a multiple comparison of the three groups, nAMD had a significantly higher incidence of PAEM compared to PCV and CSC (nAMD versus PCV: p < 0.05, nAMD versus CSC: p < 0.05, PCV versus CSC: p = 1.00).