Michal Kramer

Liposomal Benzoporphyrin Derivative Verteporfin Photodynamic Therapy

PURPOSE The authors have previously shown that photodynamic therapy (PDT) using lipoprotein-delivered benzoporphyrin derivative mono-acid (BPD) effectively closed experimental choroidal neovascularization (CNV). In the current study, the authors used a clinical preparation, liposomal BPD verteporfin in the same model, with experiments designed to establish optimal dye and light doses, and the timing of laser light irradiation after dye injection, for effective and selective closure of CNV. METHODS Experimental CNV was induced in the maculae of cynomolgus monkeys. Liposomal BPD verteporfin was injected intravenously at doses of 1.0, 0.5, 0.375, and 0.25 mg/kg. Laser light at 692 nm then was applied to CNV, with an irradiance of 600 mW/cm2 and fluence of 150 J/cm2, at various times after dye injection, ranging from 5 to 120 minutes. Treatment effect was assessed by fundus photography and fluorescein angiography and confirmed by light and electron microscopy. The PDT of experimental CNV was studied to assess efficacy; PDT performance on normal eyes was studied to investigate selectivity. RESULTS The CNV closure was demonstrated by fluorescein angiography and histopathologic findings at all tested dye doses. A dye dose of 0.375 mg/kg, with laser light irradiation applied 20 to 50 minutes after dye injection, optimized CNV closure with minimal retinal and choroidal damage. No major local adverse effects were noted, and the drug was well tolerated systematically. CONCLUSIONS Liposomal BPD verteporfin is a potent photosensitizer, and PDT using this dye is a potentially effective and selective treatment for CNV.

Bevacizumab for choroidal neovascularization related to inflammatory diseases.

Purpose:The purpose of this study was to report our experience with intravitreal bevacizumab for inflammation-related choroidal neovascularization in two tertiary centers. Methods:This study was a retrospective analysis of patients with choroidal neovascularization related to inflammatory diseases, treated with intravitreal bevacizumab injections (1.25 mg/0.05 mL). Results:Ten eyes of 10 patients (range, 14-78 years; mean age, 44 years) with underlying uveitis were treated with intravitreal bevacizumab for inflammation-related choroidal neovascularization from 2006 to 2008. Mean follow-up time was 13 ± 8 months, and the mean number of injections was 2.7 ± 2. Resolved leakage on fluorescein angiography and resolution of subretinal fluid on optical coherence tomography occurred in all patients, with improvement in visual acuity in 9 of 10 eyes and no change in visual acuity in 1 of 10 eyes. Seven patients received additional treatment based on the underlying condition. Mean macular thickness on optical coherence tomography decreased from 394 ± 116 μm to 254 ± 52 μm (P < 0.01). Mean visual acuity improved from 0.87 ± 0.74 logarithm of the minimum angle of resolution to 0.38 ± 0.63 (P = 0.005). Seven patients reached a visual acuity of 0.2 logarithm of the minimum angle of resolution (Snellen 6/9) or better. Conclusion:Intravitreal bevacizumab is an effective treatment for choroidal neovascularization related to inflammatory diseases when inflammation is controlled.

Combined photodynamic therapy and intravitreal triamcinolone acetonide injection for neovascular age-related macular degeneration with pigment epithelium detachment.

The authors report a case of acute development of an extensive retrobulbar abscess 3 weeks after an orbital floor fracture. Urgent drainage of the abscess was performed by an anterior transconjunctival approach. A dramatic recovery was observed a few days following the operation. The visual acuity increased from hand motions to 0.7 to 0.8 in the early postoperative period and to 1.0 shortly thereafter. The severity of infection, the importance of antibiotic prophylaxis for blowout fractures, and the efficacy of the transconjunctival approach on the final visual and functional outcome are described.A 38-year-old man with human immunodeficiency virus was referred for evaluation of retinal lesions in both eyes. Optical coherence tomography was performed after dilating the pupils. Biomicroscopy of the retina showed an atypical, solitary, yellowish-white lesion in the macula of both eyes with no inflammation of the vitreous. Optical coherence tomography of the lesions showed an area of extremely low reflectivity with well-defined but irregular borders in the outer retina. The surrounding retina showed normal reflectivity and was of normal thickness. Optical coherence tomography showed selective necrosis of the outer layers due to progressive outer retinal necrosis. Optical coherence tomography may serve as a useful tool for the early diagnosis of progressive outer retinal necrosis.

Photodynamic Therapy for Pseudophakic Eyes Compared to Eyes With Cataract

BACKGROUND AND OBJECTIVE Verteporfin photodynamic therapy (vPDT) plays a role in the treatment of chorioretinal conditions. The purpose of this study was to compare vPDT outcomes between cataractous and pseudophakic eyes. PATIENTS AND METHODS In this prospective study of consecutive patients with choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration (nAMD) treated with vPDT, cataract and pseudophakic eyes were compared for number and timing of vPDT treatments, duration of follow-up, angiographic features, and changes in best-corrected visual acuity (BCVA). RESULTS Overall, 103 eyes (n = 95) were included in the final analysis; 44 eyes in the cataract group and 59 eyes in the pseudophakic group. No significant difference in change in BCVA (P = .19) or leakage-free CNV lesions (P = .58) was found between the groups. CONCLUSIONS In this study of vPDT for nAMD, there was no significant difference between eyes with cataract and pseudophakic eyes. It seems that cataract does not clinically alter the effect of vPDT. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1132-1136.].

Photodynamic Therapy of Experimental Choroidal Neovascularization Using Lipoprotein-Delivered Benzoporphyrin

OBJECTIVE To investigate photodynamic therapy of experimental choroidal neovascularization using benzoporphyrin derivative monoacid (Verteporfin). METHODS Photodynamic therapy using benzoporphyrin derivative monoacid was investigated in cynomolgus monkeys. Following intravenous injection of benzoporphyrin derivative monoacid (1 to 2 mg/kg) complexed with low-density lipoprotein, the eyes were irradiated with 692-nm light at a fluence of 50 to 150 J/cm2 and irradiance of 150 to 600 mW/cm2. Choroidal neovascularization was documented before photodynamic therapy and closure was demonstrated by fundus photography, fluorescein angiography, and light and electron microscopic examination. RESULTS Following photodynamic therapy, vessels within choroidal neovascularization were occluded, and there was damage to the choroidal neovascularization endothelium and the subjacent choriocapillaris. Damage to the retinal pigment epithelium and photoreceptors was also observed. CONCLUSION Photodynamic therapy with lipoprotein-delivered benzoporphyrin derivative monoacid was effective in this animal model of choroidal neovascularization and may be a promising, potentially selective, therapy for choroidal neovascularization.