Combined use of radiotherapy and photodynamic therapy (pdt) for subfoveal choroidal neovascular membranes reduces the need for repeat treatments with Pdt: Results from a pilot study

Amoaku, W.M., Browning, A.C., Hossain, Parwez, Bhan, A and Sokal, M. (2002) Combined use of radiotherapy and photodynamic therapy (pdt) for subfoveal choroidal neovascular membranes reduces the need for repeat treatments with Pdt: Results from a pilot study. Investigative Ophthalmology & Visual Science, 43 (13).

Abstract

Purpose: To determine whether teletherapy followed by one or more doses of PDT using verteporfin has any vision threatening effects on the macular and to determine whether the PDT retreatment rate in the first year is less than expected. Methods: Nine eyes of eight patients underwent teletherapy (20Gy) for subfoveal choroidal neovascular membranes followed by PDT for sub-foveal recurrences. A control group of 20 patients received PDT only. All patients were followed-up at 3 month intervals and patients with recurrences received PDT if they were predominantly classic in nature. At each visit the Log Mar and EDTRS vision was recorded and a fluorescein angiogram was performed. Results: The time between radiotherapy and the first session of PDT was a mean of 14 months (range 4-24 months). Nine eyes of eight patients were followed up for 1 year after PDT. In the combined radiotherapy with PDT group, the mean visual acuity (VA) prior to PDT was 0.83 (0.36-1.36), at 3 months post treatment VA was 0.80 (0.34-1.36), at 6 months post treatment it was 1.0 (0.24-2.0), at 9 months post treatment it was 0.86 (0.28-1.3) and at 12 months, VA was 0.99 (0.4-2.0). There was no statistically significant difference in VA at base line compared with any of the other time point. No eye suffered a significant drop in VA immediately after PDT. In the control group the mean visual acuity was 0.61 (0.18 -1.66) prior to treatment, at 3 months 0.83 (0.32 - 1.66) at 6 months 0.82 (0.34 - 1.66), at 9 months 0.71 (0.34 - 1.66) and at 12 months 0.76 (0.36 - 1.8). At the 9 months time point, there had been an average 2.3 PDT treatment sessions per eye in the combined teletherapy and PDT group, whereas there had been an average of 3.3 treatment session per eye in PDT only group. This difference in the mean number of treatment sessions was found to be statistically significant (p <0.01, t-test). Conclusion: PDT appears to be a safe treatment when utilised after teletherapy for recurrences of predominantly classic choroidal neovascular membranes. The results from this series strongly suggest that combined radiotherapy and PDT leads to a reduction in the number of treatment sessions for PDT and indicates that clinicians should investigate further the benefits of combined radiotherapy and PDT for patients with subfoveal choroidal neovascular membranes.

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Contributors

Author: Parwez Hossain

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