Fotodynamisk behandling på Ögonkliniken Uddevalla sjukhus 2010-2018 – En utvärdering av behandlingseffekt

Abstract

Photodynamic therapy at the Department of Ophtalmology, Uddevalla hospital 2010-2018 – an evaluation of treatment effect. Degree project, Programme in Medicine Anna-Lena Olsson Supervisor: Madeleine Zetterberg, Professor, MD, Sahlgrenska University Hospital Co-supervisor: Jochen Bermig, MD, Uddevalla hospital Introduction: Photodynamic therapy (PDT) is a therapeutic technique in which a photosensitizing agent produces selective tissue damage when activated by light of a certain wavelength. In ophtalmic PDT the photosensitizing agent is Verteporfine which accumulates in abnormal neovascular endothelial cells through their increased expression of low-density lipoprotein receptors. The photochemical reaction produces selective vascular occlusion by thrombosis. Ophtalmic photodynamic therapy was initially developed to treat neovascular age-related macular disease (nAMD) with choroidal neovascularization (CNV). During the later 2000s it has been replaced by anti-vascular endothelial growth factor (anti-VEGF)-therapy. PDT is now used off-label for treating other chorioretinal disorders such as polypoidal choroidal vasculopathy (PCV), central serous chorioretinopathy (CSC) and choroidal hemangioma. Aim: The aim of this study was to evaluate the effect of PDT aministered at the Department of Ophtalmology at Uddevalla hospital during 2010-2018. Methods: This was a retrospective review of patients who were treated with PDT during 2010-2018. A total of 112 patients were identified, 107 of these patients were eligible in this study. Their medical records and optical coherence tomography (OCT) images were reviewed and baseline characteristics including visual acuity, central retinal thickness, preserved foveal contour and in some cases subretinal fluid was recorded as well as information from 3 month and 12 month follow-ups. Results: The 107 eligible patients were categorized into the following diagnostic groups: 87 patients (81 %) with PCV, 14 patients (13 %) with CSC, 3 patients (3 %) with hemangioma, 1 patient (1 %) with classic CNV, 1 patient (1 %) with CNV secondary to pathological myopia 1 patient (1 %) with retinal macroaneurysm. A correlation analysis between laser spot size and visual acuity for all 107 patients showed no correlation between the size of the treated area and logMAR. The PCV-group as a whole showed no difference between visual acuity initially and visual acuity at 12 month follow-up. A sub-group analysis revealed that preserved foveal contour before treatment was associated with significantly higher visual acuity at 3 months follow-up (logMAR 0,28 versus logMAR 0,50) and at12 months follow-up (logMAR 0,26 versus 0,40). The patients diagnosed with CSC had a higher visual acuity at 12 month follow-up (mean logMAR 0,21) compared to initially (mean logMAR 0,35). At 12 months follow-up 80 % showed a complete resolution of subretinal fluid. The amount of severe adverse effects such as subretinal bleeding was low, 5,6 %. Conclusions: PDT was mostly used to treat off-label diagnosis such as PCV and CSC. Patients diagnosed with CSC showed a better visual acuity at 12 month follow-up compared to patients diagnosed with PCV. Treatment of large lesions was not correlated with a worse outcome in visual acuity. Serious adverse effects were low compared to literature.