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Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

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Photodynamic Therapy

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Abstract

Photodynamic therapy (PDT) with Visudyne® was the first successful therapy for wet age-related macular degeneration (AMD). Clinical tests of PDT for wet AMD surprisingly showed a significantly better outcome for patients from Japan, Singapore, and China as compared to the results obtained on Caucasian patients. These differences pointed to the fact that patients with polypoidal choroidal vasculopathy (PCV), which is encountered more frequently in people with darker skin, had inadvertently been included among the AMD patients. As these two diseases are difficult to distinguish with the fluorescein angiography used in these trials, the switch to indocyanine green angiography (ICGA) then permitted the more specific and detailed study of PCV with Visudyne® therapy. The results of PCV treated with PDT turned out to be very good indeed, even though on the time scale of 1 year or more retreatment was needed in some patients. Anti-VEGF therapy by itself, however, did not show anywhere near the same benefit for treating PCV as was the case for the treatment of wet AMD. Recently, triple therapy with Visudyne®-PDT combined with anti-VEGF therapy and a steroid was found to give the best results for the visual acuity of patients with PCV. This chapter summarizes the data on PDT of PCV, and the effect of different combination therapies. Some of the pathological and genetic similarities and differences between PCV and wet AMD are also discussed.

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Abbreviations

AMD:

Age-related macular degeneration

AREDS:

Age-related eye disease study

BCVA:

Best-corrected visual acuity

BPDMA:

Benzoporphyrin derivative monoacid ring A

CNV:

Choroidal neovascularization

ELN:

Elastin gene

ETDRS:

Early treatment diabetic retinopathy study

ICGA:

Indocyanine green angiography

IVTA:

Intra-vitreal triamcinolone acetonide

OCT:

Optical coherence tomography

PCV:

Polypoidal choroidal vasculopathy

PED:

Pigment epithelial detachment

pO2 :

Partial pressure of oxygen

RPED:

Retinal pigmented epithelium detachement

TTA:

Triamcinolone acetonide

VDA:

Vascular disrupting agent

VEGF-A:

Vascular endothelial growth factor A

V-PDT:

Visudyne®-photodynamic therapy

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Acknowledgments

The authors are grateful for financial support from Dr. J. Jacobi (to PNS).

Conflict of Interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Chemistry, Ecole Polytechnique Fédérale De Lausanne, Lausanne, Switzerland

    Patrycja Nowak-Sliwinska, Michel Sickenberg & Hubert van den Bergh

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  1. Patrycja Nowak-Sliwinska
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  2. Michel Sickenberg
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Correspondence to Hubert van den Bergh .

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  1. German University of Cairo, New Cairo City, Egypt

    Mahmoud H. Abdel-Kader

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Nowak-Sliwinska, P., Sickenberg, M., van den Bergh, H. (2014). Photodynamic Therapy for Polypoidal Choroidal Vasculopathy. In: Abdel-Kader, M. (eds) Photodynamic Therapy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39629-8_10

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