Three-year results of a modified photodynamic therapy procedure (Ironing PDT) for age-related macular degeneration patients with large lesions

Figures & data

Figure 1 Schema of PDT.

Notes: (A) The PDT laser spot sometimes cannot cover a large lesion or a peripapillary lesion. (B) Using Ironing PDT, the PDT laser spot is moved at a constant speed, for 83 seconds, to cover the entire lesion. Double-headed arrows show the movement of laser spot.
Abbreviations: AMD, age-related macular degeneration; PDT, photodynamic therapy.

Table 1 Age-related macular degeneration patients treated with Ironing PDT

Case no	Age (years)	AMD type	CNV lesion	The reason for choosing PDT	BCVA before Ironing PDT	BCVA 36 months after Ironing PDT	Additional treatments in 36 months follow-up	Macular findings 36 months after Ironing PDT
1	75	PCV	Peripapillary	Cerebrovascular infarction	0.15	0.1	Ironing PDT ×3	Scarring
2	83	PCV	Peripapillary	Cerebrovascular infarction	0.08	0.05	None	Scarring
3	78	PCV	Large	Cerebrovascular infarction	0.04	0.05	PPV for vitreous hemorrhage	Scarring
4	75	tAMD	Peripapillary	Tachyphylaxis to IVB	0.05	0.1	None	Scarring
5	57	tAMD	Large	Refuse IVR	0.08	0.08	None	Scarring
6	77	tAMD	Large	Cardiovascular disease	0.2	0.08	None	Exudative
7	72	tAMD	Large	Nonresponder to IVR	0.6	0.15	Ironing PDT with IVR ×2	Scarring
8	74	PCV	Peripapillary	Tachyphylaxis to IVR	0.1	0.1	Ironing PDT with IVR	Exudative

Notes: There was no significant difference between the mean logMAR BCVA before treatment and the mean logMAR BCVA after treatment (P=0.809, paired t-test). The logMAR BCVA improved in one eye (12.5%), was maintained in five eyes (62.5%), and deteriorated in two eyes (25.0%).

Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; IVB, intravitreous bevacizumab; IVR, intravitreous ranibizumab; logMAR, logarithm of the minimum angle of resolution; PCV, polypoidal choroidal vasculopathy; PDT, photodynamic therapy; PPV, pars plana vitrectomy; tAMD, typical age-related macular degeneration.

Figure 2 The change in BCVA (evaluated in logMAR).

Note: The mean logMAR BCVA before treatment was 0.95, and after treatment was 1.09, with no significant difference.
Abbreviations: BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; PDT, photodynamic therapy.

Figure 3 Fundus photography, FA, ICGA, and OCT performed in patient 7.

Notes: (A) Baseline fundus examination shows large serous PED. (B) Late-phase FA shows typical findings of occult CNV and pooling, which demonstrates the presence of serous PED. (C) Baseline OCT shows the presence of type 1 CNV (arrowhead) and serous PED with SRD (white arrow). Inset shows the position of the scanned line (black arrow) of the OCT. (D) After five treatments of IVR, serous PED and SRD still existed, and CNV moved into the serous PED. (E) Late-phase FA shows strong leakage into the PED, indicative of fibrovascular PED. (F) OCT shows a hyper-reflective lesion under the RPE, with SRD (white arrows). Inset shows the position of the scanned line (black arrow) of the OCT.
Abbreviations: CNV, choroidal neovascularization; FA, fluorescein angiography; ICGA, indocyanine green angiography; IVR, intravitreal injections of ranibizumab; OCT, optical coherence tomography; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SRD, serous retinal detachment.

Figure 4 Ironing PDT performed in patient 7.

Notes: (A) Because the mean GLD was 9,980 μm, conventional PDT could not cover the entire lesion. (B) The laser spot was moved at a constant speed, for 83 seconds, to cover the entire lesion using a 7,200 μm laser spot (dashed line), after a 1,000 μm margin was added to the smaller diameter of the lesion. Double-headed arrow shows the movement of laser spot.
Abbreviations: GLD, greatest linear dimension; PDT, photodynamic therapy.

Figure 5 Fundus photography, FA and OCT 36 months after the first Ironing PDT performed in patient 7.

Notes: (A) Fundus examination shows CNV was scarred and exudation was resolved. (B) Late-phase FA shows hyperfluorescence of fibrosis. (C) OCT shows a hyperreflective lesion under the RPE (white arrow), but exudation was not observed. Inset shows the position of the scanned line (black arrow) of the OCT.
Abbreviations: CNV, choroidal neovascularization; FA, fluorescein angiography; OCT, optical coherence tomography; PDT, photodynamic therapy; RPE, retinal pigment epithelium.