PHOTODYNAMIC THERAPY-INDUCED ACUTE EXUDATIVE MACULOPATHY Incidence, Clinical Features, and Long-Term Outcomes

摘要

Purpose: To describe the incidence, clinical features, and long-term outcomes of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) in patients who underwent PDT for various indications. Methods: This retrospective observational case series included all cases who developed massive serofibrinous macular exudation within a week after PDT. Medical records of patients with post-PDT exudative events were reviewed for relevant data and imaging abstraction including optical coherence tomography and indocyanine green angiography features and were subjected to analysis. Results: The incidence rate of PAEM was 4.52%, being noted in 8 eyes (out of 177 PDT sessions in 155 eyes) with a mean age of 70.25 +/- 6.65 years. Pre-PDT factors commonly associated with PAEM included age >= 65 years (87.5%), clinical diagnosis of polypoidal choroidal vasculopathy (75%), spot size >= 3,500 mu m (100%), best-corrected visual acuity of 20/40 or better (87.5%), low-fluence PDT (87.5%), and the first exposure to PDT (75%). Photodynamic therapy-induced acute exudative maculopathy was noted at a mean interval of 2.9 +/- 1.7 days (2-7 days) after PDT. Photodynamic therapy-induced acute exudative maculopathy resulted in significant decrease in mean best-corrected visual acuity from logMAR 0.29 +/- 0.21 (approximate Snellen equivalent 20/39) to logMAR 0.91 +/- 0.37 (approximate Snellen equivalent 20/163) [P = 0.0018], and significant increase in mean central macular thickness from 228.1 +/- 71.8 mu m to 481.4 +/- 154.8 mu m (P = 0.0029). Photodynamic therapy-induced acute exudative maculopathy resolved to baseline or even better tomographic status at a mean interval of 4.6 +/- 1.2 weeks, resulting in complete visual recovery compared with baseline. During mean follow-up of 77.8 +/- 46.4 weeks after PDT, no activity was noted for a mean duration of 26.3 +/- 42.5 weeks after resolution. At final visit, mean best-corrected visual acuity and central macular thickness was logMAR 0.49 +/- 0.28 (approximate Snellen equivalent 20/62) and 153.6 +/- 40.0 mu m, respectively, with underlying pathology being stable in 50% of the eyes. Conclusion: Photodynamic therapy-induced acute exudative maculopathy is an uncommon complication with self-resolving course and favorable prognosis. Patients undergoing PDT should be warned of the possibility of PAEM. The factors frequently associated with PAEM include elderly age (>65 years), clinical diagnosis of polypoidal choroidal vasculopathy, larger spot size (>= 3,500 mu m), pre-PDT best-corrected visual acuity of 20/40 or better, low-fluence PDT, and the first exposure to PDT.