Photodynamic Therapy (PDT) Therapeutic procedure Utilizes the photosensitive intravenous drug, verteporfin (Visudyne) With a low power, long duration infrared laser In ophthalmology it is used to treat Neovascular age related macular degeneration (AMD) Polypoidal choroidal vasculopathy (PCV) Haemangioma Central serus retinopathy(CSR)

1. Photodynamic Therapy (PDT)
A Case Series
RS Walpitagamage1, NP Costa1, , DMMAK Dissanayake2,
KH Wickramasinghe3, DHH Wariyapola4
1Post Graduate Trainee in Ophthalmology,2Registrar in Ophthalmology,
3Senior Registrar in Ophthalmology,4Consultant Ophthalmologist,
Sri Jayewardenepura General Hospital, Kotte.

2. Introduction
• Photodynamic Therapy (PDT)
– Therapeutic procedure
– Utilizes the photosensitive intravenous drug,
verteporfin (Visudyne)
– With a low power, long duration infrared laser
• In ophthalmology it is used to treat
– Neovascular age related macular degeneration (AMD)
– Polypoidal choroidal vasculopathy (PCV)
– Haemangioma
– Central serus retinopathy(CSR)

3. Introduction
• Photodynamic Therapy (PDT)
– lead to the closure of choroidal neovascular and
other active proliferating vessels
– leaving normal retinal tissue unharmed
• Used to treat sub foveal pathologies

4. Objective
• The objective is to present series of patients
who has undergone PDT

5. Method
• Period from March 2016 to April 2017
• Number PDTs done at SJGH- 14
• Pre and post PDT(one month)
– Visual acuity - Snellen’s
– Central Macular thickness using Optical Coherence
Tomography (OCT)

6. Results
• One month after PDT
– Average reduction of macular thickness - 36.6%
– Stable VA -64% (9/14)
– One line improvement of VA -28%(4/14)
– VA and macular oedema worsen in one patient
• 93%(13/14) patients responded to PDT
• One patient did not respond to PDT

7. Case 1
• A 64 years old female
• OD VA - 6/24
• Found to have wet AMD with CNV

8. Pachychoroid
Features of VMT with
cystic appearance
Optical Coherence Tomography (OCT)

9. Intravitreal Bevacizumab
2nd Dose on 21/01/2017
1st Dose on 10/12/2016
3rd Dose on 10/03/2017
No response after 3 doses
And after 3 months

10. ICGA done on 12/04/2017
Polyps

11. • After 1 month of PDT
• 44.2% reduction of
central macular
thickness
• One line improvement
of VA- 6/18
PDT done on 19/04/2017
Followed by
IV Bevacizumab
Before PDT After 1 month of PDT

12. After 3 doses of Bevacizumab and 3 months of PDT
Before PDT
No SRF, small amount of intra retinal fluid

13. Case2
• 66 years old female
• OS wet AMD with CNV - 8 doses of IV Bevacizumab
• Patient defaulted for 8 months, presented with reduction of
vision
• VA- 6/36

14. Double hump appearance
Multiple PED suggestive of PCV
SRF

15. ICGA done on 9/11/2016
Polyps
Abnormal
vascular
network

16. PDT done on 16/11/2016
Followed by
IV Bevacizumab
• After 1 month of PDT
• 44.6% reduction of
central macular
thickness
• One line improvement
of VA- 6/24
Before PDT After 1 month of PDT

17. After 3 doses of Bevacizumab and 3 months of PDT
Before PDT
No SRF, PED has gone off

18. Case 3
• 56 years old female
• OS wet AMD with CNV
• Treated with 10 doses of IV Bevacizumab
• VA- 6/18
Multiple
Hemorrhagic PEDs

19. Double hump appearance
Multiple PED suggestive of PCV
SRF

20. ICGA done
Hemorrhagic PED
Polyps

21. PDT done on 16/03/2016
Followed by
IV Bevacizumab
• After 1 month of PDT
• 22.7% reduction of
central macular
thickness
• One line improvement
of VA 6/12
Before PDT After 1 month of PDT

22. Before PDT After PDT, 4 doses of Bevacizumab given
Now one year without Anti VEGF

23. Conclusion
• PDT is effective in treating PCV when
Bevacizumab has failed
• Always review the diagnosis when anti VEGF
does not give the expected results
• Arrange ICG to confirm PCV and offer PDT
for that patient