Author: Guillermo Pérez Rivasés (Spain)
Co-authors: Olivia Esteban Floría, Ana Honrubia Grijalbo, Ana Boned Murillo, Ismael Bakkali El Bakkali, Javier Ascaso Puyuelo, Isabel Pinilla Lozano
To analyze the response after one month of photodynamic therapy (PDT) in patients with pachychoroidal diseases using Macular Integrity Assessment Microperimetry (MAIA) and swept-source optical coherence tomography (SS-OCT).
Pachychoroid disease is characterized by retinal pigment epithelium dysfunction and neovascularization associated with pachyvessels and attenuation of choriocapillaris. Thus, pathologies with these pachychoroidal characteristics have been included in the so-called pachychoroid spectrum diseases. New therapeutic strategies have appeared in conjunction with improved diagnostics and imaging techniques. PDT was gradually introduced for the treatment of the pachychoroidal diseases, and it is used as the first choice in some of them. The results and possible adverse effects are not yet well defined in these spectrum of diseases.
Prospective study during one month of 11 patients with pachychoroidal diseases treated with half-fluece (25 J / cm2) and full-dose (6 mg / m2) PDT for the standard duration of treatment (83 seconds) after fluorescein angiography (FA) and indocyanine green angiography (ICG) . 22 eyes (11 cases and 11 controls) were evaluated before and one month after PDT with SS-OCT, measuring retinal thickness (ILM-RPE) and the choroid thickness (RPE-choroidal outer layer) in addition to the retinal sensitivity, measured by MAIA and best corrected visual acuity (BCVA). Furthermore, the correlation of both parameters was analysed.
Pachychoroid spectrum was diagnosed by FA and ICG (four central serous chorioretinopathy (n=4), four pachychoroid pigment epitheliopathy (n=4), one pachychoroid neovasculopathy (n=1) and two polypoidal choroidal vasculopathy (n=2). Before PDT, cases showed a lower retinal sensitivity in all 14 regions analyzed by MAIA compared to the control group (p <0.05), as well as one month after treatment (except superoexternal area). Regarding macular and choroidal thickness, no significant changes were observed between both groups. Cases showed an improvement in BCVA one month after PDT (p <0.05). Likewise, they showed an increase in retinal sensitivity in the foveal region C (p <0.05) and in the rest of the sectors (p> 0.05) after PDT. A decrease in retinal and choroid thickness were found by SS-OCT (p> 0.05). When correlating the upper, nasal, lower and temporal internal quadrants of the retinal and choroidal parafoveal ring, using SS-OCT and the thresholds of the 3 and 5 degree radii (MAIA), a medium-high negative correlation was observed (p> 0.05) in the retinal quadrants besides a mean negative correlation (p> 0.05) in the choroidal quadrants after PDT.
Functional changes were observed at one month of PDT. They showed an early increase in retinal sensitivity at the foveal level after one month of PDT in patients with pachychoroid diseases, as well as an improvement in BCVA. Studies with a larger number of patients are needed in order to confirm our results.