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

Manayath, George Joseph, MS; Ranjan, Ratnesh, MS; Vidhate, Swapnil, MS; Narendran, Venkatapathy, DNB

doi: 10.1097/IAE.0000000000002343
Original Study: PDF Only

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 µm (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 µm to 481.4 ± 154.8 µm (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 µm, 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 µm), pre-PDT best-corrected visual acuity of 20/40 or better, low-fluence PDT, and the first exposure to PDT.

This is the largest study describing the uncommon phenomenon of photodynamic therapy–induced acute exudative maculopathy, which has a self-resolving course with favorable prognosis. Factors frequently associated with photodynamic therapy–induced acute exudative maculopathy include elderly age (>65 years), clinical diagnosis of polypoidal choroidal vasculopathy, larger spot size (≥3,500 µm), prephotodynamic therapy best-corrected Snellen visual acuity of 20/40 or better, low-fluence photodynamic therapy and the first exposure to photodynamic therapy.

Department of Vitreo-Retina, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India.

Reprint requests: Ratnesh Ranjan, MS, Department of Vitreo-Retina, Postgraduate Institute of Ophthalmology, Aravind Eye Hospital, Coimbatore, India 641014; e-mail: drratnesh16@gmail.com

Presented as a physical poster entitled “Subretinal Exudation After Photodynamic Therapy: A Retrospective Study” at the 11th Asia-Pacific Vitreo-Retina Society (APVRS) congress, Kuala Lumpur, Malaysia, December 8–10, 2017.

None of the authors has any financial/conflicting interests to disclose.

Details and images of one case from this study (Case 6 of Table 1) have been published previously as letter to editor in Canadian Journal of Ophthalmology. However, we have not used any previously published image in this article. The reference of above mentioned article is as follows: Ranjan R, Manayath GJ, Vidhate S. Exudative complications following photodynamic therapy. Can J Ophthalmol 2017;52:e625–e627.

© 2018 by Ophthalmic Communications Society, Inc.