Purpose:

To evaluate the effect of photodynamic therapy (PDT) with verteporfin on the barrier function of retinal pigment epithelium (RPE) in age related macular degeneration (AMD) patients.

Method:

This study is retrospective and interventional case series. Twenty-eight eyes of 25 AMD patients with subfoveal or juxtafoveal lesion received PDT between June 2007 and September 2012. In 28 eyes of the study, 13 eyes were choroidal neovascularization, 13 eyes were polypoidal choroidal vasculopathy and 2 eyes were retinal angiomatous proliferation. Serial evaluation with OCT was done within 1 week before treatment, at 1 day, 1 week and 1 month after treatment. Nine eyes received PDT as a monotherapy and 19 eyes received combination therapy (Intravitreal anti-vascular endothelial growth factor [VEGF] or dexamethasone at same day). Main outcome measures were central foveal thickness (CFT) and logMAR best corrected visual acuity (BCVA).

Result:

CFT significantly increased at 1 day after PDT (p=0.005), and then decreased spontaneously to the level before PDT at 1 week after treatment (CFT before PDT: 263um, 1day: 354um, 1week: 264um, 1month: 234um). LogMAR BCVA also significantly decreased at 1 day after PDT (p=0.001), and then improved to the level before PDT at 1 month after treatment (logMAR BCVA before PDT: 0.59, 1day: 0.75, 1week: 0.75, 1month: 0.63). The pattern of CFT and logMAR BCVA change was similar in different lesion type or treatment method (p=0.249, p=940).

Conclusion:

Our study clearly demonstrates a significant and transient subretinal fluid (SRF) accumulation after PDT in AMD patients, and this observation is not affected by lesion type. Combination therapy with anti-inflammatory and/or anti-VEGF agents also could not prevent SRF accumulation after PDT. PDT may enhance the transient breakdown of the BRB and result in a serious retinal detachment of macula. For reducing the risk of SRF accumulation after PDT, individualized treatment protocols according to age, degree of RPE atrophy and previous PDT treatment history are necessary.