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Retina Visudyne helpful for rubeosis iridis

Stefanie Petrou Binder MD the treatment parameters for PDT with no significant changes in the pre- and post- the time gap until retinal laser treatment in Heidelberg verteporfin in this patient group. She PDT data, including visual acuity, itself leads to regression, she said. treated nine patients with Visudyne who (12-28mmHg), PHOTODYNAMIC therapy (PDT) with had rubeosis iridis due to proliferative posterior chamber flare (~35 pc/s) and Standard therapies frequently the photosensitizer verteporfin (Visudyne, diabetic vitreo- (PDVR), central /stroma structure. Dr Müller explained ineffective QLT/Novartis) can successfully treat both retinal vein occlusion (CRVO) or carotid that although vision was not improved by rubeosis iridis and neovascular , Dr Müller noted that current therapies for artery stenosis. this treatment, the point of therapy was to but the effects are short lived, reported proliferative with rubeosis All patients received panretinal laser prevent and eventually treat NVG. Valeska Müller MD, Berlin Day iridis included panretinal laser treatment of at least 1,500 spots at least Hospital in Berlin, Germany at the 20th photocoagulation, cyclocryotherapy and six weeks before PDT, and still presented Repeat treatments necessary Congress of the DGII (Deutschsprachige pars plana vitrectomy.With these with rubeosis.Two of the patients had Gesellschaft für Intraokularlinsen Mike Holzer MD, Heidelberg University methods, a regression from rubeosis can neovascular glaucoma (NVG) at baseline. Implantation und refraktive Chirurgie). Eye Clinic, Heidelberg, Germany, used PDT be observed in a maximum of 60%-80% of She noted that Visudyne therapy was “Rubeosis iridis is treatable with PDT in against corneal neovascularisation in an patients, after a therapeutic window of effective in patients who did not benefit combination with verteporfin, causing experimental study he conducted in 2003. four to six weeks, she explained.This from panretinal laser photocoagulation. vascular occlusion without damaging any He commented that although PDT can be means that there are approximately 20% The treatment involved subdividing the physiologic tissues.The occlusion of used for neovascular glaucoma and corneal of patients who are classified as “non- iris into four quadrants and treating two neovascular vessels is directly dependent neovascularisation, his own experience responders” to panretinal opposing quadrants in one single sitting, on the dose of light applied. Unfortunately, with this treatment modality showed that photocoagulation and for whom with two different energy levels per patient however, the duration of the therapeutic it had to be repeated once there was alternative solutions are required. group. She divided the patients into three effect following treatment is limited.This vascular regrowth and that the treatment She said that neovascular glaucoma was separate groups according to the energy technique is plausible in patients with was only helpful in certain phases of a much-feared complication in ischemic level to be applied.The other two iris neovascular glaucoma or in those patients neovascularisation. retinopathy, frequently leading to blindness quadrants represented intra-individual with rubeosis iridis who must undergo As long as there is a stimulus for or enucleation.To date, there is no controls that received only drug treatment. surgery,” she said. vascular regrowth, neovascularisation will satisfactory therapy concerning this Following the application of verteporfin, Dr Müller discussed the results of a new recur.The therapy can be effective for days serious condition, she emphasised. Dr Müller administered laser at single-centre, prospective, open-label, or weeks, but unfortunately will need to The main causative factors of 600mW/cm2 for 15 minutes following the phase II, intra-individual, controlled, pilot, be repeated, he said. neovascular glaucoma are the ischemic start of infusion.The applied energy doses dose-finding study designed to establish Dr Holzer confirmed Dr Müller’s type of central retinal vein occlusion in varied between observation that PDT was not damaging which 40% of patients develop neovascular 2 15 J/cm and 100 to the surrounding tissues, i.e. the glaucoma, proliferative diabetic 2 J/cm at a fluence and iris in his studies, and that the therapy vitreoretinopathy in which 32%-64% of rate of 600mW. was a good option for the temporary patients develop neovascular glaucoma and INTERNATIONAL Dr Müller occlusion of any kind of carotid stenosis in which 12% of cases recorded data at neovascularisation. develop neovascular glaucoma. REFRACTIVE MEETING baseline and at According to Dr Müller, the results of Dr Müller explained that once injected, one, four and 12 Visudyne therapy for rubeosis iridis were verteporfin builds a complex with the OCTOBER 26, 2006 weeks following very promising. PDT could be a useful LDLs of the vessel walls.The dye MATER MISERICORDIAE HOSPITAL DUBLIN therapy. She adjuvant instrument for eye surgeons to accumulates in this fashion on the defined the stop the progression of rubeosis iridis as endothelium of neovascular tissues. primary effects well as to avoid the onset of neovascular Verteporfin can then be activated through 3rd Dermot Pierse Memorial lecture of treatment as glaucoma, she said. She cautioned, laser light (689nm) thus producing free Presented by the changes in however, that the fourth- and twelfth-week radicals.These free radicals cause damage Professor Terence O’Brien the hyperfluor- controls demonstrated a temporary to the vascular endothelium and escence seen in Bascom Palmer Eye Institute, Miami, Florida, USA duration of treatment and that subsequently occlude neovascularisations. iris angiography, recanalisation and re-treatment were Dr Müller emphasised that neighbouring – and – as compared to inevitable. tissues remained unharmed through this the data She noted that since neovascularisation process. 3rd Tom Casey Memorial lecture recorded at starts at the pupillary margin in Dr Müller confirmed a complete Presented by baseline. approximately 95% of cases and reaches regression of rubeosis after approximately Professor Edward J. Holland She observed a toward the chamber angle, her goal was to 15 weeks post PDT in two of the study significant Cincinatti Eye Institute & University of Cincinatti, Ohio, USA occlude those vessels in order to prevent patients. She noted that in light of the hyperfluor- further progression. Furthermore, she latest results in anti-VEGF therapy studies, Topics escence after observed that since the laser has a certain combination treatment with PDT and anti- Infection - Phakic Intraocular Lenses - Hysteresis PDT therapy in tissue penetration depth at the VEGF drugs could certainly be very useful Retinal Changes after Laser - six patients who wavelengths employed, this method could in these cases. were radiated Corneal Grafting - Grand Round prove effective in directly radiating areas As patients only received treatment with 75 J/cm2, Importance of Aberrometry - Contrast Sensitivity of neovascularisation around the chamber within the framework of the investigation, and in three angle (without a gonioscope) in cases of Dr Müller was not able to comment on Registration Fees: 100 patients who open angle glaucoma causing occlusion and retreatments in this study group. were radiated regression. 2 with 100 J/cm ,as She said that CRVO cases require [email protected] Further Details from: shown by the iris several weeks following panretinal laser [email protected] Helen Murphy, Secretary to: Prof. Michael O’Keeffe angiographic data treatment for regression to occur. During Suite 5, Mater Private Hospital, Eccles St., Dublin 7, Ireland taken at one and this critical time period, vessel growth Tel: (00 353 1) 885 8626, Fax: (00 353 1) 8858490 four weeks. Email: [email protected] stimulus from the can lead to NVG Other study in some cases. Occluding these vessels criteria showed straight away in these patients might fill