The role of oral steroids in the treatment of photodynamic therapy-associated exudative maculopathy, a case report and review of the literature.

Abstract

BACKGROUND:

Photodynamic therapy (PDT) is an effective treatment of pachychoroid spectrum disease. PDT can cause a rare complication known as PDT-associated exudative maculopathy (PAEM). Treatments including intravitreal anti-vascular endothelial growth factor (anti-VEGF) medications, local or systemic steroids, and observation have been attempted with variable success to address this complication.

METHODS:

A thorough literature review was performed using the PubMed database on search terms aimed at treatments of PAEM. These cases were compared with each other and a novel case of PAEM in polypoidal choroidal vasculopathy (PCV) treated with oral prednisone by the authors.

RESULTS:

Fifteen patients were compared; 11 were treated with anti-VEGF alone or in combination with intravitreal steroid and/or vitrectomy, one was treated with topical steroid, one was observed, one was treated with intravenous methylprednisolone, and one was treated with oral prednisone. The two cases treated with systemic steroids were given adjunctive sub-tenon's triamcinolone acetonide (STTA) after a favorable response was observed. Most cases had anatomic resolution of serous retinal detachment with stability of vision between 16 days and 2 months, with the most rapid resolution occurring in a patient with PCV treated with oral prednisone and STTA.

CONCLUSIONS:

Reported treatment of PAEM includes intravitreal anti-VEGF agents with or without local or systemic steroids. Oral steroids may be advantageous in cases where there is concern regarding the risk profile of periocular steroids, intravitreal steroids or anti-VEGF agents. However, data describing the various treatments of this rare complication is limited, precluding firm conclusions regarding relative safety and efficacy.

• Authors: Andrew J Sumnicht, Kakarla V Chalam, Adel E Alset, David I Sierpina
• Journal: Photodiagnosis and photodynamic therapy (Photodiagnosis Photodyn Ther) Vol. 35 Pg. 102390 (Sep 2021) ISSN: 1873-1597 [Electronic] Netherlands
• PMID: 34119709 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Angiogenesis Inhibitors
• Photosensitizing Agents
• Steroids
• Vascular Endothelial Growth Factor A

Topics

• Angiogenesis Inhibitors (therapeutic use)
• Fluorescein Angiography
• Humans
• Intravitreal Injections
• Macular Degeneration (drug therapy)
• Photochemotherapy (methods)
• Photosensitizing Agents (adverse effects)
• Retrospective Studies
• Steroids (therapeutic use)
• Tomography, Optical Coherence
• Vascular Endothelial Growth Factor A