Ophthalmic PDT Indications and References

CNV due to Neovascular Age-related Macular Degeneration

  • Patients for whom anti-VEGF therapy cannot be performed such as hypersensitivity/reaction to anti-VEGF agents, acute inflamed or infected eye or increased ocular pressure [1-2]
  • Patients with subfoveal refractory AMD (poor or no response to anti-VEGF monotherapy (up to 25% of patients) [3-8]
  • Subfoveal CNV patients who cannot extend, refuse ocular injections or wish to reduce injection burden [9-19]
  • Patients who have had a stroke in the last 90 days [20]

Polypoidal Choroidal Vasculopathy**

  • All PCV patients should ideally be treated with PDT + anti-VEGF combination therapy (both increased efficacy and decreased injection burden), as shown in EVEREST studies) [21-22]

Central Serous Retinopathy**

  • PDT is gold standard for chronic or persistent CSR [23-25]
  • Specific acute cases [27-29]

Ocular Oncology**

  • Choroidal hemangioma patients who require treatment, PDT is gold standard [23,26]
  • Retinal capillary hemangioma or retinal vasoproliferative tumors with macular location [30]
  • Small non-pigmented choroidal melanomas or palliative treatment of choroidal metastases [30-31]

** Non-FDA approved

References

1. Intravitreal Injections, Kamjoo, S., et al. (n.d.), AAO EyeWiki https://eyewiki.aao.org/Intravitreal_Injections

2. Intravitreal Injection for Wet (Exudative) Age-Related Macular Degeneration (AMD), Tsui Jonathan C., et al. (n.d.), Medscape https://emedicine.medscape.com/article/1844351-overview

3. Combined Therapies to Treat CNV in AMD: PDT + Anti-VEGF, Mataix, J., et al. (2012), Age Related Macular Degeneration – The Recent Advances in Basic Research and Clinical Care https://www.intechopen.com/chapters/26336  

4. Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD, Ehlken, C., et al. (2014), Eye, May;28(5) https://pubmed.ncbi.nlm.nih.gov/24722504/

5. Resistance to anti-VEGF therapy in neovascular age-related macular degeneration: a comprehensive review, Yang, S., et al. (2016), Drug Design, Development and Therapy, Jun 2(10). https://pubmed.ncbi.nlm.nih.gov/27330279/

6. Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options, Wallsh, J. O., et al. (2021), Cells, Apr 29;10(5):1049. https://pubmed.ncbi.nlm.nih.gov/33946803/

7. Combination Therapy for Neovascular Age-related Macular Degeneration Refractory to Anti-Vascular Endothelial Growth Factor Agents, Tozer, K., et al (2013), Ophthalmology 120(10). https://www.aaojournal.org/article/S0161-6420(13)00240-6/fulltext 

8. Resistance to anti-VEGF therapy in neovascular age-related macular degeneration: a comprehensive review, Yang, S., et al. (2016), Drug Design, Development and Therapy, Jun 10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898027/

9. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results, Antoszyk, A. N., et al. (2008), American Journal of Ophthalmology May 145(5). https://pubmed.ncbi.nlm.nih.gov/18321465/

10. Verteporfin photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration, Kaiser, P. K., et al. (2009), Ophthalmology Apr 116(4). https://pubmed.ncbi.nlm.nih.gov/19243834/

11. Combination therapy in exudative age-related macular degeneration: visual outcomes following combined treatment with photodynamic therapy and intravitreal bevacizumab, Wan, M. J., et al. (2010), Canadian Journal of Ophthalmology, Aug 45(4). https://pubmed.ncbi.nlm.nih.gov/20648087/

12. Combined ranibizumab and photodynamic therapy to treat exudative age-related macular degeneration: an option for improving treatment efficiency, Mataix, J., et al. (2010), Retina Sep 30(8). https://pubmed.ncbi.nlm.nih.gov/20539256/

13. One-year follow-up of combined customized therapy. Photodynamic therapy and bevacizumab for exudative age-related macular degeneration, Navea, A., et al. (2009), Retina Jan 29(1). https://pubmed.ncbi.nlm.nih.gov/18854782/

14. Intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy for choroidal neovascularization in age-related macular degeneration, Smith, B. T., et al. (2008), Retina May 28(5). https://pubmed.ncbi.nlm.nih.gov/18463509/

15. Combined treatment modalities for age related macular degeneration, Das, R. A., et al. (2011), Current Drug Targets Feb 12(2). https://pubmed.ncbi.nlm.nih.gov/20887244/

16. Intravitreal ranibizumab and bevacizumab in combination with full-fluence verteporfin therapy and dexamethasone for exudative age-related macular degeneration, Forte, R., et al. (2011), Ophthalmic Research 45(3). https://pubmed.ncbi.nlm.nih.gov/20847575/

17. Low fluence rate photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration, Costagliola, C., et al. (2010), The British Journal of Ophthalmology Feb 94(2). https://pubmed.ncbi.nlm.nih.gov/19965822/

18. A retrospective analysis of triple combination therapy with intravitreal bevacizumab, posterior sub-tenon’s triamcinolone acetonide, and low-fluence verteporfin photodynamic therapy in patients with neovascular age-related macular degeneration, Kovacs, K. D., et al. (2011), Retina Mar 31(3). https://pubmed.ncbi.nlm.nih.gov/21336068/

19. Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy: the TORPEDO trial at 2 years, Spielberg, L., Leys, A. (2010), Graefes Arch Clin Exp Ophthalmol. Jul 248(7). https://pubmed.ncbi.nlm.nih.gov/20204659/

20. Evaluating photodynamic therapy as an adjuvant treatment for neovascular AMD: A comprehensive meta-analysis, Sarvepalli, S. M., et al. (2025), Asia-Pacific Journal of Ophthalmology 14(2) https://www.sciencedirect.com/science/article/pii/S2162098925000404

21. Using Photodynamic Therapy in 2019:  Current Concepts for Real-World Use, Singh, R. P., et al. (2019), Retina Today suppl. May/June. https://assets.bmctoday.net/retinatoday/pdfs/0619_supp2.pdf

22. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy, Koh, A., et al. (2012), Retina Sep 32(8). https://pubmed.ncbi.nlm.nih.gov/22426346/

23. Comparison of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: The EVEREST II Randomized Clinical Trial, Lim, T. H., et al. (2020), JAMA Ophthalmology Sep 138(9). https://pubmed.ncbi.nlm.nih.gov/32672800/

24. Clinical impact of the worldwide shortage of verteporfin (Visudyne®) on ophthalmic care, Sirks M. J., et al. (2022), Acta Ophthalmologica 100(7). https://onlinelibrary.wiley.com/doi/full/10.1111/aos.15148

25. US FDA grants orphan drug status to QLT’s Visudyne for treatment of central serous chorioretinopathy, (2012) Pharmabiz.com. http://test.pharmabiz.com/news/us-fda-grants-orphan-drug-status-to-qlt-s-visudyne-for-treatment-of-central-serous-chorioretinopathy-68111

26. When to Treat and Not to Treat Patients With Central Serous Retinopathy, Boscia, F. (2010), Retina Today Apr. https://retinatoday.com/articles/2010-apr/when-to-treat-and-not-to-treat-patients-with-central-serous-retinopathy

27. Circumscribed Choroidal Hemangioma: Visual Outcome in the Pre-Photodynamic Therapy Era versus Photodynamic Therapy Era in 458 Cases, Shields, C. L., et al. (2020), Ophthalmol Retina, Jan 4(1). https://pubmed.ncbi.nlm.nih.gov/31611094/

28. Central Serous Chorioretinopathy: Pathogenesis and Management, Semearo, F., et al. (2019), Clinical Ophthalmology 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897067/

29. Interventions for central serous chorioretinopathy: a network meta‐analysis, Salehi, M., et al. (2015), Cochrane Database Syst Rev 2015(12).  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030073/

30. An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study, Romano, M. R., et al. (2019), Acta Ophthalmologica 98(5). https://onlinelibrary.wiley.com/doi/full/10.1111/aos.14319

31. The Role of Photodynamic Therapy in Non-malignant and Malignant Eye Disorders, Nowak-Sliwinska, P., et al. (2013), Journal of Analytical & Bioanalytical Techniques, S1:007.  https://www.researchgate.net/publication/269541980_The_Role_of_Photodynamic_Therapy_in_Non-malignant_and_Malignant_Eye_Disorders

32. Primary photodynamic therapy for small amelanotic choroidal melanomas: consecutive case series of 69 patients with at least 24-month follow-up, Quhill, H., et al. (2021), British Journal of Ophthalmology Jun 105(6). https://pubmed.ncbi.nlm.nih.gov/32675064/

Related Links

Age-related Macular Degeneration (AMD)
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Modulight ML6710i
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