OCTA Guided PDT Triple Therapy
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A 49-year-old male with pachychoroid syndrome and persistent CNV in his left eye was previously treated with 7 injections of Lucentis with no success. He was then treated with 4 combinations of half-fluence PDT, Lucentis, and Triescence which resolved the leakage completely. OCTA allowed for more precise localization of the CNV compared to previous ICG imaging, targeting the origin of the CNV and reducing potential damage from a larger PDT target. OCTA also showed superior denuded vessels and more active inferior vessels responsible for recurrent exudation. The combination therapy appears to have been an effective treatment for this patient's persistent CNV where anti-VEGF monotherapy previously failed
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- 1. OCTA-guided PDT Combination Therapy for Persistent CNV in Exudative ARMD 49 year old white male with pachychoroid syndrome (299 microns) left eye with pachyvessels. Had 7 Lucentis injections for occult membrane/arteriolarization with persistent leakage (primary anti- VEGF failure) subsequently treated with 4 x combination therapy (half-fluence PDT, Lucentis, Triescence) with complete resolution. Treatments have lasted about 10 months on the average. Previously, ICG was used to identify the choroidal neovascular origin. However, OCTA allows for more precise localization/targeting. The IVFA on the left shows the targeting of the neovascularization from a previous combination therapy. The ICG on the right shows a more specific target (outlined below) courtesy of the multimodaility imaging (IVFA/ICG/OCT/OCTA) used on the most recent treatment. OCT showed the pachyvessel (red arrow) approaching a break in Bruch’s membrane and RPE (yellow arrows) that corresponds to the origin of the enhanced CNV visible on the OCTA. Targeting the origin of the large CNV creates an opportunity to mitigate any damage done by a larger PDT target.
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