Controversies in laser therapy in retinal disease

“Photodynamic therapy (PDT) is still crucial in selected cases of age-related macular degeneration (AMD),” Adrian Koh MD, FRCS, of Singapore, told delegates at the 15th EURETINA Congress in Nice.

Dr Koh and Paolo Lanzetta MD, of Udine, Italy, debated the merits of PDT treatment in patients with AMD during a session on controversies in laser therapy for retinal disease.

“PDT is especially crucial in selected cases of AMD, namely in polypoidal choroidal vasculopathy (PCV), since PDT is far more effective than anti-VEGF in polyp closure,” said Dr Koh. “Without PDT, these cases are likely to experience treatment failure, as 30 per cent of PCV cases are refractory to anti-VEGF monotherapy.”

Dr Koh added that these persistent polyps can lead to massive subretinal haemorrhage. He also addressed the current interest in the use of aflibercept for PCV. “Current evidence for aflibercept comes from small, non-comparative trials of short duration, but what happens to the polyps further down the line, for example a year later, is still unknown,” he concluded.

Presenting the other side of the case, Dr Lanzetta said that PDT represented a major advancement in the treatment of exudative AMD in the past, when macular laser was the only other option available. “However, today anti-VEGFs are the gold standard approach for the vast majority of AMD cases,” he said.

Dr Lanzetta is of the opinion that aflibercept alone may be a good option for the treatment of PCV, although he conceded that “PDT combined with ranibizumab may have a role in PCV management”.