Photodynamic Therapy of Subfoveal Choroidal Neovascularization With Verteporfin

Abstract

PHOTODYNAMIC THERAPY with verteporfin (Visudyne; Novartis Ophthalmics AG, Basel, Switzerland) has been shown to reduce the risk of moderate and severe vision loss in selected patients with subfoveal choroidal neovascularization(CNV) due to age-related macular degeneration (AMD)^1-3 and increase the chance of stable or improved visual acuity in patients with subfoveal CNV due to pathologic myopia.⁴ Analyses showed that the magnitude of the treatment effect varied according to the baseline composition and size of the choroidal neovascular lesion in patients with AMD.⁵ A variety of vision outcomes supported the recommendation that this therapy be considered specifically for the following groups⁶: (1) AMD patients with predominantly classic lesions (in which the area of classic CNV occupies at least 50% of the area of the entire lesion); (2) AMD patients with occult with no classic subfoveal CNV, particularly, but not exclusively, in the presence of either a smaller lesion size or lower levels of visual acuity; or (3) patients with subfoveal CNV due to pathologic myopia or other causes in which the natural history was judged to be similar to lesions due to AMD or pathologic myopia. In contrast, no beneficial effect of verteporfin therapy on reducing the risk of moderate or severe visual acuity loss at 12 or 24 months was noted in AMD patients with minimally classic CNV (in which the area of classic CNV occupied>0% but 7