Photodynamic Therapy with Verteporfin in Occult Choroidal Neovascularization in Age-Related Macular Degeneration

Objective: We investigated retrospectively the clinical outcome of photodynamic therapy (PDT) with verteporfin (Visudyne(R)) in patients with exudative age-related macular degeneration (ARMD) and subfoveal occult choroidal neovascularization (OCN). Methods: 77 consecutive patients (90 eyes) with OCN were retrospectively analysed using a standardised protocol. It included best corrected visual acuity (BCVA) pre- and post-PDT, greatest linear dimension of OCN (GLD), ophthalmoscopic findings, optical coherence tomography (OCT), fundus photography and fluorescein angiography (FAG). The findings were descriptively analysed by Spearman rank correlation and cross-tabulation. Results: Age ranged from 52 to 92 years (median: 79 years). 7 (8%) of 90 PDT eyes gained >= 2 lines, 67 (74%) eyes stabilised with +/- 1 line. 17 eyes (18%) showed a deterioration with loss of >= 2 lines. BCVA of all cases was pre-PDT 0.33 (+/- 0.2), post-PDT 0.27 (+/- 0.2, p < 0.05), in the improvement group pre-PDT 0.4, post-PDT 0.7 in the stable cases pre-/post-PDT 0.3 and in the deterioration group pre-PDT 0.4 and post-PDT 0.2. GLD of all cases was pre-PDT 3.91 mm (minimum: 0.76 mm, maximum: 5.43 mm). From 86 eyes with OCT follow-up of at least 3 months 51 (60%) had dry macula after last PDT and 35 (40%) persistent macular edema (ME) in OCT. In 21 eyes (23%) with leakage of fluorescein after last PDT, treatment was terminated. 10 eyes (47%) had retinal angiomatous proliferation stage III, of these, 6 eyes presented with retinochoroidal anastomoses. 4 eyes (18%) showed after PDT retinochoroidal anastomoses, 2 (10%) vitreomacular traction in epiretinal membrane of the macula, 2 (10%) had a tear of the retinal pigment epithelium, 1 (5%) eye had a gain of GLD > 7200 mu m, in 1 eye (5%) BCVA was < 0.05 and in 1 eye (5%) treatment was stopped at request of the patient. Conclusions: According to our study PDT might be helpful in the treatment of OCN in ARMD patients for stabilisation but not for improvement of BCVA. Results from large multicentre studies show that concerning BCVA ranibizumab (Lucentis(R)) is superior to PDT in OCN. Further studies are required to investigate the outcome of combined therapy with PDT and VEGF inhibitors for reducing the number of treatments or the number of recurrences of choroidal neovascularisation.