Photodynamic therapy with verteporfin for subfoveal idiopathic choroidal neovascularization - One-year results from a prospective case series

Objective: To study the safety and efficacy of photodynamic therapy (PDT) with verteporfin in treating subfoveal choroidal neovascularization (CNV) of idiopathic cause. Design: A prospective, noncomparative, consecutive, open-label, two-center, interventional case series. Participants: Patients aged 50 years or younger with the diagnosis of idiopathic CNV by exclusion of other related causes together with the CNV extending under the geometric center of the foveal avascular zone. Methods: Seventeen eyes from 17 patients received PDT with verteporfin according to a standardized protocol. Retreatment was considered if fluorescein leakage from the CNV was shown in fluorescein angiography at every 3-month follow-up. The visual, clinical, and angiographic responses were observed. Complications from treatment were monitored and documented. Main Outcomes Measures: The changes in the best-corrected visual acuity (BCVA) at the 1-year follow-up. The proportion of patients with improved (gained 2 lines or more), stable, and dropped (lost 2 lines or more) vision and the mean number of treatments required during the 1-year interval were measured. Complications were monitored and tabulated. Results: Seventeen eyes with complete 1-year follow-up were analyzed. The mean logarithm of the minimum angle of resolution BCVA improved from 0.64 to 0.41 (Wilcoxon signed-ranks test, P = 0.007). Sixteen eyes (94%) had stable or improved vision. Only one patient (6%) had moderate loss of vision. The mean number of PDT treatment was 1.8 per eye over the 1-year period. Patients with smaller lesion size or active vascular CNV on presentation were more likely to have a final BCVA of 20/100 or better (Fisher's exact test, P = 0.006 and P = 0.015, respectively). No serious local or systemic complications were encountered. Conclusions: PDT seems to be a promising treatment strategy in achieving a stable or improved vision for subfoveal idiopathic CNV. The treatment was well tolerated. Further studies and longer follow-up are warranted to assess the long-term safety and efficacy of PDT compared with observation or other treatment modalities. (C) 2003 by the American Academy of Ophthalmology.