title: Photodynamic therapy of subfoveal choroidal neovascularization: clinical and angiographic examples.
abstract: BACKGROUND
  Conventional photocoagulation of subfoveal choroidal neovascularization (CNV) is often accompanied by visual loss due to thermal damage to adjacent retinal structures. Photodynamic therapy (PDT) allows vascular occlusion by selective photochemical destruction of vascular endothelial cells only. In a pilot study we evaluated the use of PDT in CNV.
  
  
  METHODS
  In a clinical phase I/II trial, patients with subfoveal CNV were treated with PDT. Benzoporphyrin derivative monoacid ring A (BPD) was used as sensitizer at a drug dose of 6 mg/m2 or 12 mg/m2. Irradiation was performed via a diode laser emitting at 690 nm coupled into a slit lamp. Safe and maximum tolerated light doses were defined by dose escalation from 25 to 150 J/cm2. Photodynamic effects were documented ophthalmoscopically and angiographically.
  
  
  RESULTS
  Sixty-one patients received a single course of BPD-PDT. Preliminary results suggest no damage to retinal structures within the treated area clinically. Retinal perfusion was not altered, while CNV demonstrated immediate absence of fluorescein leakage in the majority of lesions subsequent to PDT. At optimized parameters (6 mg/m2 and 50 J/cm2) complete cessation of leakage from classic CNV occurred in 100% of cases at 1 week and in 50% at week 4. In 70-80% of classic CNV, leakage reappeared at week 12, but markedly less than before treatment.
  
  
  CONCLUSIONS
  PDT allows temporary absence of leakage from CNV with preservation of visual acuity. The long-term prognosis of CNV secondary to age-related macular degeneration treated with repeated courses of PDT is being evaluated in a phase III trial.
authors.affiliation: University Eye Hospital Lübeck, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Schmidt-Erfurth
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.forename: M
authors.initials: M
authors.lastname: Sickenberg
authors.forename: A
authors.initials: A
authors.lastname: Bunse
authors.forename: H
authors.initials: H
authors.lastname: Laqua
authors.forename: E
authors.initials: E
authors.lastname: Gragoudas
authors.forename: L
authors.initials: L
authors.lastname: Zografos
authors.forename: R
authors.initials: R
authors.lastname: Birngruber
authors.forename: H
authors.initials: H
authors.lastname: van den Bergh
authors.forename: A
authors.initials: A
authors.lastname: Strong
authors.forename: U
authors.initials: U
authors.lastname: Manjuris
authors.forename: M
authors.initials: M
authors.lastname: Fsadni
authors.forename: A M
authors.initials: AM
authors.lastname: Lane
authors.forename: B
authors.initials: B
authors.lastname: Piguet
authors.forename: N M
authors.initials: NM
authors.lastname: Bressler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002199:Capillary Permeability; D002829:Choroid / Q000098:blood supply*; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis; D005654:Fundus Oculi; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D011166:Porphyrins / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012449:Safety; D000077362:Verteporfin
chemical_list: D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin