Photodynamic therapy of subfoveal choroidal neovascularization with verteporfin: fluorescein angiographic guidelines for evaluation and treatment--TAP and VIP report No. 2.
OBJECTIVE
To describe fluorescein angiographic guidelines for the use of verteporfin therapy in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) or other conditions based on 2-year vision outcomes from the Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Investigation and Verteporfin in Photodynamic Therapy (VIP) Trial.


METHODS
Three multicenter, double-masked, placebo-controlled randomized clinical trials at 28 ophthalmology clinical centers in Europe and North America involving prospectively identified patients with best-corrected visual acuity (Snellen equivalent) of approximately 20/20 to 20/200, subfoveal CNV secondary to AMD or pathologic myopia with evidence of CNV, and a lesion greatest linear dimension of 5400 micro m or less. Fluorescein angiography was to be performed on all patients at enrollment and at regular 3-month follow-up visits through 2 years. The initial treatment laser spot size and all subsequent treatment decisions were based on the investigator's interpretation of these fluorescein angiograms. Photographic materials forwarded to the Wilmer Photograph Reading Center were reviewed by masked graders.


METHODS
Baseline angiographic features, including lesion composition and size, morphologic response to treatment during follow-up (eg, absence of leakage), and reliability (kappa values) of grading selected characteristics based on a 10% regrading of baseline visits.


RESULTS
Terms and examples of different lesions and lesion components are provided to assist recognition of fluorescein angiographic characteristics of choroidal neovascular lesions that were important in determining when and where to apply verteporfin therapy. The kappa statistics for agreement of identification of lesion characteristics by the Wilmer Photograph Reading Center for these trials ranged from 0.70 to 0.85.


CONCLUSIONS
Ophthalmologists should consider interpreting fluorescein angiographic images of subfoveal lesions with terms provided to follow recommendations regarding which patients are most likely to benefit from verteporfin therapy based on results from the TAP Investigation and VIP Trial.
Barbazetto
Irene
I
Medizinische Universität zu Lübeck, Klinik für Augenheilkunde, Lübeck, Germany.
Burdan
Amy
A
Bressler
Neil M
NM
Bressler
Susan B
SB
Haynes
Laurie
L
Kapetanios
Anastasios D
AD
Lukas
Julius
J
Olsen
Karl
K
Potter
Michael
M
Reaves
Al
A
Rosenfeld
Philip
P
Schachat
Andrew P
AP
Strong
H Andrew
HA
Wenkstern
Andrea
A
D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D005451:Fluorescein Angiography / Q000379:methods*; D005584:Fovea Centralis; D006801:Humans; D008268:Macular Degeneration / Q000150:complications; D009216:Myopia / Q000150:complications; D010778:Photochemotherapy; D010781:Photography; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin