Impact of lesion size on photodynamic therapy with verteporfin of predominantly classic lesions in age related macular degeneration.
OBJECTIVE
To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD).


METHODS
According to greatest linear dimension (GLD) of the entire lesion determined with fluorescein angiography (FA) patients were divided into two groups. In the first group GLD was <3000 microm and in the second one GLD was 3000-5000 microm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA).


RESULTS
64 patients (mean (SD) age, 76.7 (7.7) years; range 58-95 years) were recruited to participate in the study. All participants in the study completed the follow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesions (n = 32) compared with 15 patients (46.8%) in the group of larger lesions (n = 32) did not show significant leakage in FA at the end of follow up (p = 0.02). A GLD increase >1000 microm was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p = 0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the group of larger lesions lost less than three lines of vision (p = 0.06). Relevant side effects related to verteporfin therapy were not recorded, except for four patients (6.2%) with infusion related back pain.


CONCLUSIONS
These results suggest that lesion size at baseline may be a prognosis factor in PDT in patients with subfoveal predominantly classic CNV secondary to AMD. There are no relevant side effects or safety concerns derived from verteporfin therapy.
Arias
L
L
Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. luisarias@telefonica.net
Pujol
O
O
Berniell
J
J
Rubio
M
M
Roca
G
G
Castillo
L
L
Acebes
E
E
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D011446:Prospective Studies; D012160:Retina / Q000473:pathology*; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin
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11713079
Br J Ophthalmol. 2002 Jan;86(1):118-9
11801521
Am J Ophthalmol. 2002 Feb;133(2):211-4
11812424
Retina. 2002 Feb;22(1):6-18
11884872
Arch Ophthalmol. 2002 Jun;120(6):872
12049608
Arch Ophthalmol. 2002 Nov;120(11):1443-54
12427056
Am J Ophthalmol. 2001 May;131(5):541-60
11336929
Arch Ophthalmol. 2003 Sep;121(9):1253-68
12963608
Am J Ophthalmol. 2004 Feb;137(2):258-64
14962414
Retina. 2004 Feb;24(1):1-12
15076937
Arch Ophthalmol. 1999 Oct;117(10):1329-45
10532441
Arch Ophthalmol. 2001 Feb;119(2):198-207
11176980
Health Technol Assess. 2003;7(9):v-vi, 1-98
12709292