Self-reported acute decrease in visual acuity after photodynamic therapy for age-related macular degeneration.
OBJECTIVE
To evaluate the incidence of self-reported decrease in visual acuity within 7 days of photodynamic therapy (PDT) for choroidal neovascularization secondary to age-related macular degeneration (AMD) and to describe the anatomical and clinical course of patients with documented significant visual loss.


METHODS
Consecutive records of all patients with exudative AMD treated with PDT over a 16-month period at a community-based retina referral practice were reviewed for instances of self-reported visual change within 7 days of treatment. The primary outcome measure was Snellen visual acuity. Secondary outcome measures were fluorescein angiography (FA) and anatomical findings.


RESULTS
Among 1,894 PDT treatments performed for 821 patients, there were 32 instances (for 30 patients) of self-reported visual change within 7 days of PDT. A decrease in > or =2 lines of Snellen visual acuity was documented for 10 patients (1.2% of patients or 0.5% of treatments), and all occurred within 3 days of PDT (median, 1 day) in all patients. Median pre-PDT vision was 20/60 (range, 20/50 to 20/200). Vision within 3 days after PDT was 20/100 or worse in all 10 cases and counting fingers or worse in 3. Subretinal hemorrhage occurred in four cases. FA of eyes without hemorrhage showed a circular area of choroidal hypoperfusion (corresponding to the PDT spot) in all five eyes with persistence of the hypofluorescence up to 4 months later. Visual improvement after the initial acute decrease was seen in 3 patients (30%; 95% confidence interval, 7-65%) by 3 months after PDT.


CONCLUSIONS
Acute visual decrease after PDT for AMD is uncommon. Visual recovery may occur in some patients, but a precise estimate is difficult to determine given the small sample size.
Recchia
Franco M
FM
Department of Ophthalmology and Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, MI, USA. franco.recchia@vanderbilt.edu
Greenbaum
Shareen
S
Recchia
Cynthia A Carvalho
CA
Ruby
Alan J
AJ
Alldredge
Claron D
CD
Hassan
Tarek S
TS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy*; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D012650:Self Disclosure; D000077362:Verteporfin; D014786:Vision Disorders / Q000209:etiology*; D014792:Visual Acuity
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin