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A.F. Walter, T. Thalhammer, M.A. Gamulescu, J. Hillenkamp, V.P. Gabel, C. Framme; Photodynamic Therapy for Neovascular Age–Related Macular Degeneration – Results in Clinical Practice . Invest. Ophthalmol. Vis. Sci. 2006;47(13):381.
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© ARVO (1962-2015); The Authors (2016-present)
To review functional results of photodynamic therapy (PDT) for neovascular age–related macular degeneration (AMD) using Verteporfin (Visudyne®) in clinical practice.
The data of 221 consecutive patients treated with PDT for AMD were retrospectively evaluated. Patients were assigned to PDT treatment according to TAP and VIP criteria. PDT was performed as described in the TAP studies using a diode laser at 689nm (Zeiss Visulas 690s and Visulink PDT, Zeiss, Jena, Germany). Each patient underwent complete ophthalmologic examination including fluorescein angiography before treatment and at follow–up examinations ideally every 3 months for a period up to 24 months. Each patient was followed up at least for 6 months.
Of 221 patients (mean age: 75 years) 57.5% presented with completely classic choroidal neovascularization (CNV), 26.7% with predominantly classic CNV, 11.3% with occult without classic CNV, and 4.5% with minimally classic CNV. Localisation of CNV was subfoveal in 80.1%, juxtafoveal in 18.1% and extrafoveal in 1.8% regarding to TAP classification. Mean CNV size before treatment was 2500µm. Occult lesions were largest and classic lesions smallest. The mean number of PDT treatments was 1.86 (range: 1 – 5 treatments). Overall, mean Snellen visual acuity was 0.19 at baseline and decreased by 1.3 ETDRS lines after 3 months (n=172), 2.3 lines after 6months (n=163) and 3.7 lines after 12 months (n=63), with stable values after 2 years (0.05 to 0.1 Snellen visual acuity). One fifth of all patients gained at least one line during follow–up (19.1% after one year, 22.2% after two years). Additionally in 22% visual acuity remained stable after PDT. Regarding subgroup analysis, no significant correlation to final visual acuity was found for baseline CNV classification, baseline CNV size, baseline visual acuity or number of treatments.
Visual acuity results of this retrospective monocenter analysis of PDT for neovascular AMD in a completely clinical setting were less favourable as the results of TAP and VIP studies. Overall, the re–treatment rate in our setting was significantly lower; however, our analysis also shows that even eyes with more than 2 treatments did not show a more favourable outcome. Thus, the importance of number of treatments remains questionable. Nevertheless, if re–treatment is not considered at a control visit because of stable visual acuity and no active leakage (staining) in angiography, the following examination interval should be shortened to avoid late recurrences.
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