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D.V. Do, N.M. Bressler, S.B. Bressler; Large Hemorrhages After Photodynamic Therapy with Verteporfin Precluding Follow-Up Treatment Decisions . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1104.
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Purpose: To describe age-related macular degeneration (AMD) patients receiving ocular photodynamic therapy with verteporfin (verteporfin therapy) for subfoveal choroidal neovascularization (CNV) composed of occult with no classic CNV in whom ocular hemorrhage precluded determining if additional therapy should be given within 3 months after initiation of treatment. Methods: The records of all AMD patients who received verteporfin therapy for subfoveal lesions composed of occult with no classic CNV between February and July 2001 at the Wilmer Eye Institute were reviewed after the study was deemed exempt from requiring informed consent by the Johns Hopkins Medicine's Institutional Review Board. Subjects who reported having undergone a procedure to remove intraocular blood prior to a month 3 follow-up visit or who had ocular hemorrhage at the month 3 visit that was severe enough to preclude determining if additional verteporfin therapy should be given were identified. Medical records of these individuals were reviewed to describe their demographic, ocular, and non-ocular systemic features. Results: 55 eyes of 52 patients were reviewed. 5 eyes in 5 (9% [95% CI: 1.4 - 16.6%]) of these 52 patients developed ocular hemorrhage that precluded determining if additional verteporfin therapy should be given. All 5 had hypertension, 1 was diabetic, and 1 had chronic lymphocytic leukemia. No other bleeding diatheses were identified and none were using coumadin. 2 patients underwent vitrectomy, injection of tPA into the subretinal space, and intravitreal injection of a gas bubble in an attempt to clear the hemorrhage. 3 patients were observed with no treatment. Visual acuity 3 months after documentation of the ocular hemorrhage decreased a median of 8.5 lines compared with pretreatment acuity. 2 patients received additional verteporfin therapy after their hemorrhage cleared, and 1 of these patients developed another hemorrhage after a second session of verteporfin therapy. Conclusions: 5 (9% [95% CI: 1.4 - 16.6%]) of 55 eyes in 52 patients developed ocular hemorrhage that precluded determining if additional verteporfin therapy should be given within 3 months after initiation of verteporfin therapy. This case series is the first to provide a detailed description of this type of ocular hemorrhage following verteporfin therapy. Evaluation of a larger series of patients is needed to determine a more precise risk of this complication and to identify risk factors for it. (N Bressler is a paid consultant for Novartis Ophthalmics & QLT Inc, neither of whom funded this study)
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