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PJ Rosenfeld, I Suner, V Cruz-Villegas, N Villate; Verteporfin Therapy with Delayed Light Application for the Treatment of Occult Choroidal Neovascularization (CNV) in Age-Related Macular Degeneration (AMD) . Invest. Ophthalmol. Vis. Sci. 2002;43(13):978.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:Verteporfin therapy can prevent moderate vision loss in AMD patients with subfoveal occult CNV with no classic CNV over a 2-year period as shown in the VIP Trial. During the first year of the study, the average patient receiving verteporfin therapy lost about 3-lines of vision compared to 4-lines of vision in the placebo treated group. Based on the results of the earlier Phase I/II studies and the concern that decreased acuity was in part due to choroidal injury from verteporfin therapy, we have attempted to improve visual acuity outcomes during the first year of treatment by modifying verteporfin therapy with light applied 30 minutes after the start of the infusion. Methods:A retrospective review was performed on 44 consecutive eyes (42 patients) receiving verteporfin treatment with delayed light application. Initially, all patients had a recent history of vision loss and/or evidence of subretinal hemorrhage, and were diagnosed with subfoveal occult CNV with less than 10% classic CNV. Indocyanine green angiography using the Topcon Imagenet System revealed a subfoveal plaque in these patients. Patients received the standard verteporfin drug dose during a 10-minute infusion followed by light application at the standard irradiance and fluence applied 30-minutes after the start of the infusion. Retreatment was administered every 3 months if fluorescein angiographic leakage was identified. Best-corrected Snellen visual acuity measurements were obtained at each visit. Results: All patients were followed for at least 3 months. The median Snellen visual acuity at baseline was 20/200. Most of the lesions (84%) were characterized as occult CNV with no classic CNV, and subretinal blood was present in 48% of the lesions. Stable or improved vision was found in 39 of 44 eyes (89%) at the month 3 follow-up visit, 32 of 35 eyes (91%) at the month 6 follow-up visit, and 20 of 23 eyes (86%) at the month 12 follow-up visit. No episodes of severe vision decrease occurred after treatment, and no additional safety concerns were identified. Conclusion:Verteporfin therapy with delayed light application appears to be safe and may result in better visual acuity outcomes compared to standard therapy. A multicenter, prospective, randomized clinical trial known as the VALIO Study is now underway comparing standard verteporfin therapy with verteporfin therapy using the delayed light application.
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