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S. Bearelly, S. Ahmad, S.S. Stinnett, M.J. Cooney, S. Fekrat; Photodynamic Therapy With Verteporfin for Predominantly Hemorrhagic Choroidal Neovascularization Lesions in Neovascular Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2005;46(13):332.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the clinical response of eyes treated with photodynamic therapy (PDT) with verteporfin for predominantly hemorrhagic subfoveal choroidal neovascularization (CNV) lesions in the setting of neovascular age–related macular degeneration (NVAMD). Methods: Patient records at the Duke Center for Macular Degeneration were reviewed. Inclusion criteria consisted of: a diagnosis of NVAMD, subretinal hemorrhage (SRH) extending into the fovea, less than 50% classic CNV on fluorescein angiography (FA), and treatment with PDT. Exclusion criteria included lack of follow–up greater than 2 months. At the time of treatment with PDT, baseline visual acuity (VA), and extent of SRH on FA, in terms of Macular Photocoagulation Study (MPS) disc areas, were recorded. Post–treatment VA at the time of SRH resolution and at the most recent follow–up visit was noted. Results: A total of twenty–two eyes were identified with a mean post–treatment follow–up of 9.1 months. The mean pre–treatment VA was 20/200, and mean SRH size was 16.5 MPS disc areas. SRH completely resolved in 16 eyes (73%) after a mean 5.2 months. Nine (41%) of 22 eyes experienced improvement in VA (> or = 2 ETDRS lines) both at the time of SRH resolution and at the most recent follow–up visit. In contrast, nine (41%) experienced a decline in VA (> or = 2 ETDRS lines) noted both at the time of SRH resolution and most recent follow–up. Three eyes (14%) did not experience a significant change in VA. One (5%) had improved VA at the time of SRH resolution, which then declined below the pre–treatment value at the most recent follow–up. Eyes with worse pre–treatment VA were more likely to experience improvement in VA after treatment with PDT. Conclusions: Whereas the reported natural history of SRH in NVAMD indicates, approximately, a 20% rate of spontaneous VA improvement after 9 months, the current study's results suggest PDT may be a treatment option for predominantly hemorrhagic CNV lesions involving the fovea in NVAMD. However, further study is needed to compare PDT with other treatment modalities and with observation alone.
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