Abstract
Abstract: :
Purpose: The TAP Investigation and VIP Trial excluded AMD patients with juxtafoveal CNV, although current guidelines recommend verteporfin therapy for juxtafoveal predominantly classic lesions close to the geometric center of the fovea. In the small number of juxtafoveal lesions inappropriately enrolled in the TAP Investigation and treated with verteporfin therapy, there seemed to be a greater likelihood for visual acuity improvement compared with subfoveal lesions. Once verteporfin therapy was commercially available, it was possible to treat these predominantly classic juxtafoveal lesions. An analysis is presented of patients with juxtafoveal lesions who received verteporfin therapy at the Bascom Palmer Eye Institute.. Methods: A retrospective analysis was performed on consecutive AMD patients with juxtafoveal predominantly classic lesions treated with verteporfin therapy. Best–corrected visual acuity testing, ophthalmological examinations, color fundus photography, optical coherence tomography imaging, and fluorescein angiography were performed. Follow–up evaluations were performed every 6–14 weeks. Additional verteporfin therapy was routinely performed every 10–14 weeks if fluorescein angiographic leakage was detected. Results: Thirty–one eyes of 30 patients received verteporfin therapy from May 2000 to July 2003. The median baseline visual acuity was 20/60. After a median follow–up period of 19.0 months (ranging from 5.1 months to 39.7 months), the median visual acuity was 20/400. Compared to baseline, the visual acuity improved ≥ 3 ETDRS equivalent lines in 2 patient (6%), stabilized in 10 patients (32%), and decreased ≥ 3 ETDRS equivalent lines in 19 patients (61%). The greatest loss of vision was from 20/25 to 20/400 and the greatest improvement in vision was from 20/200 to 20/50. Conclusion: Unlike the subset of juxtafoveal lesions from the TAP Investigation with better visual acuity outcomes when compared with subfoveal lesions, our population of juxtafoveal lesions were similar to the outcomes expected for subfoveal lesions. Further study is necessary, but these preliminary results suggest that verteporfin therapy of juxtafoveal lesions does not appear to result in a greater likelihood of vision improvement.
Keywords: age–related macular degeneration • photodynamic therapy • choroid: neovascularization