Verteporfin Therapy of Predominantly Hemorrhagic Lesions in Patients with Neovascular AMD

Abstract

Abstract: : Purpose: The TAP Investigation and VIP Trial excluded AMD patients with subfoveal CNV if blood, as a lesion component, occupied 50% or more of the total lesion size. One reason for excluding such patients was that it was impossible to determine whether a lesion contained predominantly classic CNV or minimally classic CNV when blood was such a prominent lesion component. Another reason for excluding these types of lesions was that predominantly hemorrhagic CNV lesions are known to have a very poor visual prognosis, most likely due to the high prevalence of RPE tears and anastomotic components in these lesions, as well as the questionable toxic effects of subretinal blood. Consequently, the role of verteporfin therapy in the management of these predominantly hemorrhagic CNV lesions has not been investigated. Once verteporfin therapy was commercially available, it was possible to treat these predominantly hemorrhagic CNV lesions. An analysis is presented of patients with predominantly hemorrhagic CNV lesions who received verteporfin therapy. Methods: A retrospective analysis was performed on consecutive AMD patients with subfoveal CNV and predominantly hemorrhagic lesions associated with fluorescein angiographic leakage who were treated with verteporfin therapy. Best-corrected visual acuity testing, ophthalmological examinations, color fundus photography, fluorescein angiography, and indocyanine green angiography angiograms were performed. Follow-up evaluations were performed every 12 weeks, and verteporfin treatment was performed if fluorescein angiographic leakage was detected. Results: Twenty-two patients received verteporfin therapy from May 2000 to August 2002. The median baseline visual acuity was 20/200. After a mean follow-up period of 13 months (ranging from 3 months to 28 months), the median visual acuity remained stable at 20/200. Compared to baseline, the visual acuity improved > 1 line in 4 patients (18%), stabilized (± 1 line) in 10 patients (45%), and decreased > 1 line in 8 patients (36%). The greatest loss of vision was from 20/32 to 20/300 and the greatest improvement in vision was from HM to 20/40. Conclusions: In this subset of AMD patients with predominantly hemorrhagic CNV lesions, verteporfin therapy may increase the likelihood of stable or improved vision. Further study is necessary, but these preliminary results suggest a role for verteporfin therapy in the treatment of predominantly hemorrhage lesions.

Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: out • choroid: neovascularization