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G.A. Peyman, R. Ratnakaram, C. Canakis, C. Livir-Rallatos, M.D. Conway; Verteporfin Ocular Photodynamic Therapy Combined with Macular Scatter Photocoagulation fo Occult or Predominantly Occult Subfoveal Neovascularization in Age-Related Macular Degeneration: A Follow Up . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4999.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Further follow up is provided in the treatment outcome of patients with occult or predominantly occult subfoveal neovascular membranes who underwent a combination of verteporfin ocular photodynamic therapy (PDT) with macular scatter photocoagulation. Methods: In this nonrandomized, interventional, prospective study, a continuation of the study presented in ARVO 2002 (Peyman et al), 61 eyes of 53 patients were enrolled and followed. Of these, 53 eyes had more than 1 month follow up and 27 eyes had more than 6 months follow up. Prior treatment history included PDT in 13 eyes, transpupillary thermotherapy in 4, macular scleral buckle in 6, indocyanine green-guided feeder vessel photocoagulation in 2, focal laser photocoagulation in 5, intravitreal gas injection in 4, and no treatment in 39/61 eyes. Each patient showed the evidence of choroidal neovascular membrane progression, such as an increase in lesion size, new hemorrhage, decrease in visual acuity (VA), increase in macular thickness on optical coherence tomography (OCT) and biomicroscopy, and leakage on intravenous fluorescein angiography (IVFA). Each eye underwent PDT followed by argon laser photocoagulation modified to emit at 671 nm (red) with an average of 200 spots (200 mm, 400 msec, barely threshold burns). The outcome parameters included best-corrected VA, macular thickness as assessed with OCT, pattern of fluorescein leakage on IVFA, and biomicroscopic appearance. Results: In patients with more than 6 months follow up, VA improved in 12/27 (44.4%), remained unchanged in 12/27 (44.4%), and decreased in 3/27 (11.2%). In patients with more than 1 month follow up, VA improved in 20/53 (37.7%), remained unchanged in 20/53 (37.7%), and decreased in 13/53 (24.6%). Of these 53 eyes, only 5 needed retreatment. The macular thickness decreased from an average 546 µm to 265 µm. On IVFA, the area of hyperfluorescence decreased by 46% at 6 months from a baseline of 13.7 mm2 or 5.3MPS disc areas. Biomicroscopically, the vast majority of the cases appeared dry at last follow up, requiring no further treatment. Conclusions: Our data suggest that argon laser photocoagulation applied in a scatter pattern combined with PDT offered stabilization or increase in VA that continued at 6 months follow up in the vast majority of patients with occult or predominantly occult subfoveal lesions. The incidence of one retreatment at 6 months has been 20%.
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