Abstract
Abstract: :
Purpose: To describe the technique, time course, qualitative, and quantitative aspects of verteporfin angiography in humans. Methods: Eight patients were prospectively studied using verteporfin angiography. Eligible patients had subfoveal choroidal neovascularization. Patients underwent history, physical, and ophthalmic examination. Known sensitivity to verteporfin, a history of porphyria, or lack of desire to follow-up were among the exclusionary criteria. Complete ophthalmologic examination, fundus photography, red free photograpy, fluorescein angiography (FA), indocyanine green angiography (ICGA), and verteporfin angiography (VPA) were performed. VPA consisted of using a modified Zeiss angiography camera with excitation filter at 580-nm and bandpass filter at 695-nm. Patients received infusion of verteporfin (6 mg/m2 or 12 mg/m2) over 10 minutes. VPA was then performed at selected time intervals for the first 1 hour. Patients were then sent home with sunlight precautions and underwent standard photodynamic therapy 14 days later. Adobe Photoshop 7 was employed to perform the quantitative analysis of the verteporfin angiography. Briefly, all images were standardized to a relative level of 100 for any angiogram series. The brightest spot within the choroidal neovascular complex was assessed for luminescent intensity and plotted over time. Similar measurements were made for an area of normal choroid. Increased fluorescence intensity was used as a proxy for verteporfin selectivity to the lesion. Results: 6 patients were male, 5 eyes were left, and the median age was 79.5 years. Angiographically, 3 eyes were classified predominantly classic, and 5 eyes were classified 100% occult on FA. 1 area of hot spot and 2 areas of plaque were noted on ICGA. All 8 patients were noted to localize on VPA. In graphing the verteporfin fluorescent intensity curves of the brightest area vs. normal choroid, 7/8 patients demonstrated that either the bright spot was always more fluorescent than the normal choroid (n=5) or there was a cross-over time point when the bright spot was more fluorescent than normal choroid (n=2). Both the cross-over time points and the time of maximal separation between bright and normal choroid occurred between 1000 and 2000 seconds (16-33 minutes). No adverse outcomes were noted in this pilot study. Conclusions: Verteporfin angiography is selective to choroidal neovascular membranes. The technique is straightforward, well-tolerated, and without adverse effect. Quantitative angiography offers information that cannot be elucidated by qualitative techniques alone.
Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, S • photodynamic therapy • age-related macular degeneration