Verteporfin Ocular Photodynamic Therapy Combined with Macular Scatter Photocoagulation for Occult or Predominantly Occult Subfoveal Neovascularization in Age-Related Macular Degeneration

Abstract

Abstract: : Purpose: This study evaluated the treatment outcome of patients who presented with occult or predominantly occult subfoveal neovascular membranes and received a combination of verteporfin ocular photodynamic therapy (PDT) with macular scatter photocoagulation. Methods: In this nonrandomized, interventional, prospective study, 21 eyes of 18 patients were enrolled. Prior treatment history included PDT in 7 eyes, transpupillary thermotherapy in 4 eyes, macular scleral buckle in 5 eyes, indocyanine green-guided feeder vessel photocoagulation in 1 eye, focal laser photocoagulation in 1 eye, and no treatment in 8 eyes. However, each patient showed 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 150 spots (200 µm, 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 a mean follow-up period of 3 mos, the VA improved from 20/133 (mean 0.15, S.D. 0.191) to 20/106 (mean 0.188, S.D. 0.22273). The macular thickness decreased from 448±140 µm to 337±92 µm. Retreatment was applied in 2 patients for persistent vascularized retinal pigment epithelial detachment and angiographic leakage, respectively. Transient decrease in VA was observed in 1 patient. On biomicroscopy, pigmentary changes were evident after treatment and a tendency of macular drusen to decrease along with a decrease in serous macular elevation. On IVFA, the area of hyperfluorescence decreased from 6.5 mm₂ or 2.57 disc areas (DA) at baseline to 3.98 mm₂ or 1.56 DA at last follow up. Conclusion: Argon laser photocoagulation applied in a scatter pattern combined with PDT offered stabilization or increase in VA in patients with occult or predominantly occult subfoveal lesions. The macular exudation and thickness decreased and the drusen showed a tendency to resolve.

Keywords: 516 photodynamic therapy • 308 age-related macular degeneration • 346 choroid: neovascularization