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V Cruz-Villegas, CA Puliafito, PJ Rosenfeld; Early Retreatment of Choroidal Neovascularization (CNV) in Age-Related Macular Degeneration (AMD) Using Ocular Photodynamic Therapy (OPT) with Verteporfin . Invest. Ophthalmol. Vis. Sci. 2002;43(13):596.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: The TAP Investigation demonstrated a treatment benefit for AMD patients with subfoveal predominantly classic CNV receiving OPT with verteporfin. During the investigation, placebo-treated patients lost more vision than the verteporfin-treated patients. However, the average verteporfin-treated patient did lose vision. Most of the vision loss occurred during the first 6 months of the investigation while receiving verteporfin therapy every 3 months if indicated. Once verteporfin (VisudyneTM) therapy was available commercially, retreatment earlier than every three months was possible. An analysis is presented of patients who experienced decreased vision associated with an enlarging area of classic CNV 6 to 8 weeks following initial verteporfin therapy. These patients received early retreatments. Methods: A retrospective analysis was performed of AMD patients with predominantly classic lesions who received verteporfin therapy at 6 to 8 week intervals due to decreased vision secondary to enlarging areas of CNV. Results: Sixteen patients received early retreatment with verteporfin therapy. After a mean follow-up period of 6 months and an average of 4 treatments, the median visual acuity decreased from 20/200 to 20/400. Compared to baseline, the visual acuity improved in 5 patients (31%), stabilized in 1 patient (6%), and decreased in 10 patients (62.5%). The greatest linear dimension (GLD) of the lesions increased in 12 patients (75%). Three of the 10 patients with decreased vision were found to have retinal lesion anastomoses. Conclusion: In this subset of patients with decreasing visual acuity after initial verteporfin therapy, early retreatment may increase the likelihood of stable or improved vision. However, the majority of patients continue to lose vision despite early retreatment. Moreover, the presence of a retinal lesion anastomosis appears to be a poor prognostic indicator. The ongoing Visudyne in Early Retreatment (VER) Trial is examining the role of early retreatment in AMD patients with subfoveal predominantly classic CNV.
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