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A Preliminary Study of Photodynamic Therapy Using Verteporfin for Choroidal Neovascularization in Pathologic Myopia, Ocular Histoplasmosis Syndrome, Angioid Streaks, and Idiopathic Causes
Michel Sickenberg, MD;
Ursula Schmidt-Erfurth, MD;
Joan W. Miller, MD;
Constantin J. Pournaras, MD;
Leonidas Zografos, MD;
Bertrand Piguet, MD;
Guy Donati, MD;
Horst Laqua, MD;
Irene Barbazetto, MD;
Evangelos S. Gragoudas, MD;
Anne-Marie Lane, MPH;
Reginald Birngruber, PhD;
Hubert van den Bergh, PhD;
H. Andrew Strong, PhD;
Ulrike Manjuris, PhD;
Todd Gray, MSPH;
Mario Fsadni, MD;
Neil M. Bressler, MD
Arch Ophthalmol. 2000;118:327-336.
Objective To evaluate short-term safety and the effects on visual acuity and fluorescein angiography of single or multiple sessions of photodynamic therapy with verteporfin for choroidal neovascularization (CNV) not related to age-related macular degeneration (AMD), including pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes.
Design A nonrandomized, multicenter, open-label, dose-escalation phase 1 and 2 clinical trial.
Setting Four ophthalmic centers in Europe and North America providing retinal care.
Participants Thirteen patients with subfoveal CNV due to pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, or idiopathic causes.
Methods Standardized protocol refraction, visual acuity testing, ophthalmic examinations, color photographs, and fluorescein angiograms were used to evaluate the results of photodynamic therapy treatments with verteporfin. Follow-up ranged from 12 weeks for patients who were treated once to 43 weeks for patients who were treated up to 4 times.
Results Verteporfin therapy was well tolerated in patients with CNV not related to AMD. No deterioration in visual acuity was observed; most patients gained at least 1 line of vision. Reduction in the size of leakage area from classic CNV was noted in all patients as early as 1 week after verteporfin therapy, with complete absence of leakage from classic CNV in almost half of the patients. Improvement in visual acuity after verteporfin therapy was greatest (+6, +8, and +9 lines) in 3 patients with relatively poor initial visual acuity (between 20/200 and 20/800). Up to 4 treatments were found to have short-term safety even with retreatment intervals as short as 4 weeks.
Conclusions Treatment of CNV not related to AMD with verteporfin therapy achieves short-term cessation of fluorescein leakage from CNV in a small number of patients without loss of vision. Further randomized clinical trials including a larger number of patients are under way to confirm whether verteporfin therapy is beneficial for subfoveal CNV not related to AMD.
From Hopital Ophtalmique Jules Gonin, Lausanne, Switzerland (Drs Sickenberg, Zografos, and Piguet); the Retina Department, University Eye Hospital, Lübeck, Germany (Drs Schmidt-Erfurth, Laqua, Barbazetto, and Birngruber); Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Miller and Gragoudas and Ms Lane); Department of Oto-Neuro-Ophthalmology, Hopital Cantonal Universitaire de Genève, Geneva, Switzerland (Drs Pournaras and Donati); Laboratory of Air Pollution Studies, Department of Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland (Dr van den Bergh); QLT PhotoTherapeutics Inc, Vancouver, British Columbia (Drs Strong and Manjuris); CIBA Vision Inc, Duluth, Ga (Mr Gray); CIBA Vision AG, Bülach, Switzerland (Dr Fsadni); and The Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Md (Dr Bressler).
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