Verteporfin photodynamic therapy of choroidal neovascularization in angioid streaks: one-year results of a prospective case series

• Published in: Ophthalmology (Rochester, Minn.) Vol. 112; no. 7; p. 1227
• Main Authors: Browning, Andrew C, Chung, A K K, Ghanchi, F, Harding, S P, Musadiq, M, Talks, S J, Yang, Y C, Amoaku, W M
• Format: Journal Article
• Language: English
• Published: United States 01-07-2005
• Subjects: Adult; Aged; Angioid Streaks - complications; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - etiology; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Male; Middle Aged; Photochemotherapy; Photosensitizing Agents - therapeutic use; Porphyrins - therapeutic use; Prospective Studies; Safety; Treatment Outcome; Visual Acuity
• ISSN: 1549-4713
• DOI: 10.1016/j.ophtha.2005.02.011

To report the 12-month results on the use of verteporfin photodynamic therapy (PDT) in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks.
Five-center prospective case series.
Patients with CNV secondary to angioid streaks who were treated with PDT were recruited and followed up at 3-month intervals for 12 months, with the addition of visits at 1.5 and 4.5 months if deemed appropriate by the investigator. Best-corrected visual acuity (BCVA) was measured at each visit after full refraction or with their current distance spectacles using Early Treatment Diabetic Retinopathy Study logarithm of the minimum angle of resolution charts. Stereoscopic fundus fluorescein angiography was used to determine baseline lesion characteristics and location.
Twenty-two patients were recruited (23 eyes, 16 with subfoveal CNV and 7 with juxtafoveal; all classic no occult). Seventeen patients (77%) had angioid streaks secondary to pseudoxanthoma elasticum. In the subfoveal group, median BCVA at baseline was 49 letters (approximate Snellen equivalent, 20/100) and was 46 at 12 months (approximate Snellen equivalent, 20/125). Twelve of 16 eyes (75%) lost fewer than 8 letters, whereas 14 of 16 eyes (88%) lost fewer than 15 letters. The mean CNV greatest linear dimension (GLD) was 2520 microm at baseline. At 12 months, 7 of 16 eyes with subfoveal CNV at baseline were leaking (GLD = 3220 microm; P = 0.62). The mean number of treatments in the first 12 months was 2.9. In the juxtafoveal group, the median BCVA at baseline was 66 letters (approximate Snellen equivalent, 20/50) and was 51 letters at 12 months (approximate Snellen equivalent, 20/100). Two of 7 eyes (29%) gained 8 or more letters at the 12-month examination, whereas 4 of 7 eyes (57%) lost more than 15 letters. The mean CNV GLD at baseline was 1890 microm. At 12 months, 1 of 7 eyes with juxtafoveal CNV at baseline was leaking. Choroidal neovascularization progressed from juxtafoveal to subfoveal location during the follow-up period in 4 of 7 eyes. The mean number of treatments in the first 12 months was 3.4. No side effects were noted in either patient group.
This small series suggests that treatment of CNV secondary to angioid streaks with verteporfin PDT seems to limit visual loss in most patients through the first 12 months of follow-up, particularly in those with subfoveal lesions at baseline.