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Impact of lesion size on photodynamic therapy with verteporfin of predominantly classic lesions in age related macular degeneration

L Arias, O Pujol, J Berniell, M Rubio, G Roca, L Castillo and E Acebes

Department of Ophthalmology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain

Correspondence to:
Correspondence to:
Luis Arias
Department of Ophthalmology, Bellvitge University Hospital, C/Feixa Llarga, sn, 08907, L’Hospitalet de Llobregat, Barcelona, Spain; luisarias{at}telefonica.net

Aim: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD).

Methods: According to greatest linear dimension (GLD) of the entire lesion determined with fluorescein angiography (FA) patients were divided into two groups. In the first group GLD was <3000 µm and in the second one GLD was 3000–5000 µm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA).

Results: 64 patients (mean (SD) age, 76.7 (7.7) years; range 58–95 years) were recruited to participate in the study. All participants in the study completed the follow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesions (n = 32) compared with 15 patients (46.8%) in the group of larger lesions (n = 32) did not show significant leakage in FA at the end of follow up (p = 0.02). A GLD increase >1000 µm was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p = 0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the group of larger lesions lost less than three lines of vision (p = 0.06). Relevant side effects related to verteporfin therapy were not recorded, except for four patients (6.2%) with infusion related back pain.

Conclusions: These results suggest that lesion size at baseline may be a prognosis factor in PDT in patients with subfoveal predominantly classic CNV secondary to AMD. There are no relevant side effects or safety concerns derived from verteporfin therapy.

Abbreviations: AMD, age related macular degeneration; BCVA, best corrected visual acuity; CNV, choroidal neovascularisation; FA, fluorescein angiography; GLD, greatest linear dimension; PDT, photodynamic therapy

Keywords: photodynamic therapy; age related macular degeneration; choroidal neovascularisation

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