Original article
Photodynamic Therapy With Verteporfin for Juxtafoveal Choroidal Neovascularization in Pathologic Myopia: A Long-term Follow-up Study

https://doi.org/10.1016/j.ajo.2006.11.037Get rights and content

Purpose

To assess the effect of verteporfin photodynamic therapy (PDT) in juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM).

Design

Prospective, open-label, consecutive, interventional case series.

Methods

We prospectively followed a series of 48 consecutive patients (49 eyes) with pathologic myopia (≥ 6 diopters) who received verteporfin PDT for juxtafoveal CNV. This population was divided into two groups based on age (group A ≤ 55 years old, group B >55 years old), in three subgroups based on CNV lesion size, and in three categories based on refractive error at baseline.

Results

The median follow-up was 32 months (range, 12 to 56 months). Visual acuity (VA) improved by 1 or more Snellen lines in 18 eyes (37%), decreased in 12 eyes (24%), and remained stable in 19 eyes (39%). The median number of lines gained was 2.15, while the median number of lines lost was 2.4. The final mean VA in group A (mean age, 43.9 years) was 20/50 (logMAR 0.41, standard deviation [SD] 0.3) and significantly better (P = .01) than the 20/105 (logMAR 0.72, SD 0.5) in group B (mean age, 67.8 years). Neither CNV size nor refractive error magnitude influenced visual outcomes.

Conclusion

Verteporfin PDT is a promising treatment modality resulting in stable or improved vision in 76% of the myopic eyes with juxtafoveal CNV. Younger patients appear to respond more favorably to treatment.

Section snippets

Patients and methods

We prospectively followed a consecutive series of 51 patients (52 eyes) with PM who underwent verteporfin PDT for juxtafoveal CNV. CNV was classified as juxtafoveal, if the lesion was closer than 200 μm but not under the geometric center of the FAZ, through a procedure similar to that described in a previous publication.4

Patients’ inclusion criteria were: (1) highly myopic eyes with a refractive error ≥ 6 diopters, (2) posterior pole myopic changes (lacquer cracks, chorioretinal atrophy,

Results

This study considered 48 patients (49 eyes), 16 men and 32 women, treated with verteporfin therapy for juxtafoveal CNV in PM. Mean age at the initial examination was 55.5 (SD 13.5) years with a median of 53 years (range, 29 to 80 years). Mean refractive error was −13.2 diopters (SD 4.1) with a median of −14 diopters (range, −6.00 to −22.00 diopters).

The mean follow-up was 32.1 (SD 16.1) months with a median of 36 months (range, 12 to 56 months). The mean Snellen VA at baseline was 20/55 (logMAR

Discussion

Previous prospective clinical trials have shown that the most widely used treatment for myopic CNV is laser photocoagulation when fluorescein angiography reveals lesions outside the geometric center of the FAZ. This is the only technique shown to have a significant benefit in selected patient populations.2, 4, 12, 13

However, the drawback of laser therapy in the treatment of juxtafoveal CNV is the potential for foveolar damage that could result by an expansion of thermal radiation toward

Alfredo Pece, MD, an Ophthalmologist who spent 20 years in Milan, Italy, at the San Raffaele Hospital, as director of the Macula Service. In 2000, Dr Pece served as the Chief of Melegnano Hospital, Milano, Italy. He is a member of the major scientific associations such as the Macula Society, Retina Society, and Club Gonin. Dr Pece’s research interests are the diagnosis of chorioretinal diseases, retinal imaging, macular diseases, laser applications, and photodynamic therapy (PDT). He is also an

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Alfredo Pece, MD, an Ophthalmologist who spent 20 years in Milan, Italy, at the San Raffaele Hospital, as director of the Macula Service. In 2000, Dr Pece served as the Chief of Melegnano Hospital, Milano, Italy. He is a member of the major scientific associations such as the Macula Society, Retina Society, and Club Gonin. Dr Pece’s research interests are the diagnosis of chorioretinal diseases, retinal imaging, macular diseases, laser applications, and photodynamic therapy (PDT). He is also an author of 216 papers and 5 Books.

View full text