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Cho, Bae, Han, Kim, and Nam: Photodynamic Therapy of Choroidal Neovascularization in Age-Related Macular Degeneration with Verteporfin: An Analysis of 10 Years of Clinical Results
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(1): 59-67.

Published online: 16 January 2012

DOI: https://doi.org/10.3341/jkos.2012.53.1.59

Photodynamic Therapy of Choroidal Neovascularization in Age-Related Macular Degeneration with Verteporfin: An Analysis of 10 Years of Clinical Results

Doo Young Cho, MD1, So Hyun Bae, MD1, Jae Ryong Han, MD2, Ha Kyoung Kim, MD, PhD1, Woo Ho Nam, MD1

1Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

2Department of Ophthalmology, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Address reprint requests to Woo Ho Nam, MD. Department of Ophthalmology, Kangnam Sacred Heart Hospital, #948-1 Daerim 1-dong, Yeongdeungpo-gu, Seoul 150-950, Korea. Tel: 82-2-829-5193, Fax: 82-2-848-4638, wooho.nam@gmail.com

Received 7 June 2011       Accepted 18 November 2011

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To analyze the long-term results of photodynamic therapy (PDT) for exudative age-related macular degeneration (AMD).

Methods

The clinical data of patients treated with photodynamic therapy for exudative age-related macular degeneration between April 2000 and December 2000 were analyzed. Patients were followed-up for at least 10 years after PDT.

Results

Twenty-nine eyes of 29 patients were enrolled. Mean visual acuity on the logarithm of the minimum angle of resolution (log MAR) scale was 0.78 ± 0.34 at baseline, 1.01 ± 0.42 at 60 months, and 1.02 ± 0.41 at 120 months. Predominantly classic, minimally classic, and occult without classic choroidal neovascularization was noted in 51.7%, 17.2%, and 31.1% of patients, respectively. Visual acuity was improved by 1 or more lines in 27.6% of patients and was unchanged in 20.7% of patients, while 51.7% of patients had lost 1 or more lines of visual acuity by 120 months. Baseline visual acuity and age were associated with the final visual prognosis (p < 0.05). Four patients developed neovascular AMD in the contralateral eye.

Conclusions

PDT is safe and effective for neovascular AMD. However, AMD can recur at any time and thus patients should be followed-up for a long period of time.

Keywords: Age-related macular degeneration (AMD), Choroidal neovascularization (CNV), Photodynamic therapy (PDT)

Figures and Tables

Figure 1
Comparison of visual acuity (log MAR) among predominantly classic, minimally classic, and occult without classic choroidal neovascularizaion for 120 months follow-up after photodynamic therapy.
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Figure 2
Comparison of visual acuity (log MAR) between subfoveal choroidal neovascularization and juxtafoveal choroidal neovascularization for 120 months follow-up after photodynamic therapy.
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Figure 3
Multiple linear regression analysis evaluating the effect of age (A) and baseline visual acuity (B) on the amount of change of visual acuity (Δlog MAR) at the last follow-up. The lower the age and baseline visual acuity, the less the changes of log MAR visual acuity at the last follow-up (t = 4.068, p = 0.001 and t = -2.357, p = 0.027, respectively).
jkos-53-59-g003
Figure 4
Comparison of visual acuity (log MAR) between the patients only treated by photodynamic therapy and the patients who were treated by additional anti-VEGF treatment because of choroidal neovascularization recurrence.
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Figure 5
A right eye of a 68-year old man with predominatly classic choroidal neovascularization (CNV). The images were acquired by fluorescein angiography (A-D) or indocyanine green angiography (E, F) (A) Fluorescein angiography showed predominantly classic CNV in the subfoveal area before photodynamic treatment. (B) At 3 months after the first photodynamic therapy, the lesion size decreased but leakage remained. Subsequently, he was retreated by photodynamic therapy. (C) At 3 months after the second photodynamic therapy, leakage did not disappear completely and atrophy of the retinal pigment epithelium was observed. The author then performed a 3rd session of Photodynamic therapy. (D) At 18 months after the third photodynamic therapy, there was no active leakage from CNV, but RPE atrophy remained. (E) Seven years after the first photodynamic therapy, a new CNV lesion with subretinal hemorrhage appeared. The patient was then treated with combination treatment of photodynamic therapy and intravitreal bevacizumab injection, followed by two additional injections of bevacizumab. (F) Ten years later from the first photodynamic therapy, the CNV was stabilized but mild leakage still remained.
jkos-53-59-g005
Table 1
Patient characteristics and baseline data
jkos-53-59-i001

Values are mean ± SD or number.

GLD = greatest linear dimension.

*Oneway ANOVA test; †Mann-Whitney U-test.

Table 2
Visual outcomes of patients according to choroidal neovascular type at 24-month, 60-month, and 120-month follow-up visit
jkos-53-59-i002

*Amount of changes of visual acuity between baseline visual acuity and visual acuity of each visit.

Table 3
Visual acuity and variations related to the localization of choroidal neovascularization (CNV)
jkos-53-59-i003

*Mann-Whitney U-test; †Amount of changes of visual acuity between baseline and final visual acuity.

Table 4
Numbers of patients who was treated with anti-vascular endothelial growth factor after photodynamic therapy
jkos-53-59-i004

*Vascular endothelial growth factor.

Table 5
Visual acuity of patients who was treated with anti-vascular endothelial growth factor after photodynamic therapy
jkos-53-59-i005

Values are mean ± SD.

*Wilcoxon signed rank test.

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