Abstract
Subfoveal choroidal neovascularisation (CNV) is a major cause of visual disability, with age-related macular degeneration (AMD) the commonest cause. Confluent laser to CNV significantly reduces severe visual loss but the profound visual loss after treatment of subfoveal lesions and the high recurrence rate has meant its restriction to extrafoveal lesions. Developed initially as a treatment for cancers, photodynamic therapy (PDT) has been shown to successfully close CNV in the eye. Large international randomised placebo-controlled studies of the safety and efficacy of PDT with verteporfin are under way. The Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) study has demonstrated a reduction of visual loss in treated patients with any classic CNV. Subgroup analysis showed a greater benefit in predominantly classic lesions (p < 0.001, NNT: 3.6), increasing further for lesions with no occult component, roughly equivalent to pure classic (p < 0.01, NNT: 2.2) A significant benefit at 12 months has been shown in patients with CNV secondary to myopia in the Verteporfin in AMD (VIP) trial, but no benefit in pure occult lesions. Further research is required to establish cost-effectiveness and appropriate referral patterns in the UK and optimise treatment strategies. Further data are awaited from TAP/VIP. At present verteporfin PDT is indicated in eyes with subfoveal predominantly classic CNV secondary to AMD with visual acuity of 6/60 or better and lesions < 5400 µm in diameter. Juxtafoveal lesions meeting the above criteria and CNV secondary to pathological myopia should also be considered for treatment. The efficacy of treatment of larger lesions, juxtapapillary CNV, occult/no classic with high-risk characteristics (HRC) and CNV from other causes remains unclear. The treatment of minimally classic lesions and those with occult/no classic without HRC is not indicated.
Similar content being viewed by others
Article PDF
References
Klein R, Klein BE, Linton KL . Prevalence of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 1992;99:933–43.
Vingerling JR, Dielemans I, Hofman A, et al. The prevalence of age-related maculopathy in the Rotterdam study. Ophthalmology 1995;102:205–10.
Bressler NM, Bressler SB, Fine SL . Age-related macular degeneration. Surv Ophthalmol 1988;32:375–413.
Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: results of a randomized clinical trial. Arch Ophthalmol 1991;109:1220–31.
Macular Photocoagulation Study Group. Argon laser photocoagulation for neovascularisation maculopathy: five-year results from randomized clinical trials. Arch Ophthalmol 1991;109:1109–14.
Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal juxtafoveal choroidal neovascularization: five-year results from randomized clinical trial. Arch Ophthalmol 1994;112:500–9.
Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: updated findings from two clinical trials. Arch Ophthalmol 1993;111:1200–9.
Macular Photocoagulation Study Group. Visual outcome after laser photocoagulation for subfoveal choroidal neovascularization secondary to age-related macular degeneration: the influence of initial lesion size and initial visual study. Arch Ophthalmol 1994;112:480–8.
The Moorfields Macular Study Group. Treatment of senile disciform macular degeneration: single blind randomised trial by argon laser photocoagulation. Br J Ophthalmol 1982;66:745–53.
Weishaupt K, Gomer C, Doughtery T . Identification of singlet oxygen as the cytotoxic agent in photo-inactivation of murine tumor. Cancer Res 1976;36:2326–9.
Zhou C . Mechanisms of tumour necrosis induced by photodynamic therapy. J Photochem Photobiol B 1989;3:299–318.
Thomas EL, Langhofer M . Closure of experimental subretinal neovascular vessels with dihematoporphyrin ether augmented argon green laser photocoagulation. Photochem Photobiol 1987;46:881–6.
Denekamp J . Vascular endothelium as the vulnerable element in tumours. Acta Radiol Oncol 1984;23:217–25.
Rutledge JC, Curry F-RE, Lenz JF, Davis PA . Low density lipoprotein transport across a microvascular endothelial barrier after permeability is increased. Circ Res 1990;66:486–95.
Schmidt-Erfurth U, Hasan T, Gragoudas E, Michaud N, Flotte TJ, Birngurber R . Vascular targeting in photodynamic occlusion of subretinal vessels. Ophthalmology 1994;101:1953–61.
Miller JW, Walsh AW, Kramer M, et al. Photodynamic therapy of experimental choroidal neovascularization using lipoprotein-delivered benzoporphyrin. Acta Ophthalmol 1995;113:810–8.
Kramer M, Miller JW, Michaud N, et al. Liposomal benzoporphyrin derivative verteporfin photodynamic therapy: selective treatment of choroidal neovascularization in monkeys. Ophthalmology 1996;103:427–38.
Husain D, Miller JW, Michaud N, Connolly E, Flotte TJ, Gragoudas ES . Intravenous infusion of liposomal benzoporphyrin derivative for photodynamic therapy of experimental choroidal neovascularization. Arch Ophthalmol 1996;114:978–85.
Schmidt-Erfurth U, Hasan T, Schomacker K, Floffe T, Birngruber R . In vivo uptake of liposomal benzoporphyrin derivative and photothrombosis in experimental corneal neovascularization. Lasers Surg Med 1995;17:178–88.
Schmidt-Erfurth U, Banman W, Gragoudas ES, et al. Photodynamic therapy of experimental choroidal melanoma. Ophthalmology 1994;101:89–99.
Young LH, Howard MA, Hu LK, Kim RY, Gragoudas ES . Photodynamic therapy of pigmented choroidal melanomas using a liposomal preparation of benzoporphyrin derivative. Arch Ophthalmol 1996;114:186–92.
Miller JW, Schmidt-Erfurth U, Sickenberg M, et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of a single treatment in a phase 1 and 2 study. Arch Ophthalmol 1999;117:1161–73.
Schmidt-Erfurth U, Miller JW, Sickenberg M, et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of retreatments in a phase 1 and 2 study. Arch Ophthalmol 1999;117:1177–87.
Ghoto Y, Obana A, Nagata S, et al. Uptake of ATX-SlO(Na) by cultured vascular endothelial cells and its photodynamic effect. Invest Ophthalmol Vis Sci 2000;41:S175.
Hill TE, Ciulla MH, Criswell MH, Snyder WJ, Small W . Evaluation of photosensitiser MV6401 in the rabbit as a novel agent in photodynamic therapy. Invest Ophthalmol Vis Sci 2000;41:S175.
Mori K, Nakashizuka T, Hayashi N, et al. Effect of retreatment with photodynamic therapy using hydrophilic photosensitizer (NPe6) on the normal macula in Japanese monkey (M. fuscata). Invest Ophthalmol Vis Sci 2000;41:S176.
Thomas EL, Murphy RP, Tressler CS, et al. Photodynamic therapy with tin ethyl etiopurpurin (SnET2) of subfoveal choroidal neovascularisation (CNV) in age-related maculopathy: study design and baseline characteristics. Invest Ophthalmol Vis Sci 2000;41:S531.
TAP study group. Photodynamic therapy of subfoveal choroidal neovascularisation in age-related macular degeneration with verteporfin: one-year results of 2 randomised clinical trials. TAP report 1. Arch Ophthalmol 1999;117:1329–45.
Hart PA, Harding SP . Is it time for a national screening programme for sight-threatening diabetic retinopathy? [editorial]. Eye 1999;13:129–30.
Wormald R, Evans J, Smeeth L . Photodynamic therapy for neovascular age-related macular degeneration [Cochrane Review]. Cochrane Eyes and Vision Group. Cochrane Library, issue 3, 2000. Oxford: Update Software. http://www. cochrane.co.uk
Michels S, Barbazetto I, Schmidt-Erfurth U . ICG-angiographic evaluation of photodynamic therapy in the TAP investigation. Invest Ophthalmol Vis Sci 2000;41:S532.
Singerman L and the TAP study group. Photodynamic therapy of subfoveal choroidal neovascularisation in age-related macular degeneration using verteporfin (Visudyne): exploratory analysis of good visual outcomes. TAP report 4. Invest Ophthalmol Vis Sci 2000;41:S531.
Evans J, Rooney C, Ashwood F, Dattani N, Wormald R . Blindness and partial sight in England and Wales: April 1990-March 1991. Health Trends 1996;28:5–12.
Moisseiev J, Alhalel A, Masuri R, Treister G . The impact of the Macular Photocoagulation Study results on the treatment of exudative age-related macular degeneration. Arch Ophthalmol 1995;113:185–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Harding, S. Photodynamic therapy in the treatment of subfoveal choroidal neovascularisation. Eye 15, 407–412 (2001). https://doi.org/10.1038/eye.2001.145
Issue Date:
DOI: https://doi.org/10.1038/eye.2001.145
This article is cited by
-
Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization secondary to pathologic myopia—1-year results of a prospective series
Eye (2005)
-
Photodynamic therapy with verteporfin for choroidal neovascularisation associated with angioid streaks
Graefe's Archive for Clinical and Experimental Ophthalmology (2005)
-
Outcomes in verteporfin photodynamic therapy for choroidal neovascularisation—‘beyond the TAP study’
Eye (2004)
-
Editorial
Eye (2001)