Photodynamic therapy with verteporfin for age-related macular degeneration

Objective: This document describes photodynamic therapy (PDT) with vertepor fin for age-related macular degeneration (AMD) and examines the evidence to answer the key question about whether the treatment is safe and effective in reducing visual loss from AMD. Methods: A literature search that was conducted in April 2000 retrieved eig ht relevant citations, and the reference lists of these articles were consu lted for additional citations. Panel members reviewed this information, and a methodologist reviewed and rated all articles according to the strength of evidence. Results: The published literature contains a report of the combined results from two identically designed, double-masked randomized controlled trials. Ninety-four percent of participants completed the one-year follow up. Pati ents treated with verteporfin had a decreased risk of at least moderate vis ual loss over this one-year period, but the beneficial effect on visual acu ity was greatest among eyes in which the area of classic choroidal neovascu larization (CNV) occupied 50% or more of the entire lesion area. There was no statistically significant difference in visual acuity outcomes at one ye ar for eyes in which the classic CNV was more than 0% but less than 50% of the area of the entire lesion. Serious systemic complications were rare. Se vere vision decrease (equivalent to four lines or more of vision) within 7 days of treatment with verteporfin has been reported in 1% to 4% of patient s. Partial recovery of vision was observed in many of these patients. Conclusions: To date, evidence suggests that PDT using verteporfin can redu ce the risk of visual loss in patients with predominantly classic subfoveal CNV from AMD at one year. The rate of ocular and systemic complications is low. Additional clinical research is needed to determine the long-term eff ectiveness of treatment and the comparative effectiveness with existing and new treatment modalities under investigation. (C) 2000 by the American Aca demy of Ophthalmology.