Photodynamic therapy with verteporfin for choroidal neovascularization in patients with diabetic retinopathy

PURPOSE: To report the use of photodynamic therapy (PDT) with verteporfin i n three patients with choroidal neovascularization (CNV) from age-related m acular degeneration and underlying diabetic retinopathy. The level of diabe tic retinopathy would have excluded these patients from participation in pr eviously reported randomized clinical trials evaluating PDT with verteporfi n due to a theoretic concern of damage to the overlying retinal vasculature . DESIGN: Retrospective interventional case series. METHODS: Three patients from a referral practice with at least severe nonpr oliferative diabetic retinopathy and a history of clinically significant ma cular edema developed loss of vision from concurrent choroidal neovasculari za-decreased area of fluorescein leakage from CNV. One eye that had new sub retinal hemorrhage following treatment appeared to show new vasculopathy on initial evaluation of the post-treatment angiogram. Retrospective review s uggested that the subretinal hemorrhage provided increased contrast to more easily visualize vasculopathy that was present before the PDT. CONCLUSIONS : Three patients with diabetic retinopathy undergoing a total of seven PDT treatments with verteporfin in four eyes had no new retinal vascular abnorm alities develop. No other atypical responses of CNV to PDT were noted excep t new subretinal hemorrhage, providing increased contrast of the overlying vasculature, which gave the false impression of the development of new vasc ulopathy in one eye. Patients with diabetic retinopathy who have concurrent CNV for which PDT with verteporfin is recommended should be cautioned rega rding the theoretical concerns of harming the retinal vasculature. Periodic surveillance for such concerns seems warranted until more experience is ob tained. (C) 2001 by Elsevier Science Inc. All rights reserved.