Effect of photodynamic therapy with Verteporphyrinon high contrast discriminated target central fields

Stephen H. Sinclair¹, C. Pelino¹, W. Li¹, P. Presti² (¹Philadelphia, ²Atlanta)

Background: Previously vision changes with photodynamic therapy and systemic verteporphyrin
for choroidal neovascularization due to AMD have been evaluated using only visual acuity. The treatment and vision outcomes have not been evaluated with regard to the effect on the central visual field.
Patients and Methods: In this pilot project 21 eyes of 19 patients undergoing photodynamic therapy for choroidal neovascularization due to AMD were evaluated with central visual field testing using high contrast discriminated targets (MAVES) prior to and at 3 months following each treatment session. The fluorescein angiograms were examined for the type of the CNVM lesion (classic:occult), the amount of subretinal fluid,exudates, and hemorrhage, the severity of leakage, the amount of RPE atrophy, and the response of each through the treatment sessions. Correlations were drawn between these variables and the visual field alterations.
Results: The average duration of treatment and follow-up was 14.8 months with none less than 6 months. Among the 21 eyes, 8 demonstrated complete involution with variable fibrosis and RPE atrophy, but no significant residual leakage, 8 a partial decrease in size or leakage, 3 no response, and in 2 a worsening of the leakage or increase in CNVM size. Minimal or no visual acuity decline occurred among those with complete or partial regression, or those unchanged. Among the 16 who demonstrated complete or partial CNVM involution with treatment, the central field testing demonstrated a shrinkage
of the central scotoma size in 10, stabilization in 2 and enlargement in 2.
Improvement in central scotoma density was noted in 5. The greatest responses were observed following treatment sessions with intravitreal triamcinolone combined with verteporphyrin. Scotoma size rapidly increased and the density worsened if treatment produced no improvement in leakage. Central field defects correlated with progressive RPE atrophy, and with residual leakage. Fibrosis of the CNVM, if large, produced a wide central scotoma, but smaller fibrotic areas with hardened edges were associated with improved paraxial field.
Conclusion: Central visual field testing with discriminated targets offers an improved understanding of retinal pathology and resulting vision for eyes undergoing photodynamic therapy for choroidal neovascularization due to AMD.

Back