Photodynamic therapy with verteporfin following transpupillary thermotherapy for CNV evolving from an initially occult to a predominantly classic form, in patients with AMD

The purpose of this paper is to evaluate photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) that converted from occult CNV to classic CNV after treatment with transpupillary thermotherapy (TTT). One hundred and fifty-four eyes of 130 patients with symptomatic occult CNV were treated between June 2000 and August 2001. We have analyzed data from patients treated with PDT because of a conversion from occult to classic CNV after TTT. The results were that twenty-four of 154 eyes developed a predominantly classic CNV; 20 eyes of 19 consecutive patients were treated with PDT with verteporfin. The mean follow-up period was 10 months. The mean delay for retreatment with TTT was 3 months; 3 eyes initially presented a pure occult CNV, 15 a minimally classic CNV, 1 an occult CNV with pigment epithelial detachment, and 1 a large macular subretinal hemorrhage with a subfoveal focal hot spot. The average classic component within a lesion before TTT was 20%. Recurrence of classic CNV was noted in the first 3 months for 14 eyes. Visual acuity improved in 5 eyes by >/=2 lines, and in 2 eyes by 1 line; 4 of 20 eyes had stabilized visual acuity; 7 eyes had a visual acuity decline of >/=2 lines; 2 eyes lost 1 line. All patients had reduction of metamorphopsia and reduction of exudation; 14 eyes had a little subretinal fibrosis and some partially atrophic areas; 6 eyes had slightly increased leakage in the late phase of the angiogram. In conclusion, association of TTT and PDT appears to be safe and may help practitioners to manage some difficult cases. This study seems to confirm the great efficacy of PDT in CNV with recent activity.