Photodynamic therapy with verteporfin for choroidal neovascularisation associated with angioid streaks

Choroidal neovascularisations (CNV) is the major cause of significant visual loss in patients with angioid streaks. We evaluated the functional and morphological outcome of Verteporfin photodynamic therapy (PDT) in the treatment of these patients.

This was a retrospective study in two tertiary referral centres over a 3-year period. Examinations included visual acuity assessment with ETDRS charts, binocular fundoscopy and fluorescein angiography. PDT was performed with standard parameters; earlier retreatments were feasible in active CNV.

Fifteen eyes from 12 patients (9 male, 3 female) with a follow-up of 12–50 months (mean 26.1, median 19 months) were included. Five lesions were extra-or juxtafoveal and ten were subfoveal. Baseline visual acuity was between 20/63 and 20/16 (mean 20/32, median 20/32). Eyes were treated with two to eight treatments of PDT (mean 4.2, median 4). Treatment intervals were between 5.6 and 72 weeks (mean 12.1, median 9.2 weeks). At the 1-year follow-up, visual acuity was below 20/200 in 27% (4/15), 20/200 or better in 73% (11/15) and 20/63 or better in 47% (7/15) with an improvement of >3 lines in 13% (2/15), no change in 27% (4/15) and a decrease of >3 lines in 60% (9/15). At the final follow-up examination, all lesions were located subfoveally. Visual acuity was below 20/200 in 47% (7/15), 20/200 or better in 53% (8/15) and 20/63 or better in 13% (2/15) with a change in visual acuity between +2 and −18 lines (mean −9 lines, median −8 lines). No change was noted in 7% (1/15) and a decrease of >3 lines in 93% (14/15) of eyes. The maximum measured greatest linear dimension of the lesion during the follow-up varied between 2400 μm and 6200 μm (mean 3680 μm, median 3600 μm) with an increase in the lesion size compared with baseline values between ±0 μm and +3700 μm (mean+1420 μm, median+1500 μm).

PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss. Further modifications of the treatments parameters or a combination with other therapeutical options seem warranted for a more effective treatment of these lesions.