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Photodynamic therapy in Age-related Macular Degeneration

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Last updated: April 5th, 2022

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Summary of Evidence

Photodynamic therapy in Choroidal Neovascularization secondary to Age-related Macular Degeneration

Verteporfin PDT

 

Verteporfin PDT vs sham

 

Verteporfin therapy significantly reduced the risk of moderate and severe visual acuity loss in subfoveal CNV (occult with no classic) secondary to AMD.(VIP, 2001). {Verteporfin In Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization–verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 2001 May;131(5):541-60.}

 

Verteporfin therapy of subfoveal CNV from AMD can decrease the risk of vision loss and is recommended for predominantly classic CNV from AMD.(TAP, 2001). {Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials–TAP report. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group. Arch Ophthalmol. 1999 Oct;117(10):1329-45.}

 

Verteporfin PDT vs Ranibizumab

 

Ranibizumab provided greater clinical benefit than verteporfin PDT in patients with predominantly classic CNV secondary to AMD.(ANCHOR, 2009). {Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T; ANCHOR Study Group. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two-year results of the ANCHOR study. Ophthalmology. 2009 Jan;116(1):57-65.e5.}

 

 

Evidence

1. Background

2. Verteporfin PDT

2.1 Verteporfin PDT vs sham

2.1.1 Occult CNV

Clinical Trial

2001 VIP study group

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2001
Clinical Trial

Verteporfin therapy significantly reduced the risk of moderate and severe visual acuity loss in subfoveal CNV (occult with no classic) secondary to AMD. {Verteporfin In Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization–verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 2001 May;131(5):541-60.}

  • Randomized controlled trial of Verteporfin PDT vs placebo in subfoveal occult CNV (339 patients)
  • Findings (2-years):
    • Verteporfin PDT-treated patients received on average five treatments over the 2 years of follow-up.
    • At 1 year, moderate visual loss for both groups were similar.
    • At 2 years, there was less moderate visual loss in Verteporfin PDT-treated compared to placebo patients.
Verteporfin Placebo
Lost at least 15 letters Total 54% 67%
Occult with no classic 55% 68%
Lost at least 30 letters Total 30% 47%
Occult with no classic 29% 48%

VIP study group
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2.1.2 Classic CNV

Clinical Trial

2001 TAP study group

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2001
Clinical Trial

Verteporfin therapy of subfoveal CNV from AMD can decrease the risk of vision loss and is recommended for predominantly classic CNV from AMD. {Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials–TAP report. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group. Arch Ophthalmol. 1999 Oct;117(10):1329-45.}

  • Randomized controlled trial of Verteporfin PDT vs placebo in subfoveal classic CNV (609 patients)
  • Findings (1-year):
    • Patients who received Verteporfin PDT had better visual acuity and contrast sensitivity outcomes at 12 months compared to placebo.
    • This benefit was especially seen in patients with predominantly classic (>50% of the lesion) CNV.
    • No statistically significant differences in visual acuity were noted in patients with classic CNV between 0-50% of the lesion area.
Verteporfin PDT Placebo
Lost at least 15 letters Total 61% 46%
Classic CNV > 50% of entire lesion 67% 39%

TAP study group
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2.2 Verteporfin PDT vs Ranibizumab

Clinical Trial

2009 Brown et.al. (ANCHOR)

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2009
Clinical Trial

Ranibizumab provided greater clinical benefit than verteporfin PDT in patients with predominantly classic CNV secondary to AMD. {Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T; ANCHOR Study Group. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two-year results of the ANCHOR study. Ophthalmology. 2009 Jan;116(1):57-65.e5.}

  • Randomized controlled trial of Ranibizumab vs Verteporfin PDT in predominantly classic subfoveal CNV secondary to AMD (423 patients)
  • Findings (2-years):
Outcomes PDT RAN
Lost < 15 letters from baseline 65.7% 89.9-90.0%
Gained ≥ 15 letters 6.3% 34.0-41.0%
VA change (letters) -9.8 +8.1 to 10.7

Brown et.al. (ANCHOR)
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