Photodynamic therapy with verteporfin for choroidal neovacularization in patient with diabetic retinopathy

PURPOE: To report the ue of photodynamic therapy (PDT) with verteporfin in three patient with choroidal neovacularization (CNV) from age-related macular degeneration and underlying diabetic retinopathy. The level of diabetic retinopathy would have excluded thee patient from participation in previouly reported randomized clinical trial evaluating PDT with verteporfin due to a theoretic concern of damage to the overlying retinal vaculature. DEIGN: Retropective interventional cae erie. METHOD: Three patient from a referral practice with at leat evere nonproliferative diabetic retinopathy and a hitory of clinically ignificant macular edema developed lo of viion from concurrent choroidal neovacularization evaluated with fundu photography and fluorecein angiography before and after PDT with verteporfin to identify advere retinal vacular event. REULT: Four eye in three patient had PDT uing verteporfin. Three eye received two treatment. With hort follow-up, viual acuity remained table in two eye, improved from 20/400 to 20/320 in one eye, and decreaed from 20/200 to 20/400 in one eye. Fluorecein angiogram at interval from 2 week to 3 month after PDT howed no damage to the retinal vaculature or progreion of the diabetic retinopathy, but did how a decreaed area of fluorecein leakage from CNV. One eye that had new ubretinal hemorrhage following treatment appeared to how new vaculopathy on initial evaluation of the pot-treatment angiogram. Retropective review uggeted that the ubretinal hemorrhage provided increaed contrat to more eaily viualize vaculopathy that wa preent before the PDT. CONCLUION: Three patient with diabetic retinopathy undergoing a total of even PDT treatment with verteporfin in four eye had no new retinal vacular abnormalitie develop. No other atypical repone of CNV to PDT were noted except new ubretinal hemorrhage, providing increaed contrat of the overlying vaculature, which gave the fale impreion of the development of new vaculopathy in one eye. Patient with diabetic retinopathy who have concurrent CNV for which PDT with verteporfin i recommended hould be cautioned regarding the theoretical concern of harming the retinal vaculature. Periodic urveillance for uch concern eem warranted until more experience i obtained