Objective:To determine whether data from patients with agerelated macular degeneration(AMD)assigned to the placebo group in the Verteporfin in Photodynamic Therapy(VIP)-Trial provide a rationale for continuation or ce...Objective:To determine whether data from patients with agerelated macular degeneration(AMD)assigned to the placebo group in the Verteporfin in Photodynamic Therapy(VIP)-Trial provide a rationale for continuation or cessation of follow-up of individuals with subfoveal occult choroidal neovascularization(CNV)with no classic lesions,presumed recent disease progression,larger lesion size(> 4 disc areas),and a higher level of visual acuity(approximate Snellen equivalent,≥ 20/50 in the affected eye)in whom no treatment is given at initial examination.Methods:In a prospective,noncomparative case series,angiograms of participants assigned to a placebo group who had occult with no classic lesion composition at baseline were reviewed to identify conversion to minimally classic(area of classic CNV > 0% but < 50% of the entire lesion area)or predominantly classic(area of classic CNV ≥ 50% of the entire lesion area)composition.Results:Of the 114 patients with AMD assigned to the placebo group,89 were judged to have occult with no classic lesion composition at baseline in the study eye when fluorescein angiograms were reviewed in late 2001 for this report.By 24 months,7(8%)of the 89 patients had lesions that converted to predominantly classic composition,and 41(46%)had minimally classic composition.Among the 24 patients with a baseline visual acuity better than 20/50-1 and lesion size greater than 4 disc areas whose lesions did not convert to predominantly classic composition,the visual acuity of 18(75%)dropped below 20/50.Six of these 18 continued to have occult with no classic CNV with a visual acuity of 20/100 or better and had a lesion size no greater than 9 disc areas at the time that visual acuity dropped below 20/50.Conclusions:Continued monitoring,rather than cessation of follow-up,is recommended for patients with occult with no classic lesions,similar to those patients enrolled in the VIP Trial who did not initially receive treatment when they had relatively large lesions with good visual acuity.In these cases,if visual acuity decreases or predominantly classic features develop,photodynamic therapy with verteporfin or pegaptanib sodium injections may be considered.展开更多
Objective To evaluate the safety, effect on visual function, and fluorescein a ngiographic appearance of subfoveal choroidal neovascularization (CNV) through 2 years after photodynamic therapy with verteporfin (Visudy...Objective To evaluate the safety, effect on visual function, and fluorescein a ngiographic appearance of subfoveal choroidal neovascularization (CNV) through 2 years after photodynamic therapy with verteporfin (Visudyne; Novartis AG, Basel , Switzerland) in patients with ocular histoplasmosis syndrome (OHS). Design Ope n-label, 3-center, uncontrolled clinical study. Participants Ocular histoplasm osis syndrome patients with subfoveal CNV (N=26) with a greatest linear dimensio n no larger than 5400 μm with classic or occult CNV extending under the geometr ic center of the fovea, and best-corrected visual acuity letter score of approx imately 20/40 to 20/200. Methods The methods were similar to those described in the 1-year results with follow-up examinations every 3 months continuing throu gh the second year. During the second year, additional therapy was recommended i f fluorescein angiography showed leakage at a scheduled visit. Main outcome meas urements Visual function measurements included the changes from baseline in visu al acuity and contrast sensitivity scores. Lesion size and leakage from classic and occult CNV were assessed at month 12 and month 24. Safety assessments also w ere made. Results A 24-month examination was completed in 22 of the 26 enrolled participants (85%). At the 24-month examination, median improvement from base line in visual acuity of the 22 patients evaluated was 6 letters; median contras t sensitivity improved by 3.5 letters. At the 24-month examination, 10 patients (45%) gained 7 or more letters of visual acuity from baseline, whereas 4 patie nts (18%) lost 8 or more letters, including 2 patients (9%) who lost at least 15 letters. There was absence of fluorescein angiographic leakage from classic C NV in 17 of the 20 evaluable lesions (85%), and leakage from occult CNV was abs ent in all eyes. No serious ocular adverse events were reported, and no serious systemic event was considered to be associated with treatment. Conclusions Media n visual acuity improved and fluorescein angiographic leakage decreased after ve rteporfin therapy in this small, uncontrolled clinical study of patients with su bfoveal CNV resulting from OHS. Verteporfin therapy seemed to be relatively safe in these patients. The selected cases feature fluorescein angiographic examples of CNV that are important in determining when to apply verteporfin therapy.展开更多
文摘Objective:To determine whether data from patients with agerelated macular degeneration(AMD)assigned to the placebo group in the Verteporfin in Photodynamic Therapy(VIP)-Trial provide a rationale for continuation or cessation of follow-up of individuals with subfoveal occult choroidal neovascularization(CNV)with no classic lesions,presumed recent disease progression,larger lesion size(> 4 disc areas),and a higher level of visual acuity(approximate Snellen equivalent,≥ 20/50 in the affected eye)in whom no treatment is given at initial examination.Methods:In a prospective,noncomparative case series,angiograms of participants assigned to a placebo group who had occult with no classic lesion composition at baseline were reviewed to identify conversion to minimally classic(area of classic CNV > 0% but < 50% of the entire lesion area)or predominantly classic(area of classic CNV ≥ 50% of the entire lesion area)composition.Results:Of the 114 patients with AMD assigned to the placebo group,89 were judged to have occult with no classic lesion composition at baseline in the study eye when fluorescein angiograms were reviewed in late 2001 for this report.By 24 months,7(8%)of the 89 patients had lesions that converted to predominantly classic composition,and 41(46%)had minimally classic composition.Among the 24 patients with a baseline visual acuity better than 20/50-1 and lesion size greater than 4 disc areas whose lesions did not convert to predominantly classic composition,the visual acuity of 18(75%)dropped below 20/50.Six of these 18 continued to have occult with no classic CNV with a visual acuity of 20/100 or better and had a lesion size no greater than 9 disc areas at the time that visual acuity dropped below 20/50.Conclusions:Continued monitoring,rather than cessation of follow-up,is recommended for patients with occult with no classic lesions,similar to those patients enrolled in the VIP Trial who did not initially receive treatment when they had relatively large lesions with good visual acuity.In these cases,if visual acuity decreases or predominantly classic features develop,photodynamic therapy with verteporfin or pegaptanib sodium injections may be considered.
文摘Objective To evaluate the safety, effect on visual function, and fluorescein a ngiographic appearance of subfoveal choroidal neovascularization (CNV) through 2 years after photodynamic therapy with verteporfin (Visudyne; Novartis AG, Basel , Switzerland) in patients with ocular histoplasmosis syndrome (OHS). Design Ope n-label, 3-center, uncontrolled clinical study. Participants Ocular histoplasm osis syndrome patients with subfoveal CNV (N=26) with a greatest linear dimensio n no larger than 5400 μm with classic or occult CNV extending under the geometr ic center of the fovea, and best-corrected visual acuity letter score of approx imately 20/40 to 20/200. Methods The methods were similar to those described in the 1-year results with follow-up examinations every 3 months continuing throu gh the second year. During the second year, additional therapy was recommended i f fluorescein angiography showed leakage at a scheduled visit. Main outcome meas urements Visual function measurements included the changes from baseline in visu al acuity and contrast sensitivity scores. Lesion size and leakage from classic and occult CNV were assessed at month 12 and month 24. Safety assessments also w ere made. Results A 24-month examination was completed in 22 of the 26 enrolled participants (85%). At the 24-month examination, median improvement from base line in visual acuity of the 22 patients evaluated was 6 letters; median contras t sensitivity improved by 3.5 letters. At the 24-month examination, 10 patients (45%) gained 7 or more letters of visual acuity from baseline, whereas 4 patie nts (18%) lost 8 or more letters, including 2 patients (9%) who lost at least 15 letters. There was absence of fluorescein angiographic leakage from classic C NV in 17 of the 20 evaluable lesions (85%), and leakage from occult CNV was abs ent in all eyes. No serious ocular adverse events were reported, and no serious systemic event was considered to be associated with treatment. Conclusions Media n visual acuity improved and fluorescein angiographic leakage decreased after ve rteporfin therapy in this small, uncontrolled clinical study of patients with su bfoveal CNV resulting from OHS. Verteporfin therapy seemed to be relatively safe in these patients. The selected cases feature fluorescein angiographic examples of CNV that are important in determining when to apply verteporfin therapy.
