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Evidence summaries

Photodynamic Therapy for Neovascular Age-Related Macular Degeneration

Photodynamic therapy for choroidal neovascularisation due to age-related macular degeneration (AMD) is effective in preventing visual loss; approximately eight people need to be treated with an average of five treatments over two years to prevent one person losing 3 or more lines of visual acuity. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 4 trials comparing photodynamic therapy (PDT) with verteporfin to PDT with 5% dextrose in water (placebo treatment), with a total of 1 429 participants. Three out of the four trials were performed by the same investigators using largely the same clinical centres and funded by manufacturers of verteporfin. Participants received on average five treatments over two years. The risk ratio of losing three or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.80 (95% CI 0.73 to 0.88). The risk ratio of losing six or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.66 (95% CI 0.56 to 0.83). The results at 12 months were similar to those at 24 months. The most serious adverse outcome, acute (within 7 days of treatment) severe visual acuity decrease, occurred in about 11 per 1000 patients (RR 3.75, 95% CI 0.87 to 16.12). Infusion related back pain was experienced by 20 per 1000.Two further trials compared different treatment regimens: standard versus delayed light application; retreatment every two months versus every three months. Neither trial demonstrated differences in effectiveness.

    References

    • Wormald R, Evans J, Smeeth L, Henshaw K. Photodynamic therapy for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2007;(3):CD002030 [Last assessed as up-to-date: 22 April 2009]. [PubMed]

Primary/Secondary Keywords