Verteporfin: new preparation. In combination with laser therapy: helpful in some forms of age-related macular...

(1) The reference treatment for neovascular forms of age-related macular degeneration is laser coagulation of the neovessels, but it is not applicable to subfoveal lesions. (2) Verteporfin, a photosensitising agent, is injected 15 minutes before red laser therapy in patients with neovascularisation predominantly visible in the subfoveal choroidial region. (3) The clinical file mainly comprises two double-blind placebo-controlled trials with identical designs, in which verteporfin was injected before laser therapy. These trials show that verteporfin-laser combination therapy sometimes improves visual acuity (16% of eyes, versus 7% with laser therapy alone). It also moderately reduces the loss of vision measured at 2 years: 53% of patients have a limited loss, compared with 38% of patients treated with laser alone. The impact of this difference on daily life activities is not known. (4) A retrospective subgroup analysis suggests that only patients with predominantly visible neovascularisation benefit from treatment with verteporfin. (5) The main adverse effects of verteporfin are visual. Prolonged reduction in visual acuity has mainly been reported in patients with occult neovascularisation. The main systemic risk is of photosensitivity reactions, and precautions must be taken for 48 hours following treatment. (6) In practice, only patients with subfoveal neovessels are likely to benefit from red laser + verteporfin combination therapy. (7) Verteporfin therapy is very expensive.