Verteporfin: new indication. In certain age-related macular degeneration: too little evidence

(1) The standard treatment for neovascular forms of age-related macular degeneration is thermal coagulation by argon or krypton laser, but it is only suitable for patients with juxtafoveal or extrafoveal neovascularisation. (2) Verteporfin, a photosensitising agent, is injected intravenously 15 minutes before non thermal red laser activation. This protocol was initially restricted to patients with predominantly visible neovascularisation in the subfoveal choroidal region. In Europe (but not in the United States), this treatment has now been approved for patients with occult subfoveal neovascularisation, i.e. poorly defined zones of fluorescein diffusion. (3) Use in this indication is supported by a single double-blind trial comparing red laser + verteporfin with red laser + placebo. After one year's treatment there was no difference between the groups in the number of patients whose loss of visual acuity had stabilised. One of the several statistical analyses showed that red laser + verteporfin was significantly more effective than red laser + placebo at two years, after five treatment sessions on average. Only a minority of patients benefited, however, and these cannot yet be identified before treatment. It is unclear whether efficacy persists in the long term. (4) Some patients experienced a transient visual deterioration. Verteporfin infusion can provoke local reactions and thoracic or lumbar pain. Cutaneous photosensitisation can occur for 48 hours after treatment. (5) Treatment with verteporfin is expensive. (6) In practice, there is currently no reason to use red laser + verteporfin in patients with age-related macular degeneration and occult neovascularisation, other than in clinical trials.