Choroidal neovascularization

Early macular changes are often called age-related macu-lopathy and are characterized by large drusen and pigmentary abnormalities in the macula.20 Age-related maculopathy accounts for 85% to 90% of all age-related macular changes. Ten to fifteen percent of these patients will develop advanced atrophy and/or develop abnormal blood vessels in and under the retina called choroidal neovascular membranes. Patients are then classified as having AMD.23... 

Drusen ablation may help patients with multiple large drusen in both eyes that have not progressed to neovascular macular degeneration. These laser treatments may lead to resolution of the drusen and improved visual acuity. However, it is not clear if progression to choroidal neovascular membranes and neovascular macular degeneration is reduced.23 There is a possibility that the laser treatments may induce choroidal neovascularization and retinal atrophy.22... 

Choroidal neovascular membranes Development of abnormal blood vessels in and under the retina. 

Izumi-Nagai, K., N. Nagai et al. (2007). Macular pigment lutein is antiinflammatory in preventing choroidal neovascularization. Arterioscler. Thromb. Vase. Biol., Oct. 11 [Epub ahead of print]. 

Miller, JW, Walsh, AW, Kramer, M, Hasan, T, Michaud, N, Flotte, TJ, Haimovici, R, and Gragoudas, ES, 1995. Photodynamic therapy of experimental choroidal neovascularization using lipoprotein-delivered benzo-porphyrin. Arch Ophthalmol 113, 810-818. 

Nozaki, M, Raisler, BJ, Sakurai, E, Sarma, JV, Bamum, SR, Lambris, JD, Chen, Y, Zhang, K, Ambati, BK, Baffi, JZ, and Ambati, J, 2006. Drusen complement components C3a and C5a promote choroidal neovascularization. Proc Natl Acad Sci USA 103, 2328-2333. 

Owens, SL, Bunce, C, Brannon, AJ, Xing, W, Chisholm, IH, Gross, M, Guymer, RH, Holz, FG, and Bird, AC, 2006. Prophylactic laser treatment hastens choroidal neovascularization in unilateral age-related maculopathy Final results of the drusen laser study. Am J Ophthalmol 141, 276-281. 

Motexafin lutetium is also in clinical trials, having completed several Phase I and II studies. The completed trials are for the photodynamic treatment of recurrent breast cancer [41,42], light-based treatment of choroidal neovascularization, [43] and the photoangioplastic reduction of atherosclerotic plaque in peripheral [19,44] and coronary arterial disease [20,45], On the basis of these studies, MLu (Antrin Phototherapy) is currently being developed for the treatment of atherosclerotic plaque. Additionally, the National Cancer Institute is testing MLu for the PDT based treatment of prostate [46,47] and cervical cancers. 

Vine AK, Brewer GJ. Tetrathiomolybdate as an antiangiogenesis therapy for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Trans Am Ophthalmol Soc 2002 100 73-76 discussion 76-77. 

Choroidal neovascularization associated with age-related macular degeneration is difficult to treat with conventional laser procedures because normal retinal tissues can be destroyed, which results in loss of central vision. Photodynamic therapy offers the opportimity to selectively eradicate neovascular membranes while producing minimal damage to normal retinal and choroidal tissues. 

Augustin AJ, D Amico DJ, Mieler WF, et al. Safety of posterior juxtascleral depot administration of the angiostatic cortisone anecortave acetate for treatment of subfoveal choroidal neovascularization in patients with age-related macular degeneration. Graefes Arch CUn Exp Ophthalmol 2005 243 9-12. 

MUler JW, Schmidt-Erfurth U, Sickenberg M, et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration. Arch OphthaUnol 1999 117 1161-1173. 

Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macmar degeneration with verteporfin. Arch Ophthalmol 1999 117 1329-1345. 

Destro M, PuMafito CA. Indocyanine green videoangiography of choroidal neovascularization. Ophthalmology 1989 ... 

Slatker JS, Yannuzzi LA, Sorenson AJ, et al. A pilot smdy of indocyanine green videoangiography-guided laser photocoagulation of occult choroidal neovascularization in... 

Yannuzzi LA, Slakter JS, Sorenson JA, et al. Digital indocyanine green videoangiography and choroidal neovascularization. Retina 1992 12 191-221. 

PDT has become a widely used treatment modality for choroidal neovascularization in AMD and has been extensively studied in the TAP and VIP trials. There is less extensive study of PDT in other conditions, but clinicians have reported its use in a variety of entities, including... 

Although it has not been compared directly with verteporfin, rostaporfin appears to have the same potential for management of choroidal neovascularization. Fifteen minutes after intravenous infusion, a red nonthermal diode laser source (664 nm) is used to activate the drug. The phase III trial compared rostaporfin with placebo in over 900 patients with vision between 20/500 and 20/40 and determined that patients treated with rostaporfin 0.5 mg/kg had stable vision compared with placebo recipients (65.6% vs. 39.3%). Patients with vision better than 20/200 and study-compliant lesion size likewise had significantly higher rates of stable vision compared with placebo (63.2% vs. 25%). A smaller subset of patients with predominantly occult CNV detrived a treatment benefit relative to placebo for patients losing less than 15 letters of acuity (63.6% vs. 29.4%). 

Keam SJ, Scott LJ, Curran MR Verteporfin a review of its use in the management of subfoveal choroidal neovascularization. Drugs 2003 63 2521. 

Verteporfin in Photodynamic Therapy Smdy Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—Verteporfin in Photodynamic Therapy Report 2. Am J Ophthalmol 2001 131 541. 

Verteporfin Roundtable Participants. Guidelines for using verteporfin (Visudyne) in photodynamic therapy for choroidal neovascularization due to age-related macular degeneration and other causes update. Retina 2005 25 119. 

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