Subfoveal choroidal neovascularisation (CNV)

Active Ingredient: Verteporfin

Indication for Verteporfin

Population group: only adults (18 years old or older)

Verteporfin is indicated for the treatment of:

  • adults with exudative (wet) age-related macular degeneration (AMD) with predominantly classic subfoveal choroidal neovascularisation (CNV) or
  • adults with subfoveal choroidal neovascularisation secondary to pathological myopia.

For this indication, competent medicine agencies globally authorize below treatments:

6 mg/m² once

Route of admnistration

Intravenous

Defined daily dose

6 - 6 mg per m² of body surface area (BSA)

Dosage regimen

From 6 To 6 mg per m² of body surface area (BSA) once every day

Detailed description

Verteporfin photodynamic therapy (PDT) is a two-step process:

The first step is a 10-minute intravenous infusion of verteporfin at a dose of 6 mg/m² body surface area, diluted in 30 ml infusion solution.

The second step is the light activation of verteporfin at 15 minutes after the start of the infusion.

Patients should be re-evaluated every 3 months. In the event of recurrent CNV leakage, verteporfin therapy may be given up to 4 times per year.

Treatment of the second eye with verteporfin

There are no clinical data to support concomitant treatment of the second eye. However, if treatment of the second eye is deemed necessary, light should be applied to the second eye immediately after light application in the first eye but no later than 20 minutes from the start of the infusion.

Dosage considerations

For the light activation of verteporfin, a diode laser generating non-thermal red light (wavelength 689 nm ± 3 nm) is used via a slit lamp mounted fibre optic device and a suitable contact lens. At the recommended light intensity of 600 mW/cm², it takes 83 seconds to deliver the required light dose of 50 J/cm².

The greatest linear dimension of the choroidal neovascular lesion is estimated using fluorescein angiography and fundus photography. Fundus cameras with a magnification within the range of 2.4-2.6X are recommended. The treatment spot should cover all neovasculature, blood and/or blocked fluorescence. To ensure treatment of poorly demarcated lesion borders, an additional margin of 500 μm should be added around the visible lesion. The nasal edge of the treatment spot must be at least 200 μm from the temporal edge of the optic disc. The maximum spot size used for the first treatment in the clinical studies was 6,400 μm. For treatment of lesions that are larger than the maximum treatment spot size, apply the light to the greatest possible area of active lesion.

It is important to follow the above recommendations to achieve the optimal treatment effect.

Active ingredient

Verteporfin

Verteporfin, also referred to as benzoporphyrin derivative monoacids (BPD-MA) consists of a 1:1 mixture of the equally active regioisomers BPD-MAC and BPD-MAD. It produces cytotoxic agents only when activated by light in the presence of oxygen. The selectivity of PDT using verteporfin is based, in addition to the localised light exposure, on selective and rapid uptake and retention of verteporfin by rapidly proliferating cells including the endothelium of choroidal neovasculature.

Read more about Verteporfin

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