MACULAR PHOTOCOAGULATION STUDY (MPS)

• Purpose: to evaluate laser treatment of CNV through 3 sets of RCTs

1. ARGON STUDY – to study the efficacy of argon blue-green laser

photocoagulation in the treatment of CNV in the prevention or delay of
central vision loss (AMD, POH, INVM)
2. KRYTON STUDY – to determine whether krypton red laser
photocoagulation of CNVs within the parafoveal area is beneficial in the
prevention or delay of visual acuity
3. FOVEAL STUDY – to determine whether laser photocoagulation is
beneficial in the prevention or delay of further visual acuity loss in
patient with new or recurrent CNV under the center of FAZ
ELIGIBILITY CRITERIA:
• Visual symptoms attributable to macular lesion
• Visible, well-demarcated hyperfluorescence consistent with classic
CNV on FA
• AMD: >50 years old, drusen in macula in >1 eye
• POH: >18 years old, one characteristic histo spot in >1 eye
• INVM: >18 years old, no evidence of AMD, POH, angioid streaks, high
myopia, DR, or other identifiable cause of CNV
• Argon Study: Clinical serous RD with diffuse area of leakage and
discrete extrafoveal CNV, VA>20/100 in study eye
• Krypton Study: CNV with blood/pigment extending into the CNV;
posterior border of CNV extend as close as 1 micron to FAZ center;
VA>20/400
• Foveal Study: AMD patients only. FA showing leaking CNV extending
under center of FAZ, or CNV consisting of old laser treatment scar and
contiguous leaking CNV within 150 microns from center of FAZ. New,
never-treated subfoveal lesions <4 DA in size; recurrent lesions <6 DA
in size. VA<20/40 and >20/230.
RESULTS
• Argon Study: All trials (AMD, POH, INVM) halted early due to
dramatic reduction in severe VA loss with argon laser treatment
• Krypton Study:
• Beneficial effect for krypton red laser treatment in eyes with AMD, most
pronounced in normotensive patients (not apparent among pts with HTN).
• POH patients with significant benefit from krypton red laser
• Results in INVM patients were intermediate between AMD and POH.
• Foveal Study:
• Generally, eyes with AMD and subfoveal CNV benefitted from laser
• Initially, laser-treated eyes had immediately lost more vision than observed
eyes; this loss was similar to the untreated group at 12 months
CONCLUSIONS:
• For patients with well-demarcated classic CNV from AMD, POH, or
INVM, treatment with laser photocoagulation, performed according
to MPS guidelines, had better visual prognosis
• Patients with extrafoveal and juxtafoveal CNV from AMD, POH, or
INVM had better visual prognosis with laser photocoagulation.
• Eyes with AMD and subfoveal CNV:
• Eyes with smaller lesion and worse initial VA had greater and earlier benefits
of laser treatment
• Eyes with large subfoveal CNV lesions and good initial VA are not good
candidates for focal laser photocoagulation
VERTEPORFIN IN PHOTODYNAMIC THERAPY
STUDY (VIP)
• PDT vs sham for purely occult CNV
• Treatment benefit greatest in occult CNV without classic

• In the VIP trial, 339 (average age of 75), primarily with occult CNV
lesions were enrolled.
• The trial examined patients over a period of two years, allowing for
patients to be potentially treated 8 times.
• In a 24 month period, PDT treatment demonstrated greater efficacy
than the placebo at 46.2% versus 33.3% (percentage of eyes losing
less than 15 ETDRS letters)
TREATMENT OF AMD WITH PHOTODYNAMIC
THERAPY STUDY (TAP)
• PDT vs sham for classic CNV
• PDT effective for classic CNV

• conducted in both Europe and the US

• randomized, multi-center, double-masked, placebo-controlled trials enrolled 402 patients with a
classic component of choroidal neovascularization (CNV) in the treatment arm ( PDT) and 207
patients in the placebo arm.
• The primary endpoint was the percentage of eyes that lost less than 15 ETDRS letters from the
baseline at the 12 month mark.
• Patients treated with PDT had a higher percentage of eyes retaining baseline vision than placebo
(12 months: 61% treated, 46% placebo; 24 months:53% treated, 37% placebo).
• Some of the patients in the 2-year TAP study also continued in the 3-year TAP extension study, to
examine PDT’s efficacy and safety in the long term over a 5 year period.
• The extension study showed no significant systemic safety problems over the 5 year period and
demonstrated stable vision over the 60 month period.
VERTEPORFIN IN MINIMALLY CLASSIC CNV
(VIM)
• Smaller minimally classic lesions benefit from PDT

• This study analyzed PDT treatment in minimally classic CNV lesions, as well as the
effects of the standard full fluence (600 mW/cm2 for 83 seconds at 50 J/cm3)
versus a reduced half fluence (300 mW/cm2 for 83 seconds at 25 J/cm3)
treatment.
• The results of the standard treatment protocol indicated no apparent vision loss
over the 12 and 24 month periods; each treatment had a reduced risk of losing 15
letters of visual acuity compared with the 18 (47%)of 38 eyes assigned to placebo
(reduced fluence group P=0.002; standard fluence group P=0.08) .
• However, data from patients treated with half fluence had better results, with a
greater percentage of eyes retaining vision above the baseline (P = 0.15).
•
MINIMALLY CLASSIC/OCCULT TRIAL OF
RANIBIZUMAB IN THE TREATMENT OF
NEOVASCULAR AMD (MARINA)
ANTI VEG ANTIBODY FOR TREATMENT OF
PREDOMINANTLY CLASSIC CNV IN AMD (ANCHOR)
INHIBITION OF VEGF IN AGE-RELATED
CHOROIDAL NEOVASCULARIZATION (IVAN)
VEGF TRAP-EYE: INVESTIGATION OF EFFICACY AND
SAFETY IN WET AMD 1 & 2 STUDY (VIEW)
COMPARISON OF AGE RELATED MACULAR
DEGENERATION TREATMENT TRIALS (CATT)