Overview

Photodynamic therapy (PDT) with verteporfin is used to treat central serous chorioretinopathy (CSCR).

It involves giving you a medicine called verteporfin (brand name Visudyne^®) as an injection into a vein in your arm. The medicine circulates around your body and is absorbed by the abnormal blood vessels in the back of your eye. A low-energy laser is then directed at these vessels to activate the medicine. Activated verteporfin slows down blood flow and allows the CSCR to settle.

Benefits of PDT

In CSCR, fluid leaks under the retina (the thin lining at the back of your eye that allows you to see) from a deeper layer of abnormally leaky blood vessels. For most patients this condition resolves by itself within a few months, without needing treatment.

Your eye doctor (ophthalmologist) is recommending that you should have PDT because your CSCR has not cleared. About 8 in 10 patients who have PDT will notice an improvement in their vision within 2 months of a single course of treatment.

In some patients there is no effect after 1 session of PDT, and a second (final) course might be needed about 3 months later. 

Some people might be worried by information available on the internet about verteporfin because it is also used to treat age-related macular degeneration. We are using this medicine to treat CSCR, and we do not think you have age-related macular degeneration. 

Medicine – Taking an unlicensed medicine

The use of verteporfin to treat CSCR is unlicensed, which means that the manufacturer of the medicine has not specified it can be used in this way. However, there is evidence that it works to treat this particular condition. You are being offered this treatment because your current condition meets the very strict guidelines that we have in place for giving this medicine.

You can read our information about unlicensed medicines. 

Risks of PDT

PDT with verteporfin therapy is not suitable for everyone.

People who should not have it are those with:

• porphyria (a very rare condition)
• severe liver problems 
• allergies to any of the ingredients of verteporfin

Check with your eye doctor or other healthcare professional if you think any of these apply to you.

Out of every 100 people having this procedure, 1 or 2 have a decrease in vision in the 7 days after treatment.

Some of these patients achieve a partial or full recovery.

Side effects

The most common (1 to 3 out of 10 patients) side effects are: 

• injection site reactions 
• feeling sick (nausea)
• temporary back pain during the injection 
• changes in vision, including blurring

Let the staff in the eye department know if you have any of these problems during your appointment.

We have only listed the most common side effects here. On the day of your appointment, you will also be given a copy of the patient information leaflet produced by the manufacturer of verteporfin. This lists all reported side effects of the medicine, and what to do if you get them. 

If you have any questions about the side effects of verteporfin, you should discuss these with your doctor or call the pharmacy medicines helpline. 

You should avoid direct sunlight or bright indoor (halogen) light for 2 days after therapy with verteporfin. This does not mean you need to stay completely in the dark. Exposure to normal indoor lighting will help your body to get rid of verteporfin more quickly.

If you need to go outdoors in daylight during this time, you must cover all parts of your skin (including your head) and eyes by wearing protective clothing and dark glasses.

Other treatment options

Most cases of CSCR resolve without needing any treatment within a few months. If this does not happen and the leaking blood vessels are close to the centre of the back of the eye, PDT with vertoporfin is recommended as other types of laser treatment can be harmful. 

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what the treatment involves, and you agree to have it. 

Read more about our consent process. 

On the day of your treatment

On the day of your appointment, make sure you bring sunglasses and clothes that protect your skin from sunlight for your journey home, such as a:

• hat
• scarf
• long-sleeved top
• trousers 
• gloves

During your treatment

You will have your height and weight measured to calculate the correct dose of verteporfin.

Your vision will be checked, and drops put in your eyes to enlarge (dilate) your pupils before the treatment begins.

The verteporfin will be prepared and infused through a small tube (cannula inserted into a vein) in your arm. The medicine infusion takes 10 minutes.

After that, you will be given the PDT treatment. Some anaesthetic drops will also be applied to the affected eye to numb its surface. A contact lens will be placed on the eye to help keep the eye still and the eyelids out of the way.

The doctor will tell you when the laser will start. You must keep still, and concentrate on the red laser light. The PDT treatment will take 83 seconds. 

You should not feel any pain during the procedure. 

After your treatment

The contact lens and cannula will be removed, and you will need to change into the clothes and sunglasses you brought with you, to protect your skin and eyes from sunlight when you leave hospital.

Driving

You will not be able to drive home after the treatment because the dilating drops can take 2 to 3 hours to wear off.

Leaving hospital

After leaving hospital you should:

• stay indoors without any bright light sources, including halogen lights
• try to avoid direct sunlight. We recommend keeping curtains half-drawn
• avoid watching TV or using a computer for the first day.

You can resume your usual physical activities. You can return to all normal activities after 2 days.

A dimming of vision is normal, and can last up to a month.

When to get help

Follow-up appointment

A follow-up appointment will be arranged in the eye clinic 6 to 8 weeks after you have had treatment to see if it has worked. You might need a repeat treatment to be booked for a future date if there has been no improvement.