Douglas J. Rhee, MD

APPENDIX 7. DOSING PROTOCOL FOR VERTEPORFIN (VISUDYNE)Indication: Photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV)Supplied as: Comes as single use vial, 15 mg verteporfin, lyophilized. Reconstitute with 7 mL sterile water to provide 7.5 mL of2 mg/mL.Dose: 6 mg/m 2 diluted to 30 mL in 5% dextrose. Infusion is given over 10 minutes at a rate of 3 mL/minute using syringe pump andin-line filter.Light administration: 689 nm wavelength of laser light exactly 15 minutes after the start of the 10 minute infusion (i.e., 5 minutes afterthe infusion ends). The exposure time is 83 seconds. [Recommended light dose is 50 J/cm 2 at an intensity of600 mW/cm 2 .]Treatment: PDT is currently approved in the United States for the treatment of subfoveal predominantly classic CNV (>50% classic)and subfoveal occult CNV with evidence of recent progression. Nasal edge of treatment spot must be at least 200 micronsfrom the temporal edge of the optic disc, even if this will result in lack of treatment within 200 microns of the optic nerve.Spot size should be 1000 microns larger then greatest linear dimension of the CNV lesion. Maximum spot size used inclinical trials was 6400 microns.Contraindicated in patients with porphyriaTreatment should be carefully considered in patients with moderate to severe hepatic impairment (eliminated via liver)After dye administration, patients must avoid direct sunlight, indoor halogen lighting, tanning beds, or other bright lighting for5 days.Side effects: headache, injection site reaction, visual disturbance (including blurred vision, decreased vision, and visual field defects),and photosensitivity in 10–20% of patientsOther side effects occurring in