Acute severe visual decrease after photodynamic therapy with verteporfin: spectral-domain OCT features.

In this report, spectral-domain optical coherence tomography (OCT) was used to characterize the acute morphologic alterations that occur when photodynamic therapy with verteporfin results in an acute severe visual decrease. The clinical and imaging records of a patient with neovascular age-related macular degeneration who suffered this complication were reviewed. Using spectral-domain OCT, two relatively distinct subretinal fluid compartments were visualized: a sparsely hyperreflective pocket of subretinal fluid overlying the fibrovascular pigment epithelial detachment, consistent with fibrinous exudation, and a more homogeneously hyporeflective compartment at the periphery of the choroidal neovascular lesion, consistent with serous exudation. The higher axial resolution, and greater sensitivity, of spectral-domain OCT allows improved visualization of the subretinal space. As experience with spectral-domain OCT grows, new parameters will emerge-such as those related to subretinal fluid-that will facilitate improvements in both the qualitative and quantitative evaluation of macular disease.