Visudyne (Verteporfin)
Photosensitizing agent for photodynamic therapy of wet age-related macular degeneration
Visudyne (verteporfin) is a photosensitizing medication used in photodynamic therapy (PDT) to treat the wet form of age-related macular degeneration (AMD) and choroidal neovascularization due to pathologic myopia. It is administered as an intravenous infusion followed by non-thermal laser activation in the eye. Patients must avoid direct sunlight and bright lighting for 48 hours after treatment.
Quick Facts
Key Takeaways
- Visudyne is used in photodynamic therapy (PDT) to treat wet age-related macular degeneration and pathologic myopia by selectively destroying abnormal blood vessels in the retina.
- Treatment is a two-step process: intravenous infusion over 10 minutes followed by laser activation 15 minutes later, taking only 83 seconds of laser exposure.
- Patients become photosensitive for 48 hours after infusion and must avoid direct sunlight and bright indoor lighting. Normal indoor light is safe and helps eliminate the drug faster.
- Treatment can be repeated every 3 months, up to 4 times per year, depending on clinical response.
- Visudyne is for adults only and should not be used in patients with porphyria, severe liver disease, or known hypersensitivity to verteporfin.
What Is Visudyne and What Is It Used For?
Visudyne is a unique medication that works through a process called photodynamic therapy (PDT). The active ingredient, verteporfin, is a benzoporphyrin derivative that acts as a light-sensitive photosensitizer. When administered intravenously and subsequently activated by a specific wavelength of laser light (689 nm), verteporfin generates reactive oxygen species that selectively damage abnormal blood vessels in the eye.
The primary condition treated with Visudyne is the wet (exudative) form of age-related macular degeneration. AMD is the leading cause of vision loss in people over 50 in developed nations. In wet AMD, new abnormal blood vessels grow beneath the retina in a process called choroidal neovascularization (CNV). These fragile vessels leak blood and fluid, damaging the macula and causing rapid, progressive vision loss if untreated.
There are two types of choroidal neovascularization: classic and occult. Classic CNV has well-defined boundaries on fluorescein angiography and tends to progress more rapidly. Occult CNV has poorly defined boundaries and may progress more slowly. Visudyne is primarily indicated for the treatment of predominantly classic subfoveal CNV in adults with wet AMD. Clinical trials, including the landmark TAP (Treatment of Age-Related Macular Degeneration with Photodynamic Therapy) study, demonstrated that Visudyne PDT significantly reduced the risk of moderate and severe vision loss compared to placebo in patients with predominantly classic lesions.
Visudyne is also approved for treating all types of choroidal neovascularization in adults with pathologic myopia (severe nearsightedness). In pathologic myopia, abnormal stretching of the eyeball can damage the retinal layers and promote new vessel growth. The VIP (Verteporfin in Photodynamic Therapy) trial showed significant benefits in this patient population, with treated patients much less likely to experience vision loss over 12 to 24 months compared to those receiving placebo.
How Photodynamic Therapy Works
Photodynamic therapy with Visudyne is a two-step process that relies on selective vascular targeting. After intravenous infusion, verteporfin binds to low-density lipoproteins (LDL) in the blood. Because rapidly proliferating neovascular endothelial cells express more LDL receptors, verteporfin preferentially accumulates in abnormal choroidal neovascular tissue. When the non-thermal 689 nm diode laser is applied, it activates the verteporfin molecules in these blood vessels, generating singlet oxygen and other reactive oxygen species. These cytotoxic radicals damage the endothelial lining of the neovascular vessels, triggering platelet aggregation, thrombus formation, and ultimately vessel occlusion.
The selectivity of this process is a key advantage: the surrounding normal retinal tissue is largely spared because the laser energy is non-thermal and verteporfin accumulates preferentially in the abnormal vessels. This targeted mechanism distinguishes PDT from conventional thermal laser photocoagulation, which destroys tissue indiscriminately and causes permanent retinal scarring.
What Should You Know Before Receiving Visudyne?
Contraindications
Visudyne is contraindicated in several specific situations. Your treating ophthalmologist will carefully assess whether this treatment is appropriate for you before proceeding.
- Allergy to verteporfin or any excipient: If you have had an allergic reaction to verteporfin or any other component of the formulation (including dimyristoylphosphatidylcholine, egg phosphatidylglycerol, ascorbyl palmitate, butylated hydroxytoluene E321, or lactose monohydrate), you must not receive Visudyne.
- Porphyria: Patients with porphyria, a rare group of metabolic disorders that cause increased sensitivity to light, must not be treated with Visudyne. The photosensitizing nature of the drug would severely exacerbate this condition.
- Severe liver impairment: Because verteporfin is metabolized by the liver and eliminated primarily through biliary excretion, patients with severe hepatic dysfunction or biliary obstruction should not receive this medication, as drug clearance would be significantly impaired.
Warnings and Precautions
You will be sensitive to bright light for 48 hours after the Visudyne infusion. During this period, you must avoid direct sunlight, bright indoor lighting (tanning beds, halogen lamps, high-intensity surgical or dental lights), and light from medical devices such as pulse oximeters. Wear protective clothing and dark sunglasses if you must go outdoors. Sunscreen does NOT protect against photosensitivity reactions caused by Visudyne.
Do not stay in complete darkness. Normal indoor lighting is safe and actually helps your body eliminate Visudyne more quickly.
Infusion-related reactions may occur during or shortly after the Visudyne infusion. These can include chest pain, sweating, dizziness, rash, shortness of breath, flushing, irregular heartbeat, or seizures. In rare cases, syncope (sudden loss of consciousness) may occur. If you experience any of these symptoms, inform your healthcare team immediately, as the infusion may need to be stopped and your condition may require immediate treatment.
If Visudyne extravasates (leaks out of the vein) during infusion, it can cause pain, swelling, blistering, and skin discoloration at the site, particularly if the area is exposed to light. If extravasation occurs, the infusion must be stopped immediately. The affected skin should be treated with cold compresses and carefully protected from light until the discoloration resolves. Pain relief medication may be needed.
Patients with mild to moderate liver impairment or biliary obstruction should discuss their condition with their ophthalmologist before beginning Visudyne therapy, as altered drug metabolism may affect treatment outcomes and safety.
After treatment, some patients may experience visual disturbances such as decreased vision, blurred vision, or visual field changes. If you notice any significant change in your vision after treatment, contact your ophthalmologist promptly. You should not drive or operate machinery until your vision has recovered adequately.
Pregnancy and Breastfeeding
There is very limited clinical experience with Visudyne use during pregnancy. Animal studies have shown some reproductive toxicity at doses substantially higher than clinical doses. Visudyne should only be used during pregnancy if the treating physician determines that the potential benefit justifies the potential risk to the fetus. If you are pregnant, think you may be pregnant, or are planning to become pregnant, discuss this thoroughly with your doctor before treatment.
Verteporfin passes into human breast milk in small quantities. If you are breastfeeding, your physician will assess whether the clinical benefit of treatment outweighs any potential risk. If treatment proceeds, it is recommended that you do not breastfeed for 48 hours after receiving the Visudyne infusion to allow adequate drug elimination.
Driving and Operating Machinery
After Visudyne PDT, you may experience temporary visual disturbances including abnormal or decreased vision. These effects are usually transient but can impair your ability to drive safely. Do not drive or operate machinery until your vision has returned to normal. Your ophthalmologist will advise you on when it is safe to resume these activities.
How Does Visudyne Interact with Other Drugs?
Drug interactions with Visudyne primarily fall into two categories: medications that increase the risk of photosensitivity reactions, and agents that may reduce the therapeutic effectiveness of photodynamic therapy. Because Visudyne works by generating reactive oxygen species in response to light activation, any drug that either increases light sensitivity or neutralizes free radicals can significantly affect treatment outcomes and safety.
It is essential to inform your ophthalmologist about all medications you are currently taking, have recently taken, or plan to take, including prescription drugs, over-the-counter medicines, herbal supplements, and vitamins.
Drugs That Increase Photosensitivity
The following medications can increase your sensitivity to light and may amplify the photosensitivity effects of Visudyne. If you are taking any of these drugs, your treating physician needs to be aware, as additional light precautions may be necessary.
| Drug Class | Common Uses | Interaction Type |
|---|---|---|
| Tetracyclines | Bacterial infections, acne | Increased photosensitivity |
| Sulfonamides | Bacterial infections, UTIs | Increased photosensitivity |
| Phenothiazines | Psychiatric disorders, nausea | Increased photosensitivity |
| Sulfonylureas | Type 2 diabetes | Increased photosensitivity |
| Thiazide diuretics | Hypertension, edema | Increased photosensitivity |
| Griseofulvin | Fungal infections | Increased photosensitivity |
Drugs That May Reduce Effectiveness
Certain substances can interfere with the mechanism of action of Visudyne by neutralizing the reactive oxygen species generated during photodynamic therapy. This can reduce the therapeutic benefit of treatment.
| Agent | Mechanism | Clinical Significance |
|---|---|---|
| Beta-carotene | Quenches singlet oxygen | May reduce PDT efficacy |
| DMSO (dimethyl sulfoxide) | Free radical scavenger | May reduce PDT efficacy |
| Mannitol | Free radical scavenger | May reduce PDT efficacy |
| Ethanol (alcohol) | Free radical scavenger | May reduce PDT efficacy |
| Formate | Free radical scavenger | May reduce PDT efficacy |
Additionally, calcium channel blockers (used for hypertension, angina, and abnormal heart rhythms) and vasodilators (used to widen blood vessels) may affect the uptake and distribution of verteporfin in neovascular tissue. Patients undergoing radiation therapy should discuss the potential for additive photosensitivity effects with their healthcare team.
What Is the Correct Dosage of Visudyne?
Visudyne treatment is always performed in a specialized ophthalmology setting by trained healthcare professionals. The dosing regimen is standardized and based on body surface area. It is critical that both the drug infusion and laser application are timed precisely for optimal therapeutic effect.
Adults
Standard Treatment Protocol
Step 1 — Intravenous Infusion: Visudyne is reconstituted in 7.0 mL of water for injection to yield 7.5 mL of solution at a concentration of 2.0 mg/mL. The required volume is then diluted in 5% glucose solution to a final volume of 30 mL. The dose is 6 mg/m² body surface area, infused intravenously over 10 minutes. Sodium chloride solution must not be used for dilution.
Step 2 — Laser Activation: Exactly 15 minutes after the start of the infusion, a non-thermal 689 nm diode laser is applied to the treatment area of the retina through a special contact lens. The laser exposure time is 83 seconds, delivering a light dose of 50 J/cm² at an intensity of 600 mW/cm². During this procedure, the patient must keep their eyes steady and follow the physician's instructions.
Retreatment: Treatment can be repeated every 3 months if needed, up to a maximum of 4 treatments per year. The decision to retreat is based on fluorescein angiography findings showing persistent or recurrent choroidal neovascularization leakage.
Children
Pediatric Use
Visudyne is intended for use in adults only. There is no established dosage for children, and the safety and efficacy of verteporfin PDT have not been studied in pediatric populations. Age-related macular degeneration and pathologic myopia with CNV are conditions that primarily affect adults.
Elderly Patients
Elderly Use
No dose adjustment is required for elderly patients. The standard dose of 6 mg/m² body surface area applies regardless of age. Since the majority of patients with wet AMD are over 65, the pivotal clinical trials predominantly enrolled elderly patients, providing robust safety and efficacy data in this age group.
Overdose
An overdose of Visudyne may prolong the period of photosensitivity, potentially beyond the standard 48-hour window. If an overdose is suspected, the patient must continue to follow strict light avoidance precautions for an extended period as directed by their physician. The protective measures described in the photosensitivity warning section should be maintained until the treating ophthalmologist confirms that photosensitivity has resolved.
An overdose of Visudyne combined with excessive laser light applied to the treated eye could result in severe, potentially irreversible vision impairment due to non-selective retinal and choroidal damage. This underscores the importance of precise dosing and laser parameters during the procedure.
Reconstituted Visudyne should be inspected visually for particulate matter and discoloration before administration. The solution is an opaque dark green color. Use standard infusion line filters with hydrophilic membranes (e.g., polyethersulfone) with a minimum pore size of 1.2 µm. Chemical and physical stability of the reconstituted solution has been demonstrated for 4 hours at 25°C protected from light.
What Are the Side Effects of Visudyne?
Like all medicines, Visudyne can cause side effects, although not everyone experiences them. Some side effects are related to the drug itself (photosensitivity, systemic reactions), while others are consequences of the photodynamic therapy process affecting the treated eye. Most ocular side effects are transient, but some can be serious and require immediate medical attention.
The frequency of side effects is classified according to standard medical convention. If you experience any of the following symptoms, especially those listed as serious, contact your ophthalmologist or seek medical care immediately.
Serious Side Effects
Common (up to 1 in 10 people)
Affects 1–10% of patients
- Severe visual acuity decrease — loss of 4 or more lines of vision within 7 days of treatment
- Visual disturbances — blurred, cloudy, or dim vision; light flashes; decreased visual acuity
- Visual field changes — gray or dark shadows, blind spots, or black spots in the treated eye
- Hypersensitivity reactions — allergic reactions of varying severity
- Syncope — fainting
- Headache and dizziness
- Dyspnea — shortness of breath
Uncommon (up to 1 in 100 people)
Affects 0.1–1% of patients
- Retinal hemorrhage — bleeding in the retina or vitreous humor
- Retinal edema — swelling or fluid accumulation in the retina
- Retinal detachment in the treated eye
- Injection site reactions — bleeding, discoloration, hypersensitivity with increased photosensitivity
- Skin rash, urticaria, pruritus
Rare (up to 1 in 1,000 people)
Affects 0.01–0.1% of patients
- Retinal or choroidal non-perfusion — loss of blood circulation in retinal or choroidal vessels
Not Known (frequency cannot be estimated)
Isolated reports
- Retinal pigment epithelial damage
- Macular edema — swelling or fluid in the macula
- Vasovagal reactions — dizziness and fainting, may include seizures
- Myocardial infarction — reported particularly in patients with pre-existing cardiovascular disease, sometimes within 48 hours of treatment
- Local skin necrosis — tissue death at extravasation site
Other Side Effects
Common (up to 1 in 10 people)
Affects 1–10% of patients
- Injection site pain, swelling, inflammation, and leakage
- Nausea
- Photosensitivity skin reactions (sunburn-like)
- Fatigue
- Infusion-related reactions — chest pain, back pain
- Elevated cholesterol levels
Uncommon (up to 1 in 100 people)
Affects 0.1–1% of patients
- Pain
- Elevated blood pressure
- Increased sensitivity
- Fever
Not Known (frequency cannot be estimated)
Isolated reports
- Injection site blistering
- Heart rate changes
- Infusion-related pain radiating to hips, shoulders, or chest
Contact your ophthalmologist or seek emergency medical care immediately if you experience sudden vision loss, severe eye pain, signs of heart attack (chest pain, arm pain, shortness of breath), severe allergic reaction (difficulty breathing, swelling of face or throat), or seizures during or after treatment.
Reporting suspected adverse reactions after authorization of the medicinal product is important for ongoing monitoring of the benefit-risk balance. Healthcare professionals and patients are encouraged to report suspected adverse reactions to their national pharmacovigilance authority (e.g., FDA MedWatch in the US, Yellow Card Scheme in the UK, or EMA in the EU).
How Should You Store Visudyne?
Visudyne is a hospital-use medication that is stored, prepared, and administered by healthcare professionals. However, understanding the storage requirements provides context for the drug's light-sensitive nature, which directly relates to the photosensitivity precautions patients must observe after treatment.
- Temperature: Store at or below 25°C (77°F). Do not freeze.
- Light protection: Keep the vial in the original outer carton at all times to protect from light. Verteporfin is inherently photosensitive, which is the same property that makes it therapeutically active.
- Reconstituted solution: Chemical and physical stability has been demonstrated for 4 hours at 25°C. From a microbiological standpoint, the product should be used immediately after reconstitution. If not used immediately, in-use storage times and conditions are the responsibility of the user.
- Shelf life: Do not use after the expiration date printed on the carton and vial (marked "EXP"). The expiration date refers to the last day of the stated month.
- Keep out of sight and reach of children.
- Disposal: The vial and any unused reconstituted solution should be discarded after the treatment session according to local regulations for pharmaceutical waste.
If spillage occurs during preparation, the area should be contained and wiped up with a damp cloth. Avoid contact with eyes and skin. Use of rubber gloves and eye protection is recommended when handling the product. Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
What Does Visudyne Contain?
Active Ingredient
The active substance is verteporfin. Each glass vial contains 15 mg of verteporfin. After reconstitution with 7.0 mL of water for injection, the resulting 7.5 mL of solution has a concentration of 2.0 mg/mL. The reconstituted solution is an opaque dark green liquid.
Excipients (Inactive Ingredients)
Visudyne is formulated as a liposomal preparation to facilitate intravenous administration and targeted delivery. The excipients include:
- Dimyristoylphosphatidylcholine (DMPC) — a phospholipid that forms the liposomal bilayer
- Egg phosphatidylglycerol — a phospholipid component of the liposome membrane
- Ascorbyl palmitate — an antioxidant stabilizer
- Butylated hydroxytoluene (BHT, E321) — an antioxidant preservative. This excipient may be irritating to eyes, skin, and mucous membranes upon direct contact.
- Lactose monohydrate — a bulking agent for lyophilization
Appearance and Packaging
Visudyne is supplied as a dark green to black lyophilized (freeze-dried) powder in a clear glass vial. The powder is reconstituted with sterile water for injection before use. Each package contains 1 vial of powder for solution for infusion. The marketing authorization holder is CHEPLAPHARM Arzneimittel GmbH (Greifswald, Germany), and the product is manufactured by Delpharm Huningue S.A.S. (Huningue, France).
Frequently Asked Questions About Visudyne
Visudyne (verteporfin) is used in photodynamic therapy (PDT) to treat the wet form of age-related macular degeneration (AMD) with predominantly classic choroidal neovascularization. It is also approved for treating all types of choroidal neovascularization caused by pathologic myopia (severe nearsightedness). The drug is administered as an intravenous infusion followed by laser activation in the affected eye to selectively destroy abnormal blood vessels.
You must avoid direct sunlight and bright indoor lighting for 48 hours after receiving the Visudyne infusion. This includes tanning beds, halogen lamps, high-intensity surgical or dental lights, and light-emitting medical devices like pulse oximeters. Wear protective clothing and dark sunglasses if you go outdoors. Importantly, do not stay in complete darkness, as normal indoor lighting helps your body eliminate the drug faster. Sunscreen does NOT provide protection against Visudyne-related photosensitivity.
Visudyne photodynamic therapy can be repeated every 3 months if clinically indicated, up to a maximum of 4 treatments per year. The decision to retreat is based on fluorescein angiography results showing persistent or recurrent leakage from choroidal neovascularization. Your ophthalmologist will assess your response to previous treatment and determine whether retreatment is appropriate.
There is very limited clinical data on Visudyne use during pregnancy. It should only be used if the treating physician considers it absolutely necessary and the potential benefit outweighs the risk. Verteporfin passes into breast milk in small amounts, so breastfeeding should be stopped for 48 hours after treatment. Always discuss your pregnancy or breastfeeding status with your doctor before receiving Visudyne.
While anti-VEGF therapies (such as ranibizumab, aflibercept, and bevacizumab) have largely replaced Visudyne as the first-line treatment for wet AMD, Visudyne PDT still has an important role. It is used as combination therapy with anti-VEGF agents in certain cases, particularly polypoidal choroidal vasculopathy (PCV). It may also be considered for patients who do not respond adequately to anti-VEGF monotherapy. For pathologic myopia-related CNV, anti-VEGF agents have become preferred, but Visudyne remains an approved option.
Several drug classes can increase photosensitivity when combined with Visudyne: tetracyclines, sulfonamides, phenothiazines, sulfonylureas, thiazide diuretics, and griseofulvin. Additionally, antioxidants such as beta-carotene and free radical scavengers (DMSO, mannitol, alcohol) may reduce the therapeutic effectiveness of photodynamic therapy. Calcium channel blockers and vasodilators may affect drug distribution. Always inform your ophthalmologist about all medications you are taking.
References
This article is based on the following peer-reviewed sources and authoritative medical guidelines:
- European Medicines Agency (EMA). Visudyne Summary of Product Characteristics (SmPC). CHEPLAPHARM Arzneimittel GmbH. Last updated 2020. Available at: ema.europa.eu
- Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials. Archives of Ophthalmology. 2001;119(2):198-207. doi:10.1001/archopht.119.2.198
- Verteporfin in Photodynamic Therapy (VIP) Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results. Ophthalmology. 2003;110(4):667-673. doi:10.1016/S0161-6420(02)01998-1
- Lim TH, Lai TYY, Takahashi K, et al. Comparison of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: The EVEREST II Randomized Clinical Trial. JAMA Ophthalmology. 2020;138(9):935-942. doi:10.1001/jamaophthalmol.2020.2443
- World Health Organization (WHO). WHO Model List of Essential Medicines — 23rd List, 2023. Geneva: WHO; 2023.
- U.S. Food and Drug Administration (FDA). Visudyne (verteporfin for injection) Prescribing Information. Approved April 2000, revised 2016.
- British National Formulary (BNF). Verteporfin monograph. National Institute for Health and Care Excellence (NICE). Updated 2025.
Editorial Team
This article has been written and reviewed by qualified medical professionals following international clinical guidelines and peer-reviewed research.
iMedic Medical Editorial Team — specialists in ophthalmology and clinical pharmacology with extensive experience in retinal disease management and photodynamic therapy.
iMedic Medical Review Board — an independent panel of physicians who verify medical accuracy against current EMA, FDA, WHO, and BNF guidelines.
All content on iMedic is evidence-based and follows the GRADE framework for evaluating medical evidence. We use Level 1A evidence (systematic reviews and randomized controlled trials) wherever available. Our content is free from commercial funding and pharmaceutical company sponsorship. For more details, see our editorial standards.