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C. G. Kiss, J. Wagner, C. Simader, S. Michels, U. Schmidt-Erfurth; Effect of Photodynamic Therapy (PDT) and Ranibizumab on Vascular Anatomy and Retinal Function in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4544.
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To evaluate the effect of verteporfin PDT and same-day intravitreal ranibizumab on retinal vasculature and visual function in patients with neovascular age-related macular degeneration (AMD).
Eleven patients with choroidal neovascularization (CNV) secondary to AMD were treated with verteporfin PDT combined with same-day intravitreal injection of ranibizumab. Ranibizumab injections were repeated every month to a total of 4 injections. Patients were seen at days 4, 8, 15, 30, 60, 90, 120, 180 and 270 after baseline. Fluorescein (FA) and indocyanine-green (ICG) angiography, Stratus OCT, ETDRS visual acuity and fundus-controlled microperimetry (Nidek MP1) were performed at these visits to evaluate treatment effects.
Immediately after combination treatment a complete occlusion of the CNV and surrounding choroidal capillaries could be observed in FA. First signs of recanalization were evident at week 2. Complete recovery of the central choriocapillary perfusion was commonly seen at month 3. Planimetric analysis showed an immediate decrease in the area of leakage of minus 70% at week 1, at the end of follow-up at 9 months it was 37% smaller than at baseline. ICG showed a complete occlusion of small vessels in the treated area, larger vessels were unaffected. Small vessel perfusion recovered around day 30 with a concomitant reduction of the area of absolute vascular occlusion. Compared to the first post-treatment analysis (day 4) the area of absolute vascular occlusion dropped to 34% at month 1 and disappeared completely by month 3. In OCT, PDT induced sub- and intraretinal vascular leakage increased dramatically despite same day ranibizumab therapy, but resolved after 2 weeks and remained stable until the end of follow up. At month 9 follow-up 7 patients showed stabilization of vision, 3 gained more than 3 lines and 1 patient lost more than 3 lines. Central retinal sensitivity of the central 2 degrees of the macula evaluated using microperimetry was at a mean of 1.9 ± 2.3dB at baseline and showed a continuous improvement to a mean of 5.4 ± 2.9 dB at month 9.
Single PDT in combination with repeated ranibizumab injections show vascular effects similar to reported effects of PDT monotherapy. Combination of PDT and anti-VEGF therapy might be a valuable treatment option, but modification of PDT treatment parameters should be considered to reduce PDT induced vascular effects on the choroid.
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