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Hirotaka Yokouchi, Masayasu Kitahashi, Madoka Sakurai, Mariko Kubota-Taniai, Takayuki Baba, Shuichi Yamamoto; Long-term Results of Combination Therapy with Half-time Reduced Fluence Photodynamic Therapy and Intravitreal Ranibizumab for Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3792.
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To determine the efficacy of half-time reduced fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for retinal angiomatous proliferation (RAP).
Ten eyes of 10 patients with RAP were studied; there were 2 eyes with RAP stage II A, 3 eyes with stage II B, and 5 eyes with stage III. One course of combination therapy consisted of three injections of IVR at monthly intervals and a single half-time RF-PDT with verteporfin about 1-3 days after the first IVR. The dose and fluence of the half-time RF-PDT were administered according to the standard protocol for age-related macular degeneration (AMD). The laser was applied for 42 seconds guided by the indocyanine green angiographic images. The best-corrected visual acuity (BCVA) in logMAR units and central foveal thickness (CFT) measured on the optical coherence tomographic (OCT) images were examined before and 12 months after treatment.
The BCVA significantly improved from 0.76±0.11 to 0.60±0.10 logMAR units 12 months after the treatment (P=0.01). The BCVA improved by ≥0.15 logMAR units in 6 eyes (60%), remained stable in 3 eyes (30%), and worsened in 1 eye (10%). The CFT was significantly reduced from 613.0±91.8 μm to 217.6±39.1 μm (P=0.001) at 12 months. The CFT decreased by ≥30% in 8 eyes (80%), remained stable in 2 eyes (20%), and worsened in no eye. No additional treatment was required in 6 eyes (60%), but additional IVR was required in 4 eyes. A complete occlusion of the retina-retinal anastomosis (RRA) was achieved and central macular edema (CME) disappeared in 9 eyes at 12 months. The mean number of PDT treatments and mean number of IVR injections during 12 months, including that of the initial regimen, was 1 and 3.6, respectively. No complications such as severe vision loss, endophthalmitis, occlusion of the choriocapillaris, or systemic events developed.
Combined IVR and half-time RF-PDT for RAP effectively maintained or improved visual acuity and reduced the exudation for at least 12 months. Although further evaluations with a larger number of patients and a longer follow-up are required, our results suggest a beneficial effect of the combination therapy for RAP.
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