April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Twelve-month results of treatment with intravitreal ranibizumab, intravitreal ranibizumab plus ketorolac eye drops, and intravitreal ranibizumab plus low-fluence photodynamic therapy for exudative age-related macular degeneration
Author Affiliations & Notes
  • Andrea Russo
    Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy
  • Ciro Costagliola
    Department of Health Sciences, Eye Clinic, University of Molise, Campobasso, Italy
  • Luisa Delcassi
    Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy
  • Mario R Romano
    Eye Clinic, Istituto Clinico Humanitas, Milano, Italy
  • Raffaele Turano
    Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy
  • Francesco Semeraro
    Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy
  • Footnotes
    Commercial Relationships Andrea Russo, None; Ciro Costagliola, None; Luisa Delcassi, None; Mario Romano, None; Raffaele Turano, None; Francesco Semeraro, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3912. doi:https://doi.org/
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      Andrea Russo, Ciro Costagliola, Luisa Delcassi, Mario R Romano, Raffaele Turano, Francesco Semeraro; Twelve-month results of treatment with intravitreal ranibizumab, intravitreal ranibizumab plus ketorolac eye drops, and intravitreal ranibizumab plus low-fluence photodynamic therapy for exudative age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3912. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To compare the effectiveness of treatment with intravitreal ranibizumab (IVR), IVR plus ketorolac eye drops, and IVR plus low-fluence photodynamic therapy (PDT) for choroidal neovascularization (CNV).

 
Methods
 

This was a multicenter, prospective, pilot study of eyes with new-onset CNV. Seventy-five eyes were enrolled consecutively and randomized to one of 3 groups at a ratio of 1:1:1. Group 1 (n = 25) received IVR; Group 2 (n = 25) received IVR along with topical ketorolac eye drops 3 times a day; while Group 3 (n = 25) received 1 session of low-fluence PDT followed by IVR. In all groups, ranibizumab 0.5 mg was injected monthly for 3 months, and then as needed in accordance with the standard of care. All patients were followed up for 12 months.

 
Results
 

At 12 months, all groups showed significant improvements in best-corrected visual acuity (BCVA; p < 0.001). Group 2 showed a greater mean 12-month BCVA improvement than both groups 1 and 3 (p = 0.049 and p = 0.039, respectively). The mean 12-month change in central macular thickness (CMT) was -131 µm (-29.4%; p < 0.001) in Group 1, -138 µm (-33.4%; p < 0.001) in Group 2, and -129 µm (-29.5%; p < 0.001) in Group 3. Group 2 showed a greater mean CMT reduction than both Groups 1 and 3 (p = 0.002 and p = 0.014, respectively), while anatomical improvements were similar between Groups 1 and 3. None of the 3 groups showed any adverse effects.

 
Conclusions
 

This is the first study to report better BCVA outcomes over a 12-month period with a combination of 0.45% ketorolac eye drops 3 times a day and IVR in patients with CNV, further indicating that topical ketorolac supplements the CMT-reducing activity of IVR in CNV. A combination therapy of PDT plus ranibizumab injections did not yield anatomical or functional improvements; however, fewer ranibizumab injections were required. Larger trials are needed to confirm the findings of this pilot study.

 
 
Change in monthly visual acuity. Blue line indicates Group 1; red line indicates Group 2; and green line indicates Group 3. Mean values are shown for each timepoint.
 
Change in monthly visual acuity. Blue line indicates Group 1; red line indicates Group 2; and green line indicates Group 3. Mean values are shown for each timepoint.
 
 
Change in monthly central macular thickness. Blue line indicates Group 1; red line indicates Group 2; and green line indicates Group 3. Mean values are shown for each timepoint.
 
Change in monthly central macular thickness. Blue line indicates Group 1; red line indicates Group 2; and green line indicates Group 3. Mean values are shown for each timepoint.
 
Keywords: 453 choroid: neovascularization • 748 vascular endothelial growth factor • 647 photodynamic therapy  
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