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Akihiro Chiba, Hirotaka Yokouchi, Masayasu Kitahashi, Mariko Kubota, Takayuki Baba, Shuichi Yamamoto; Two-year Outcome of Half-time Reduced Fluence Photodynamic Therapy Combined with Intravitreal Ranibizumab for Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4943.
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© ARVO (1962-2015); The Authors (2016-present)
To study 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; 2 eyes with RAP stage II A, 4 eyes with RAP stage II B, and 4 eyes with RAP stage III. Combination therapy consisting of three monthly injections of IVR and a single half-time RF-PDT with verteporfin applied 1-3 days after the first ranibizumab injection. The dose and fluence of the half-time RF-PDT was administered according to the standard protocol for age-related macular degeneration (AMD). The laser treatment was given for 42 seconds guided by the indocyanine green (ICG) angiograms. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) determined by optical coherence tomography (OCT) were measured before and 24 months after the treatment.
The BCVA was 0.90±0.44 logMAR units at the baseline and 0.74±0.43 logMAR units at 24 months after half-time RF-PDT. The BCVA improved at 24 months but the improvement was not significant (P=0.06). The BCVA improved by ≥0.15 logMAR units in 5 eyes (50%), remained stable in 3 eyes (30%), and worsened in 2 eyes (20%). The CFT was significantly reduced from 638.9±235.0 μm to 146.6±85.7 μm (P=0.005) at 24 months. The CFT decreased by ≥30% in 9 eyes (90%), remained stable in 1 eye (10%), and no eye was worsened. No any additional treatment was required in 5 eyes (50%), but additional treatment was required in 5 eyes (50%). A complete occlusion of the retinal-retinal anastomosis (RRA) was achieved and central macular edema (CME) disappeared in 9 eyes at 24 months. The mean number of RF-PDT treatments and IVR injections during the 24 month follow-up, including the treatments in the initial regimen, was 1.3 and 5.0, respectively. No complications such as severe vision loss, endophthalmitis, occlusion of the choriocapillaris, or systemic events developed.
Half-time RF-PDT combined with IVR for RAP effectively maintained or improved the BCVA and reduced the exudation in the long-term.
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