Purchase this article with an account.
Filippo Missiroli, Federico Regine, Antonio Calabrese, Massimo Grossi, Massimo Cesareo, Cecilia De Felici, Federico Ricci; ICGA Guided Low-fluence Photodynamic Therapy Combined With PRN Ranibizumab For Active Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1675.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report 12-months follow-up results of active polypoidal choroidal vasculopaty (PCV) patients treated with low-fluence photodynamic therapy (PDT) combined with intravitreal PRN Ranibizumab
In this retrospective consecutive series, clinical, angiographic and OCT data of 17 eyes with PCV were analyzed for a minimum follow up period of 12 months. ICGA guided PDT was performed in all patient and fluence was reduced decreasing laser exposure time to 70’’ (LF-PDT). After 24 hours intravitreal Ranibizumab ( 50ul, 0.5mg) was performed. The Ranibizumab with or without low-fluence PDT was repeated according to clinical and angiographyc features on PRN basis.
Baseline mean BCVA was 0,45 ± 0,29 LogMAR. This value significantly improved to 0,29 ± 0,28 at 12 months. The mean total macular volume based on OCT retinal map examination was 7,5 ± 1,18 mmc at baseline and to 6,7 ± 0,8 at 12 months. In 95% of patients BCVA remained stable or improved. Only one patient lost ≥ 15 letters in visual acuity at 12 months
Standard fluence PDT with Verteporfin has an important angio-occlusive effect but it causes choriocapillaris vessels occlusion and inflammation which stimulate proangiogenic cytokine release responsible of neo vessels recanalization and CNV recurrence. Low fluence PDT maintains the angiocclusive effect reducing the side effects, such as retinal pigment epithelium phototoxicity, choriocapillaris closure with consequent VEGF upregulation, severe choriocapillaris endothelial damage and bleeding. Combined Ranibizumab intravitreal injection could further decrease the post PDT VEGF up-regulation, reducing inflammation, leakage and neovessels recurrence. Our results suggest that ICGA guided LF-PDT combined with Ranibizumab may induce morphologic and functional stabilization of the PCV lesions. The therapeutic effect is characterized by the decrease of macular thickness and the regression of the size of polypoidal vascular lesion.
This PDF is available to Subscribers Only