Short-term Outcome of Combined Reduced Fluence Photodynamic Therapy and Intravitreal Ranibizumab for Retinal Angiomatous Proliferation

Abstract

Purpose: : To study the efficacy of reduced fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for retinal angiomatous proliferation (RAP).

Methods: : Eleven eyes of 11 patients with RAP were studied; 4 eyes with RAP stage I, 1 with stage II, and 6 with stage III. A course of combination therapy consisted of three monthly ranibizumab injections and a single RF-PDT with verteporfin about 1-2 days after the first injection. The dose and fluence of RF-PDT was administered according to the standard protocol for age-related macular degeneration (AMD) with the laser applied for 42 seconds guided by indocyanine green angiograms. The best corrected visual acuity (BCVA) and central foveal thickness (CFT) determined by optical coherence tomography (OCT) were evaluated before and 6 months after treatment. Five of 11 eyes had a history of treatments; 1 eye with bevacizumab and standard-PDT, 4 eyes with ranibizumab alone.

Results: : The BCVA significantly improved from 0.76±0.11 to 0.61±0.08 logMAR units at 6 months after RF-PDT (P=0.003). The BCVA improved by ≥0.2 logMAR units in 4 eyes, remained stable in 6 eyes, and worsened in 1 eye. The CFT was significantly reduced from 613.0 ± 91.8 μm to 284.5 ± 63.5 μm (P=0.025). The CFT decreased by ≥20% in 9 eyes, remained stable in 1 eye, and increased in 1 eye. No additional treatment was required in 10 patients. The complications included subretinal hemorrhage in 1 eye at 6 months after RF-PDT with IVR which was successfully treated with intravitreal SF6 gas tamponade.

Conclusions: : RF-PDT and ranibizumab combination therapy appears to be effective for anatomical and functional improvement in patients with RAP. Moreover, the rate of re-treatment seems to be less with the combination therapy. Further evaluation with a larger patient samples and a long-term controlled study is required to estimate treatment efficacy.

Keywords: age-related macular degeneration • photodynamic therapy