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I. R. Fromer, E. D. Roth, D. M. Chacko; Combination Therapy Using Verteporfin and Ranibizumab for Treatment of Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2008;49(13):541.
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To test the efficacy of a combination therapy for AMD of an occlusive agent (vPDT) to attack the vascular component and an anti-angiogenic agent (Ranibuzumab) to prevent new vessels from forming and counteract the suspected upregulation of VEGF caused by PDT. This could potentially reduce the re-treatment frequency and thus the total cost of treatment while producing excellent visual results.
A retrospective chart review of 77 virgin eyes of 71 patients (mean age:80.8) with subfoveal CNVM secondary to AMD treated by a single ophthalmologist was performed. These consisted of all lesion types with an average lesion size of 3220 microms. Study subjects were examined and diagnosed using slit lamp biomicroscopy, flourescein angiography, and optical computerized tomography. Patients were initially treated with PDT followed by intravitreal ranibizumab 3 weeks later. If, at a three-week follow-up exam, the patient still exhibited lesion leakage the treatment protocol was repeated at three-week intervals until active CNVM leakage stopped. This took a mean of 2.7 PDT treatments and 2.7 injections. The mean treatment duration and follow-up was 7.6 months.
The average pre-treatment VA was 20/125+2 (range: 20/25 to CF) and the average post-treatment VA was 20/125+3 (range: 20/25+2 to CF). Forty-nine patients (63.6%) maintained or improved their baseline VA. Fifteen patients (19.5%) gained ≥15 snellen letters and 15 patients also lost ≥15 letters. Thirty-two (41.6%) patients had post-treatment VA of ≥20/50 and 57 (74.0%) patients had ≥20/200 VA.
Combination therapy seems to be effective in maintaining visual acuity and even increasing it in some cases. More controlled and long-term studies need to be conducted to determine if it is an effective long-term treatment protocol.
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