[Intravitreal ranibizumab in combination with verteporfin photodynamic therapy in neovascular macular degeneration]

Abstract

Purpose: To evaluate safety and efficacy of intravitreal ranibizumab (IVR) combined with verteporfin photodynamic therapy (PDT) in neovascular macular degeneration.

Methods: Ten eyes of ten patients received one IVR 0.5 mg after verteporfin PDT (standard regimen), then the treatment has been indicated PRN (pro re nata; when necessary). Patients were examined to exclude acute disease, which could prevent to initiate the treatment. Eyes were evaluated, with ETDRS the best-corrected visual acuity (BCVA), intraocular pressure, and slit lamp and after pupil dilatation biomicroscopy and optical coherence tomography (OCT) at baseline and monthly thereafter. Fluorescein angiography (FA) was performed at baseline and after three months. In the study group, there were two cases (20%) of new idiopathic choroidal neovascularization and 8 patients (80%) who were previously treated at least once by verteporfin due to age-related macular degeneration. Another session of IVR would be performed in case of 5-letter decrease of BCVA, 100-microm increase of central retinal thickness (CRT) or new hemorrhages in the macula. Next verteporfin PDT therapy would be indicated in case of a leakage on FA. The mean BCVA before the treatment was of 0.3, CRT of 228 microm and macular volume of 6.79 mm3. The mean follow-up was 3.5 months.

Results: There were no BCVA decrease, OCT increase bigger than stated above or new hemorrhages at any visit (n = 25). There was no leakage on any FA at month 3 (n = 10). That is why only one session of combined verteporfin PDT and IVR was performed in all patients (100 %). The mean BCVA improved to 0.5 (mean increase by 13.5 letters), CRT dropped to 198 microm and macular volume to 6.33 mm3. No systemic or ocular side effects were noted.

Conclusion: Longer follow-up and larger study group are mandatory to confirm early positive results of this therapy (improvement by 13.5 letters after one session of combination of verteporfin PDT and RIV) which seems to be the most promising due to absence of serious complications with smoother disease management and lower financial burden.