One-year results of intravitreal ranibizumab combined with reduced-fluence photodynamic therapy for polypoidal choroidal vasculopathy

Abstract

PurposeTo compare the 1-year results of intravitreal ranibizumab combined with reduced-fluence photodynamic therapy (RF-PDT) to intravitreal ranibizumab (IVR) alone for eyes with polypoidal choroidal vasculopathy (PCV).MethodsWe reviewed the medical records from 47 consecutive patients with PCV (47 naïve eyes). Seventeen eyes from 17 patients had one IVR treatment combined with RF-PDT followed by two additional IVR treatments (combined group), and 30 eyes from 30 patients were treated with 3 monthly IVR treatments (IVR group). All eyes had a follow-up period of at least 12 months.ResultsAt 12 months, the mean logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) significantly improved from 0.55 to 0.38 logMAR units in the combined group (P=0.041) but did not change significantly in the IVR group (P=0.371). The central foveal thickness (CFT) was significantly thinner in both groups at 6 months (P<0.01). Additional IVR injections were required less frequently in the combined group (n=3; 17%) than in the IVR group (n=16; 53%) during the 12 month follow-up (P=0.029).ConclusionThe IVR and RF-PDT combination led to significant BCVA improvements and required fewer additional IVR treatments for at least 12 months in eyes with PCV.

Intravitreal ranibizumab injection combined with photodynamic therapy for polypoidal choroidal vasculopathy

“…However, retinal hemorrhage, RPE tear and other complications have been reported to be associated with PDT in the treatment of PCV (9). Ranibizumab may reduce lesion leakage and improve or stabilize visual acuity in patients with PCV (19).…”

“…Furthermore, photodynamic therapy (PDT) has also been demonstrated to effectively seal the blood vessels in PCV, and subsequently limit lesion development (6,7). However, long-term follow-up observations have indicated a higher recurrence rate and retinal hemorrhage incidence following PDT, and therefore repeated treatments are required (8,9). By contrast, combination therapy with intravitreal ranibizumab (IVR) injection and PDT has been demonstrated to have more satisfactory outcomes, which may significantly reduce the incidence of complications (10,11).…”

Comparing efficacy of reduced-fluence and standard-fluence photodynamic therapy in the treatment of polypoidal choroidal vasculopathy

“…To mitigate the risk of complications using standard PDT, less intensive protocols for PDT treatment have been suggested. They include reducing the dose of verteporfin administered or reducing one of the laser parameters (dose rate or duration of laser application) to achieve a reduction in the laser fluence (light dose) [13][14][15][16][17][18][19][20]. Various authors have described treatment success with these less intensive protocols which theoretically reduces the risk of complications [13][14][15][16][17][18][19][20].…”

“…They include reducing the dose of verteporfin administered or reducing one of the laser parameters (dose rate or duration of laser application) to achieve a reduction in the laser fluence (light dose) [13][14][15][16][17][18][19][20]. Various authors have described treatment success with these less intensive protocols which theoretically reduces the risk of complications [13][14][15][16][17][18][19][20]. Several studies have reported the success of reduced-fluence PDT in the treatment of PCV [13][14][15][16][18][19][20].…”

“…Several studies have reported the success of reduced-fluence PDT in the treatment of PCV [13][14][15][16][18][19][20]. However, all except one of these reports are single-arm interventional series involving only the reduced-fluence arm, without the inclusion of a standard-fluence arm for comparison [14][15][16][18][19][20]. Only Fan et al compared the outcomes between reduced-fluence and standard-fluence PDT [13].…”