Combined ranibizumab and photodynamic therapy to treat exudative age-related macular degeneration: an option for improving treatment efficiency.
OBJECTIVE
The purposes of this study were to determine whether the association of photodynamic therapy (PDT) and intravitreal ranibizumab could improve vision in a group of patients with choroidal neovascularization secondary to age-related macular degeneration and whether it could reduce the number and frequency of intravitreal injections, thus minimizing adverse effects.


METHODS
A nonrandomized, prospective, interventional study was conducted of a case series of 53 patients with sub- and juxtafoveal choroidal neovascularization secondary to age-related macular degeneration treated with a single initial dose of PDT and intravitreal ranibizumab. Retreatments were performed as required with monthly ranibizumab and PDT every 3 months if there were relapses. The retreatment criteria were based on visual acuity, optical coherence tomography, and fluorescein angiography. Follow-up lasted 12 months in all cases.


RESULTS
The mean initial visual acuity was 40.6 letters versus 47.8 letters at the end of follow-up with a gain of 7.2 letters (P < 0.001). Moreover, 78.8% maintained or improved their initial vision, and 92.3% avoided moderate vision loss (>15 letters). A total of 65 PDT treatments (mean, 1.22 per patient) was performed and 126 doses of ranibizumab were injected (mean, 2.37 per patient). Only a single initial dose (PDT + ranibizumab) was required in 21 cases (39.6%). The central retinal thickness and choroidal neovascularization size decreased to 118 microm and 0.26 disk areas, respectively, from baseline to 12 months.


CONCLUSIONS
Combined customized PDT + ranibizumab treatment can achieve visual results similar to those obtained with intravitreal monotherapy with the advantage of fewer intravitreous injections and reduced potential for adverse effects.
Mataix
Jorge
J
Vitreoretinal Department, Fundación Oftalmológica del Mediterráneo, Valencia, Spain. jormabo@ono.com
Palacios
Elena
E
Carmen
Desco M
DM
Garcia-Pous
Maria
M
Navea
Amparo
A
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D003131:Combined Modality Therapy; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010778:Photochemotherapy; D011446:Prospective Studies; D000069579:Ranibizumab; D019233:Retreatment; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab