Abstract

SA.16.08

Combination of intravitreal injection of Ranibizumab and photodynamic therapy in neovascular age-related macular degeneration

Guido Kürzinger, Gerhard K. Lang, Gabriele E. Lang
Augenklinik, Universität Ulm, Ulm

Objective
We investigated the clinical outcome of intravitreal injection (IVT) of Ranibizumab (Lucentis®) and photodynamic therapy with Visudyne® (PDT) in patients with subfoveal classic (CCN) or occult (OCN) choroidal neovascularization in age-related macular degeneration (ARMD).
Methods
Data of 94 consecutive patients (100 eyes) were retrospectively analyzed. Eyes were treated with PDT, then IVT with Ranibizumab mostly 3 injections, one per month. Cases with persistent macular edema were re-treated with IVT monthly and PDT every 3 months. Protocol included best corrected visual acuity (BCVA) pre- and post-treatment, ophthalmoscopy findings, optical coherence tomography (OCT) examination, fundus photography and fluorescein angiography (FAG). It was analyzed descriptively, by Spearman rank correlation and crosstabulation.
Results
Age ranged from 54 to 89 years (median: 80 years). Median 1 PDT (minimum:1, maximum: 3) and 3 IVT (minimum:1, maximum: 9) were performed. Median BCVA pre-treatment was 0.2 (minimum: 0.05, maximum: 0.9) and post- treatment 0.2 (minimum: 0.04, maximum: 1.0). After IVT+ PDT 15 of 100 eyes gained >= 3 lines BCVA, 79 eyes stabilized with ± 2 lines, 6 eyes showed a deterioration with loss of >= 3 lines. BCVA in the melioration group was pre-PDT 0.3, post-treatment 0.7 in the stable cases pre-/post-treatment 0.2/0.2 and in the deterioration group pre-treatment 0.45 and post 0.08. 88 of 100 eyes had in OCT, 3 months after last treatment dry macula. 62 eyes had CCN, 38 OCN. 14 (23% of CCN) of 15 eyes with BCVA melioration >= 3 lines had CCN, 1 eye (7 % of OCN) OCN. Median BCVA of CCN and OCN was pre-/post-treatment 0.2/0.2 for both. As complication we had 2x large subretinal hemorrhages, 1x stroke and 1x hole of the inner retinal macular layer, we had no endophthalmitis.
Conclusions
According to our study combined treatment of Ranibizumab and PDT showed a stabilization or melioration of BCVA in 94 % of the eyes. Combined therapy seems to stabilize the findings and leads faster to a dry macula as monotherapy. Further large multicenter studies are required to investigate the outcome of combined VEGF inhibitors with PDT in neovascular ARMD for reducing the number of therapies and the relapse rate.

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