ABSTRACT
PURPOSE: To compare verteporfin photodynamic therapy combined with intravitreal ranibizumab (combination therapy) versus ranibizumab monotherapy for management of neovascular age-related macular degeneration. METHODS: Thirty patients (40 eyes) with neovascular age-related macular degeneration were prospectively allocated to combination therapy or monotherapy. In monotherapy, the induction phase consisted of 3 consecutive monthly ranibizumab injections (0.5 mg), while the combination therapy had a single session of photodynamic therapy with intravitreal ranibizumab. Follow-up treatment for either group consisted only of additional as-needed ranibizumab injections. The main outcome measure was that a proportion of eyes losing <15 letters of visual acuity after 12 months. RESULTS: Except for 1 eye in combination therapy, all eyes in both groups lost <15 letters of visual acuity. At 12 months, there was a mean gain of +12 letters and +3.2 letters for monotherapy and combination therapy, respectively (relative percent change of 32% vs. 7%, P = 0.03). Anatomical improvement was similar in both groups. After induction, the time until ranibizumab retreatment was longer for combination therapy (P = 0.002) while ranibizumab injections were required more frequently with monotherapy (P = 0.015). CONCLUSION: Ranibizumab monotherapy showed greater improvement in visual acuity versus combination therapy. However, combination therapy required fewer ranibizumab injections. Larger trials need to confirm the findings of this pilot study.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Photochemotherapy , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Wet Macular Degeneration/drug therapy , Aged , Antibodies, Monoclonal, Humanized/adverse effects , Combined Modality Therapy , Female , Fluorescein Angiography , Humans , Intravitreal Injections , Male , Photosensitizing Agents/adverse effects , Porphyrins/adverse effects , Prospective Studies , Ranibizumab , Retina/pathology , Retreatment , Time Factors , Tomography, Optical Coherence , Treatment Outcome , Verteporfin , Visual Acuity/physiology , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/physiopathologyABSTRACT
A 66-year-old woman with prior posterior vitreous detachment underwent photodynamic therapy with verteporfin for a juxtafoveolar choroidal neovascularization. Twenty days after the photodynamic therapy, fluorescein angiography showed regression of the membrane and the new onset of a macular hole. Macular hole formation following photodynamic therapy could be related to choroidal swelling leading to dehiscence of the foveal pit, or to exacerbation of either tangential traction or cystoid spaces by the laser administered over the fovea.
