Combined ranibizumab and photodynamic therapy to treat exudative age-related macular degeneration: an option for improving treatment efficiency.

PURPOSE

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.

CONCLUSION

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.