Combined photodynamic therapy and intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

Abstract

Objective To observe the efficacy and safety of combined photodynamic therapy (PDT)with intravitreal ranibizumab injection in patients with polypoidal choroidal vasculopathy (PCV).Methots Twenty-four PCV patients (24 eyes) were enrolled in this retrospective case study.All patients were assessed by the examinations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart,color fundus photography,fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optic coherence tomography (OCT).The mean visual acuity was (33.41± 19.43) letters; the mean macular retinal thickness was (343.63 ± 88.60) μm.Patients received PDT first,and intravitreal injected ranibizumab 0.5 mg (0.05 ml) 72 hours later.Treatments were repeated as a single intravitreal injection of ranibizumab combined with or without PDT if the monthly follow-up indicated that it was necessary.The average follow-up period was 13.1 months.The average treatment times were analyzed for each eye.Systemic and ocular adverse events were observed.Visual acuity,macular retinal thickness and leakage of PCV before and after the treatment were analyzed.Results Intravitreal ranibizumab injections was repeated (2.8± 1.6) times per eye on average,and intravitreal injection of ranibizumab combined with PDT was repeated (0.4±0.5) times per eye on average.No systemic and ocular adverse effects were found during and after combined therapy.In the last follow-up,the mean visual acuity of ETDRS was (44.21±17.24)letters,improved by 10.8 letters (t=-4.77,P＜0.01).Visual acuity was improved in 11 eyes (45.8％) and stable in 13 eyes (54.2％).FFA and ICGA showed complete closed PCV in 17 eyes (70.8％),partial closed PCV in 7 eyes (29.2％).OCT image showed that the retinal edema was disappeared in 19 eyes (79.2％) and alleviated in 5 eyes (20.8％).The mean macular retinal thickness was (171.33±38.06) μm,which was 172.30 μm less than that of pre-treatment values (t =11.96,P＜ 0.05).Conclusion Photodynamic therapy combined with intravitreal ranibizumab injections for PCV is safe and effective,with visual acuity improvement,reduction of retinal edema and PCV leakage. Key words: Choroid diseases/therapy;  Photochemotherapy;  Antibodies, monoclonal