Comparison of visual outcomes between intravitreal ranibizumab injection combined with or without photodynamic therapy for polypoidal choroidal vasculopathy

Abstract

Objective To compare the visual outcomes of treatment with intravitreal ranibizumab alone or in combination with photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).Methods In this retrospective and comparative study,36 eyes of 36 patients with PCV were enrolled.Eighteen eyes received 0.5 mg (0.05 ml) ranibizumab injection only (simple injection group) and the other 18 eyes underwent combination therapy of ranibizumab injection and PDT (combination treatment group).Intravitreal ranibizumab was given at the third day after PDT.Re-treatment was considered in clinic examination.The minimum re-treatment interval was 3 months for combination therapy and 1 month for ranibizumab.Best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) at baseline and each follow-up visit at 1,3,6,12 month was measured as a primary outcome,and complications also observed in every follow-up.Results No complications occurred in these 36 patients during the treatment or follow-up,such as retinal detachment,sustained high intraocular pressure,retinal holes,intraocular inflammation,and systemic adverse reactions.The average times of ranibizumab injections of simple injection group and combined treatment group were (3.00 ± 0.84) and (1.89±0.68) times respective,and the difference was significant (t=4.370,P=0.000).The logMAR BCVA of the first and third month after initial treatment between two groups were significant different (t=0.668,0.940; P＞0.05).However,there was no significant difference between them at the 6th and 12th month (t=2.188,2.547; P＜0.05).In the last follow-up,the logMAR BCVA were improved in simple injection group and combination treatment group compared to the pre-treatment values (t =3.351,9.408; P=0.012,0.000).In simple injection group,visual acuity was improved in 3 eyes (16.7％),stable in 13 eyes (72.2％) and decreased in 2 eyes (11.1％).In combination treatment group,visual acuity was improved in 4 eyes (22.2％),stable in 13 eyes (72.2％) and decreased in 1 eyes (5.6％).Conclusions Intravitreal ranibizumab injection and combined with PDT are both effective to improve vision in patients with PCV.Visual acuity was the same between the two treatments in 3 months after initial treatment; however 6 to 12 months after first treatment,patients received PDT combined with intravitreal ranibizumab injection had better visual acuity than those received the intravitreal ranibizumab injection only. Key words: Choroid diseases/therapy; Photochemotherapy; Antibodies, monoclonal; Comparative effectiveness research