To compare verteporfin photodynamic therapy combined with intravitreal ranibizumab (combination therapy) versus ranibizumab monotherapy for management of neovascular age-related macular degeneration.
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.
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).
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.
Patients with neovascular age-related macular degeneration were allocated to either intravitreal ranibizumab monotherapy or photodynamic therapy/intravitreal ranibizumab combination treatment and followed prospectively for 12 months. The combination therapy group required fewer ranibizumab injections to maintain a fluid-free macula while the monotherapy group had more improvement in visual acuity.
From the *Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; and †Department of Ophthalmology, Hotel Dieu de France, St. Joseph University, Beirut, Lebanon.
G. M. El-Mollayess and S. Arafat contributed equally to this manuscript.
Supported by Novartis, Basel, Switzerland.
The authors have no financial interest in any product mentioned in the study.
Reprint requests: Ziad Bashshur, MD, Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/B11, Beirut, Lebanon; e-mail: email@example.com