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INTRAVITREAL RANIBIZUMAB WITH OR WITHOUT PHOTODYNAMIC THERAPY FOR THE TREATMENT OF SYMPTOMATIC POLYPOIDAL CHOROIDAL VASCULOPATHY

Lai, Timothy Y Y MD, FRCS; Lee, Gary K Y MRCS; Luk, Fiona O J MRCS; Lam, Dennis S C MD, FRCS, FRCOphth

doi: 10.1097/IAE.0b013e31820d3f3f
Original Study

Purpose: To evaluate the efficacy of intravitreal ranibizumab with or without verteporfin photodynamic therapy (PDT) in the treatment of symptomatic polypoidal choroidal vasculopathy.

Methods: Twenty-three eyes of 23 patients received 3 monthly intravitreal ranibizumab injections with or without indocyanine green angiography-guided PDT at baseline. All patients had follow-up of ≥12 months. Visual and anatomical outcomes were compared between the two groups and a PDT monotherapy group.

Results: Seven eyes had ranibizumab monotherapy, 16 had combined ranibizumab injections and verteporfin PDT, and 12 had PDT monotherapy. At 3 months, the mean logarithm of minimal angle of resolution best-corrected visual acuity improved from 0.92 to 0.74 in the ranibizumab group (P = 0.18), from 0.70 to 0.59 in the combined group (P = 0.037), and from 0.74 to 0.57 in the PDT monotherapy group (P = 0.014). Complete regression of polypoidal lesions in indocyanine green angiography was found in 1 (14.3%) eye in the ranibizumab group, compared with 15 (93.8%) eyes in the combined group (P = 0.001). Additional PDT and ranibizumab injections in eyes with persistent polyps and fluorescein leakage resulted in regression of polyps in all eyes. At 12 months, no significant difference in logarithm of minimal angle of resolution best-corrected visual acuity and visual change was found between eyes initially treated with ranibizumab monotherapy, combined ranibizumab and PDT, or PDT monotherapy (P = 1.00 and P = 0.11, respectively).

Conclusion: Intravitreal ranibizumab appeared to result in stabilization of vision in patients with symptomatic polypoidal choroidal vasculopathy. However, combined ranibizumab and PDT appeared to be more effective in causing complete regression of the polypoidal lesions in indocyanine green angiography compared with ranibizumab monotherapy.

This retrospective comparative study showed that although intravitreal ranibizumab could stabilize vision in eyes with polypoidal choroidal vasculopathy, ranibizumab monotherapy was less effective compared with combined ranibizumab and verteporfin photodynamic therapy for regression of polypoidal lesions seen in indocyanine green angiography.

From the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon. Hong Kong.

Presented as a poster presentation at the 2009 Annual Meeting of the American Academy of Ophthalmology, San Francisco, CA, November 2009.

Dr T. Y. Y. Lai has received honoraria for lecture fees and for serving as a consultant in the advisory board of Novartis, Inc. Other authors have no conflicts of interest to disclose.

Reprint requests: Timothy Y. Y. Lai, MD, FRCS, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong; e-mail: tyylai@cuhk.edu.hk

© The Ophthalmic Communications Society, Inc.