Combined photodynamic therapy and intravitreal ranibizumab injection for polypoidal choroidal vasculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

WangQinhui ,  YuXiaobing , DaiHong , 龙力

Department of Ophthalmology, Beijing Hospital, Beijing 100730, China;

Corresponding author：

YuXiaobing, Email: yuxiaobing@sina.com

Keywords：

Choroid diseases/therapy; Photochemotherapy; Antibodies, monoclonal

DOI：

10.3760/cma.j.issn.1005-1015.2014.03.005

Video：

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Objective To observe the efficacy and safety of combined photodynamic therapy (PDT) with intravitreal ranibizumab injection in patients with polypoidal choroidal vasculopathy (PCV). Methods 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.

Citation： WangQinhui, YuXiaobing, DaiHong. Combined photodynamic therapy and intravitreal ranibizumab injection for polypoidal choroidal vasculopathy. Chinese Journal of Ocular Fundus Diseases, 2014, 30(3): 245-248. doi: 10.3760/cma.j.issn.1005-1015.2014.03.005 Copy

1.	Spaide RF, Donsoff I, Lam DL, et al.Treatment of polypoidal choroidal vasculopathy with photodynamic therapy[J].Retina, 2002, 22:529-535.
2.	Chan WM, Lam DS, Lai TY, et al.Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy:one-year results of a prospective case series[J].Ophthalmology, 2004, 111:1576-1584.
3.	金陈进,张燕,田臻,等. 光动力疗法治疗息肉样脉络膜血管病变[J]. 中华眼科杂志,2007,43:642-645.
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12.	喻晓兵,戴虹,卢颖毅,等. 光动力疗法联合玻璃体腔曲安奈德注射治疗脉络膜新生血管[J]. 中华眼底病杂志, 2007, 23:13-16.
13.	Otani A, Sasahara M, Yodoi Y, et al.Indocyanine green angiography:guided photodynamic therapy for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2007,144:7-14.
14.	Kim M, Kim K,Kim DG,et al.Two-year results of photodynamic therapy combined with intravitreal anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy [J].Ophthalmologica,2011,226:205-213.
15.	Lee YA,Yang CH,Yang CM,et al.Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy:two years of follow up [J].Am J Ophthalmol,2012,154:872-880.
16.	Nemoto R,Miura M,Iwasaki T,et al.Two-year follow-up of ranibizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy [J].Clin Ophthalmol,2012,6:1633-1638.
17.	Akaza E,Yuzawa M,Mori R.Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy [J]. Jpn J Ophthalmol,2011,55:39-44.
18.	Saito M,Iida T,Kano M,et al.Five-year results of photodynamic therapy with and without supplementary antivascular endothelial growth factor treatment for polypoidal choroidal vasculopathy[J].Graefe's Arch Clin Exp Ophthalmol,2013, 251: 2099-2011.
19.	Matsuoka M,Ogata N,Otsuji T,et al.Expression of pigment epithelium derived factor and vascular endothelial growth factor in choroidal neovascular membranes and polypoidal choroidal vasculopathy[J].Br J Ophthalmol,2004,88:809-815.
20.	Sato T,Kishi S,Matsumoto H,et al.Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2010,149:947-954.
21.	Ruamviboonsuk P,Tadarati M,Vanichvaranont S,et al.Photodynamic therapy combined with ranibizumab for polypoidal choroidal vasculopathy:results of a 1-year preliminary study[J].Br J Ophthalmol,2010,94:1045-1051.
22.	Adrian K, Won KL, Lee JC, et al.EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy[J].Retina, 2012, 32:1453-1464.
23.	Saito M,Iida T,Kano M.Combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy[J].Retina,2012,32:1272-1279.
24.	喻晓兵,戴虹,卢颖毅,等.光动力疗法治疗黄斑中心凹下脉络膜新生血管后激光照射区视网膜厚度的变化[J].中华眼科杂志,2007, 43:505-507.
25.	戴虹,岳枚,杨絮,等.抗血管内皮生长因子单克隆抗体Ranibizumab联合光动力疗法治疗渗出型年龄相关性黄斑变性的临床观察[J].中华眼视光学与视觉科学研究,2011,13:84-87.

1. Spaide RF, Donsoff I, Lam DL, et al.Treatment of polypoidal choroidal vasculopathy with photodynamic therapy[J].Retina, 2002, 22:529-535.
2. Chan WM, Lam DS, Lai TY, et al.Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy:one-year results of a prospective case series[J].Ophthalmology, 2004, 111:1576-1584.
3. 金陈进,张燕,田臻,等. 光动力疗法治疗息肉样脉络膜血管病变[J]. 中华眼科杂志,2007,43:642-645.
4. Hirami Y, Tsujikawa A, Otani A, et al. Hemorrhagic complication after photodynamic therapy for polypoidal choroidal vasculopathy[J]. Retina, 2007, 27: 335-341.
5. Leal S,Silva R,Figueira J,et al.Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy:results after 3 years of follow-up[J].Retina,2010,30:1197-1205.
6. Kokame GT, Yeung L, Lai JC. Continuous anti-VEGF treatment with ranibizumab for polypoidal choroidal vasculopathy: 6-month result[J]. Br J Ophthalmol,2010,94:297-301.
7. Hikichi T, Higuchi M, Matsushita T, et al.Results of 2 years of treatment with as-needed ranibizumab reinjection for polypoidal choroidal vasculopathy[J].Br J Ophthalmol,2013,97:617-621.
8. Kim SJ,Yu HG.Efficacy of combined photodynamic therapy and intravitreal bevacizumab injection versus photodynamic therapy alone in polypoidal choroidal vasculopathy[J].Retina, 2011, 31:1827-1834.
9. Gomi F,Sawn M,Wakabayashi T,et al.Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2010,150:48-54.
10. Ghajarnia M, Kurup S, Eller A.The therapeutic effects of intravitreal bevacizumab in a patient with recalcitrant idiopathic polypoidal choroidal vasculopathy[J].Semin Ophthalmol, 2007, 22:127-131.
11. Koh AH, Expert PCV Panel, Chen LJ, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment[J]. Retina, 2013, 33:686-716.
12. 喻晓兵,戴虹,卢颖毅,等. 光动力疗法联合玻璃体腔曲安奈德注射治疗脉络膜新生血管[J]. 中华眼底病杂志, 2007, 23:13-16.
13. Otani A, Sasahara M, Yodoi Y, et al.Indocyanine green angiography:guided photodynamic therapy for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2007,144:7-14.
14. Kim M, Kim K,Kim DG,et al.Two-year results of photodynamic therapy combined with intravitreal anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy [J].Ophthalmologica,2011,226:205-213.
15. Lee YA,Yang CH,Yang CM,et al.Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy:two years of follow up [J].Am J Ophthalmol,2012,154:872-880.
16. Nemoto R,Miura M,Iwasaki T,et al.Two-year follow-up of ranibizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy [J].Clin Ophthalmol,2012,6:1633-1638.
17. Akaza E,Yuzawa M,Mori R.Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy [J]. Jpn J Ophthalmol,2011,55:39-44.
18. Saito M,Iida T,Kano M,et al.Five-year results of photodynamic therapy with and without supplementary antivascular endothelial growth factor treatment for polypoidal choroidal vasculopathy[J].Graefe's Arch Clin Exp Ophthalmol,2013, 251: 2099-2011.
19. Matsuoka M,Ogata N,Otsuji T,et al.Expression of pigment epithelium derived factor and vascular endothelial growth factor in choroidal neovascular membranes and polypoidal choroidal vasculopathy[J].Br J Ophthalmol,2004,88:809-815.
20. Sato T,Kishi S,Matsumoto H,et al.Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2010,149:947-954.
21. Ruamviboonsuk P,Tadarati M,Vanichvaranont S,et al.Photodynamic therapy combined with ranibizumab for polypoidal choroidal vasculopathy:results of a 1-year preliminary study[J].Br J Ophthalmol,2010,94:1045-1051.
22. Adrian K, Won KL, Lee JC, et al.EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy[J].Retina, 2012, 32:1453-1464.
23. Saito M,Iida T,Kano M.Combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy[J].Retina,2012,32:1272-1279.
24. 喻晓兵,戴虹,卢颖毅,等.光动力疗法治疗黄斑中心凹下脉络膜新生血管后激光照射区视网膜厚度的变化[J].中华眼科杂志,2007, 43:505-507.
25. 戴虹,岳枚,杨絮,等.抗血管内皮生长因子单克隆抗体Ranibizumab联合光动力疗法治疗渗出型年龄相关性黄斑变性的临床观察[J].中华眼视光学与视觉科学研究,2011,13:84-87.

Chinese Journal of Ocular Fundus Diseases

Combined photodynamic therapy and intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

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