Skip to main content

Advertisement

SpringerLink
Log in

Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To clarify the efficacy of combined therapy with intravitreal ranibizumab injections and photodynamic therapy (PDT) in patients with symptomatic polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively reviewed 57 treatment-naïve eyes of 57 patients. Thirty-two patients were treated with standard fluence PDT (PDT group), and 25 patients were treated with three consecutive monthly intravitreal injections of ranibizumab and standard fluence PDT (ranibizumab plus PDT group). All patients were followed for at least 24 months.

Results

In the ranibizumab plus PDT group, the mean best-corrected visual acuity (BCVA) levels of decimal (logMAR equivalent) significantly improved from 0.30 (0.52) at baseline to 0.55 (0.26) at 24 months (P < 0.001). In the PDT group, the BCVA levels stabilized from 0.26 (0.58) at baseline to 0.25 (0.60) at 24 months. The mean changes in the BCVA in the ranibizumab plus PDT group and the PDT group were improvement of 2.63 lines and decline of 0.16 lines respectively (P = 0.010). The mean number of PDTs at 24 months in the ranibizumab plus PDT group and the PDT group were 1.4 and 2.6 respectively. Increased subretinal hemorrhages were seen in eight (18.0 %) eyes, all of which were belonging to the PDT group.

Conclusions

Combined intravitreal ranibizumab and PDT was significantly more effective in maintaining and improving VA for PCV patients compared with PDT monotherapy over 24 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Yannuzzi LA, Sorenson J, Spaide RF, Lipson B (1990) Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina 10:1–8

    Article  PubMed  CAS  Google Scholar 

  2. Spaide RF, Yannuzzi LA, Slakter JS, Sorenson J, Orlach DA (1995) Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina 15:100–110

    Article  PubMed  CAS  Google Scholar 

  3. Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA (1997) The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 115:478–485

    Article  PubMed  CAS  Google Scholar 

  4. Imamura Y, Engelbert M, Iida T, Freund KB, Yannuzzi LA (2010) Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol 55:501–515

    Article  PubMed  Google Scholar 

  5. Maruko I, Iida T, Saito M, Nagayama D, Saito K (2007) Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol 144:15–22

    Article  PubMed  Google Scholar 

  6. Lafaut BA, Leys AM, Snyers B, Rasquin F, De Laey JJ (2000) Polypoidal choroidal vasculopathy in Caucasians. Graefes Arch Clin Exp Ophthalmol 238:752–759

    Article  PubMed  CAS  Google Scholar 

  7. Uyama M, Wada M, Nagai Y, Matsubara T, Matsunaga H, Fukushima I, Takahashi K, Matsumura M (2002) Polypoidal choroidal vasculopathy: natural history. Am J Ophthalmol 133:639–648

    Article  PubMed  Google Scholar 

  8. Kvanta A, Algvere PV, Berglin L, Seregard S (1996) Subfoveal fibrovascular membranes in age-related macular degeneration express vascular endothelial growth factor. Invest Ophthalmol Vis Sci 37:1929–1934

    PubMed  CAS  Google Scholar 

  9. Kliffen M, Sharma HS, Mooy CM, Kerkvliet S, de Jong PT (1997) Increased expression of angiogenic growth factors in age-related maculopathy. Br J Ophthalmol 81:154–162

    Article  PubMed  CAS  Google Scholar 

  10. Tong JP, Chan WM, Liu DT, Lai TY, Choy KW, Pang CP, Lam DS (2006) Aqueous humor levels of vascular endothelial growth factor and pigment epithelium-derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization. Am J Ophthalmol 141:456–462

    Article  PubMed  CAS  Google Scholar 

  11. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY, MARINA Study Group (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431

    Article  PubMed  CAS  Google Scholar 

  12. Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S, ANCHOR Study Group (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355:1432–1444

    Article  PubMed  CAS  Google Scholar 

  13. Mitchell P, Korobelnik JF, Lanzetta P, Holz FG, Prünte C, Schmidt-Erfurth U, Tano Y, Wolf S (2010) Ranibizumab (Lucentis) in neovascular age-related macular degeneration: evidence from clinical trials. Br J Ophthalmol 94:2–13

    Article  PubMed  CAS  Google Scholar 

  14. Gomi F, Sawa M, Sakaguchi H, Tsujikawa M, Oshima Y, Kamei M, Tano Y (2008) Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy. Br J Ophthalmol 92:70–73

    Article  PubMed  CAS  Google Scholar 

  15. Kokame GT, Yeung L, Lai JC (2010) Continuous anti-VEGF treatment with ranibizumab for polypoidal choroidal vasculopathy: an Interim 6-month report. Br J Ophthalmol 94:297–301

    Article  PubMed  Google Scholar 

  16. Hikichi T, Higuchi M, Matsushita T, Kosaka S, Matsushita R, Takami K, Ohtsuka H, Ariga H (2012) One-year results of three monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in japanese patients. Am J Ophthalmol 154:117–124

    Article  PubMed  CAS  Google Scholar 

  17. Tano Y, Ophthalmic PDT Study Group (2008) Guidelines for PDT in Japan. Ophthalmology 115:585

    Article  PubMed  Google Scholar 

  18. Gomi F, Ohji M, Sayanagi K, Sawa M, Sakaguchi H, Oshima Y, Ikuno Y, Tano Y (2008) One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients. Ophthalmology 115:141–146

    Article  PubMed  Google Scholar 

  19. Saito M, Iida T, Nagayama D (2008) Photodynamic therapy with verteporfin for age-related macular degeneration or polypoidal choroidal vasculopathy: comparison of the presence of serous retinal pigment epithelial detachment. Br J Ophthalmol 92:1642–1647

    Article  PubMed  CAS  Google Scholar 

  20. Kurashige Y, Otani A, Sasahara M, Yodoi Y, Tamura H, Tsujikawa A, Yoshimura N (2008) Two-year results of photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol 146:513–519

    Article  PubMed  Google Scholar 

  21. Akaza E, Mori R, Yuzawa M (2008) Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy. Retina 28:717–722

    Article  PubMed  Google Scholar 

  22. Sato T, Kishi S, Matsumoto H, Mukai R (2010) Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy. Am J Ophthalmol 149:947–954

    Article  PubMed  CAS  Google Scholar 

  23. Gomi F, Sawa M, Wakabayashi T, Sasamoto Y, Suzuki M, Tsujikawa M (2010) Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol 150:48–54

    Article  PubMed  CAS  Google Scholar 

  24. Ruamviboonsuk P, Tadarati M, Vanichvaranont S, Hanutsaha P, Pokawattana N (2010) Photodynamic therapy combined with ranibizumab for polypoidal choroidal vasculopathy: results of a 1-year preliminary study. Br J Ophthalmol 94:1045–1051

    Article  PubMed  CAS  Google Scholar 

  25. Maruko I, Iida T, Sugano Y, Saito M, Sekiryu T (2011) Subfoveal retinal and choroidal thickness after verteporfin photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol 151:594–603

    Article  PubMed  CAS  Google Scholar 

  26. Lee YH, Lee EK, Shin KS, Lee KM, Kim JY (2011) Intravitreal ranibizumab combined with verteporfin in photodynamic therapy for treating polypoidal choroidal vasculopathy. Retina 31:1287–1293

    Article  PubMed  CAS  Google Scholar 

  27. Rouvas AA, Papakostas TD, Ntouraki A, Douvali M, Vergados I, Ladas ID (2011) Photodynamic therapy, ranibizumab, and ranibizumab with photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Retina 31:464–474

    Article  PubMed  CAS  Google Scholar 

  28. Lai TY, Lee GK, Luk FO, Lam DS (2011) Intravitreal ranibizumab with or without photodynamic therapy for the treatment of symptomatic polypoidal choroidal vasculopathy. Retina 31:1581–1588

    Article  PubMed  CAS  Google Scholar 

  29. Saito M, Iida T, Kano M (2012) Combined Intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy. Retina 32:1272–1279

    PubMed  CAS  Google Scholar 

  30. Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, Lai TY, Pilz S, Ruamviboonsuk P, Tokaji E, Weisberger A, Lim TH (2012) 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. Retina 32:1453–1464

    Article  PubMed  CAS  Google Scholar 

  31. Tano Y, Ohji M, Ishibashi T, Shiraga F, Tokoro T, Yuzawa M, Yoshimura N (2009) Re-treatment guideline of ranibizumab (genetical recombination) in the maintenance phase. Nippon Ganka Gakkai Zasshi 113:1098–1103, In Japanese

    PubMed  Google Scholar 

  32. Saito M, Iida T, Kano M (2012) Intravitreal ranibizumab for exudative age-related macular degeneration with good baseline visual acuity. Retina 32:1250–1259

    PubMed  CAS  Google Scholar 

  33. Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group (1999) Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials—TAP Report 1. Arch Ophthalmol 117:1329–1345

    Article  Google Scholar 

  34. Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 148:43–58

    Article  PubMed  CAS  Google Scholar 

  35. Leal S, Silva R, Figueira J, Cachulo ML, Pires I, de Abreu JR, Cunha-Vaz JG (2010) Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy: results after 3 years of follow-up. Retina 30:1197–1205

    Article  PubMed  Google Scholar 

  36. Ishikawa K, Kondo M, Ito Y, Kikuchi M, Nishihara H, Piao CH, Sugita T, Terasaki H (2007) Correlation between focal macular electroretinograms and angiographic findings after photodynamic therapy. Invest Ophthalmol Vis Sci 48:2254–2259

    Article  PubMed  Google Scholar 

  37. Tatar O, Adam A, Shinoda K, Stalmans P, Eckardt C, Lüke M, Bartz-Schmidt KU, Grisanti S (2006) Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy. Am J Ophthalmol 142:95–104

    Article  PubMed  CAS  Google Scholar 

  38. Saito M, Iida T, Kano M (2011) Intravitreal ranibizumab for polypoidal choroidal vasculopathy with recurrent or residual exudation. Retina 31:1589–1597

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Masaaki Saito, Tomohiro Iida, Mariko Kano & Kanako Itagaki

  2. Department of Ophthalmology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan

    Tomohiro Iida

Authors
  1. Masaaki Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohiro Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariko Kano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kanako Itagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masaaki Saito.

Additional information

The authors have no proprietary interest in any aspect of this study, and received no government funding.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saito, M., Iida, T., Kano, M. et al. Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 251, 2099–2110 (2013). https://doi.org/10.1007/s00417-013-2323-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-013-2323-6

Keywords

Search

Navigation