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Japanese Journal of Ophthalmology

, Volume 57, Issue 3, pp 283–293 | Cite as

Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy

  • Yusaku Yoshida
  • Takeya Kohno
  • Manabu Yamamoto
  • Tasuku Yoneda
  • Hisashi Iwami
  • Kunihiko Shiraki
Clinical Investigation

Abstract

Purpose

To report the 2-year results of reduced-fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).

Methods

Twenty-four previously untreated eyes of 23 AMD patients with decimal best-corrected visual acuity (BCVA) of less than 0.7 received the combined therapy, followed by retreatments as needed over the subsequent 2 years. When the BCVA was better than or equal to 0.7, only 3 monthly IVR injections were performed during the retreatment.

Results

The BCVAs were maintained in 7 of 10 typical AMD eyes and in 13 of 14 PCV eyes at month 24. The mean BCVA improved in the PCV group (P < 0.05) but not in the typical AMD group. The central foveal thickness decreased in both groups (P < 0.01, P < 0.001). The mean numbers of the total PDT and IVR injections were 1.8 and 7.2 in the typical AMD group and 1.8 and 6.4 in the PCV group.

Conclusion

After RF-PDT combined therapy with administration of retreatments as needed that consisted of either 3 IVR injections alone or combined therapy, the BCVA was maintained in typical AMD and improved in PCV during a 2-year follow-up period.

Keywords

Age-related macular degeneration Polypoidal choroidal vasculopathy Ranibizumab Reduced-fluence photodynamic therapy 

References

  1. 1.
    Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology. 2009;116:57–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol. 2009;148:43–58.PubMedCrossRefGoogle Scholar
  4. 4.
    Holz FG, Amoaku W, Donate J, Guymer RH, Kellner U, Schlingemann RO, et al. Safety and efficacy of a flexible dosing regimen of ranibizumab in neovascular age-related macular degeneration: the SUSTAIN study. Ophthalmology. 2011;118:663–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Dhalla MS, Shah GK, Blinder KJ, Ryan EH Jr, Mittra RA, Tewari A, et al. Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration. Retina. 2006;26:988–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Lazic R, Gabric N. Verteporfin therapy and intravitreal bevacizumab combined and alone in choroidal neovascularization due to age-related macular degeneration. Ophthalmology. 2007;114:1179–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Costa RA, Jorge R, Calucci D, Melo LA, Cardillo JA, Scott IU. Intravitreal bevacizumab (Avastin) in combination with verteporfin photodynamic therapy for choroidal neovascularization associated with age-related macular degeneration (IBeVe Study). Graefe’s Arch Clin Exp Ophthalmol. 2007;245:1273–80.CrossRefGoogle Scholar
  8. 8.
    Ahmadieh H, Taei R, Soheilian M, Riazi-Esfahani M, Ahadi H. Single-session photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration. Eur J Ophthalmol. 2008;18:297–300.PubMedGoogle Scholar
  9. 9.
    Ladewig MS, Karl SE, Hamelmann V, Helb HM, Scholl HP, Holz FG, et al. Combined intravitreal bevacizumab and photodynamic therapy for neovascular age-related macular degeneration. Graefe’s Arch Clin Exp Ophthalmol. 2008;246:17–25.CrossRefGoogle Scholar
  10. 10.
    Smith BT, Dhalla MS, Shah GK, Blinder KJ, Ryan EH Jr, Mittra RA. Intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy for choroidal neovascularization in age-related macular degeneration. Retina. 2008;28:675–81.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaiser PK. Verteporfin photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration. Ophthalmology. 2009;116:747–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Hara R, Kawaji T, Inomata Y, Tahara J, Sagara N, Fukushima M, et al. Photodynamic therapy alone versus combined with intravitreal bevacizumab for neovascular age-related macular degeneration without polypoidal choroidal vasculopathy in Japanese patients. Graefes Arch Clin Exp Ophthalmol. 2010;248:931–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Spielberg L, Leys A. Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy: the TORPEDO trial at 2 years. Graefes Arch Clin Exp Ophthalmol. 2010;248:943–56.PubMedCrossRefGoogle Scholar
  14. 14.
    Lim JY, Lee SY, Kim JG, Lee Jy, Chung H, Yoon YH. Intravitreal bevacizumab alone versus in combination with photodynamic therapy for the treatment of neovascular maculopathy in patients aged 50 years or older: 1-year results of a prospective clinical study. Acta Ophthalmol. 2012;90:61–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Larsen M, Schmidt-Erfurth U, Lanzetta P, Wolf S, Simader C, Tokaji E, et al. Verteporfin plus ranibizumab for choroidal neovascularization in age-related macular degeneration. Twelve-month MONT BLANC Study Results. Ophthalmology. 2012;119:992–1000.PubMedCrossRefGoogle Scholar
  16. 16.
    Kaiser PK, Boyer DS, Cruess AF, Slakter JS, Pilz S, Weisberger A, et al. Verteporfin plus ranibizumab for choroidal neovascularization in age-related macular degeneration. Twelve-month results of the DENALI study. Ophthalmology. 2012;119:1001–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Schmidt-Erfurth U, Michels S, Barbazetto I, Laqua H. Photodynamic effects on choroidal neovascularization and physiological choroid. Invest Ophthalmol Vis Sci. 2002;43:830–41.PubMedGoogle Scholar
  18. 18.
    Schmidt-Erfurth U, Schlötzer-Schrehard U, Cursiefen C, Michels S, Beckendorf A, Naumann GO. Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF), VEGF receptor 3, and pigment epithelium-derived factor. Invest Ophthalmol Vis Sci. 2003;44:4473–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Azab M, Boyer DS, Bressler NM, Bressler SB, Cihelkova I, Hao Y, et al. Verteporfin therapy of subfoveal minimally classic choroidal neovascularization in age-related macular degeneration: 2-year results of a randomized clinical trial. Arch Ophthalmol. 2005;123:448–57.PubMedCrossRefGoogle Scholar
  20. 20.
    Potter MJ, Claudio CC, Szabo SM. A randomised trial of bevacizumab and reduced light dose photodynamic therapy in age-related macular degeneration: the VIA study. Br J Ophthalmol. 2010;94:174–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Costagliola C, Romano MR, Rinaldi M, dell’Omo R, Chiosi F, Menzione M, et al. Low fluence rate photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration. Br J Ophthalmol. 2010;94:180–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Chan WM, Lam DSC, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy. One-year results of a prospective case series. Ophthalmology. 2004;111:1576–84.PubMedCrossRefGoogle Scholar
  23. 23.
    Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, 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. Retina. 2012;32:1453–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Hirami Y, Tsujikawa A, Otani A, Yodoi Y, Aikawa H, Mandai M, et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy. Retina. 2007;27:335–41.Google Scholar
  25. 25.
    Yamashita A, Shiraga F, Shiragami C, Ono A, Tenkumo K. One-year results of reduced-fluence photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2010;149:465–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Kurashige Y, Otani A, Sasahara M, Yodoi Y, Tamura H, Tsujikawa A, et al. Two-year results of photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2008;146:513–9.Google Scholar
  27. 27.
    Yamashiro K, Tsujikawa A, Nishida A, Mandai M, Kurimoto Y. Recurrence of polypoidal choroidal vasculopathy after photodynamic therapy. Jpn J Ophthalmol. 2008;52:457–62.PubMedCrossRefGoogle Scholar
  28. 28.
    Akaza E, Yuzawa M, Mori R. Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2011;55:39–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Sawa M, Iwata E, Ishikawa K, Gomi F, Nishida K, Terasaki H. Comparison of different treatment intervals between bevacizumab injection and photodynamic therapy in combined therapy for age-related macular degeneration. Jpn J Ophthalmol. 2012;56:470–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Augustin AJ, Puls S, Offermann I. Triple therapy for choroidal neovascularization due to age-related macular degeneration. verteporfin PDT, bevacizumab, and dexamethasone. Retina. 2007;27:133–40.PubMedCrossRefGoogle Scholar
  31. 31.
    Sato T, Kishi S, Matsumoto H, Mukai R. Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2010;149:947–54.PubMedCrossRefGoogle Scholar
  32. 32.
    Gomi F, Sawa M, Wakabayashi T, Sasamoto Y, Suzuki M, Tsujikawa M. Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2010;150:48–54.PubMedCrossRefGoogle Scholar
  33. 33.
    Ruamviboonsuk P, Tadarati M, Vanichvaranont S, Hanutsaha P, Pokawattana N. Photodynamic therapy combined with ranibizumab for polypoidal choroidal vasculopathy: results of a 1-year preliminary study. Br J Ophthalmol. 2010;94:1045–51.PubMedCrossRefGoogle Scholar
  34. 34.
    Song MH, Ryu HW, Roh YJ. One-year results of intravitreal ranibizumab with or without photodynamic therapy for polypoidal choroidal vasculopathy. Ophthalmologica. 2011;225:119–26.CrossRefGoogle Scholar
  35. 35.
    Kim M, Kim K, Kim do G, Yu SY, Kwakx HW. Two-year results of photodynamic therapy combined with intravitreal anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy. Ophthalmologica. 2011;226:205–13.PubMedCrossRefGoogle Scholar
  36. 36.
    Tomita K, Tsujikawa A, Yamashiro K, Ooto S, Tamura H, Otani A, et al. Treatment of polypoidal choroidal vasculopathy with photodynamic therapy combined with intravitreal injections of ranibizumab. Am J Ophthalmol. 2012;153:68–80.PubMedCrossRefGoogle Scholar
  37. 37.
    Sagong M, Suho L, Chang W. Reduced-fluence photodynamic therapy combined with intravitreal bevacizumab for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2012;153:873–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Kim KS, Lee WK. Bevacizumab for serous changes originating from a persistent branching vascular network following photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2011;55:370–7.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2013

Authors and Affiliations

  • Yusaku Yoshida
    • 1
  • Takeya Kohno
    • 1
  • Manabu Yamamoto
    • 1
  • Tasuku Yoneda
    • 1
  • Hisashi Iwami
    • 1
  • Kunihiko Shiraki
    • 1
  1. 1.Department of Ophthalmology and Visual Science, Graduate School of MedicineOsaka City UniversityOsakaJapan

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