Photodynamische Therapie mit Verteporfin kombiniert mit intravitrealer Injektion von Ranibizumab zur Behandlung okkulter und klassischer choroidaler Neovaskularisationen bei AMD

Zusammenfassung

Hintergrund: Untersucht wird der Effekt einer Kombination von photodynamischer Therapie (PDT) und intravitrealer Behandlung mit Ranibizumab (0,5 mg) bei okkulter und klassischer choroidaler Neovaskularisation (CNV) bei AMD. Methoden: In einer Pilotstudie wurden 28 Patienten mit okkulter oder klassischer CNV bei AMD mit intravitrealer Injektion von Ranibizumab (0,5 mg) 12 bis 24 Stunden nach Standard-PDT behandelt. Es folgten 2 weitere Injektionen nach 1 und 2 Monaten. Vor, 3 und 6 Monate nach Behandlung wurden die Sehschärfe und die Netzhautdicke mit dem OCT untersucht sowie eine Fluoreszenzangiografie durchgeführt. Ergebnisse: Die mittlere Sehschärfe verbesserte sich im Vergleich zur Ausgangssehschärfe und war nach 3 Monaten signifikant besser (Visus vor Behandlung = 0,27, nach 3 Monaten 0,39, nach 6 Monaten 0,37). Wir fanden keine choroidale Hypoperfusion und keinen RPE-Riss. Die OCT-Untersuchung vor, 3 and 6 Monate nach Kombinationstherapie zeigte eine Reduktion der Netzhautdicke (Baseline: 307 µm, nach 1 Monat: 210 µm nach 3 Monaten: 228 µm und nach 6 Monaten 282 µm). Die Fluoreszenzangiografie zeigte eine Reduktion der Leckage im Vergleich zum Ausgangsbefund. Schlussfolgerung: Die photodynamische Therapie kombiniert mit intravitrealer Applikation von Ranibizumab wurde gut vertragen und ergab eine Visusstabilisierung bei 96 % der Patienten. Unsere Kurzzeitergebnisse sind vielversprechend. Weitere Untersuchungen sind nötig, um den Langzeiteffekt der Kombinationstherapie von PDT und intravitrealer Anti-VEGF-Therapie zu überprüfen.

Abstract

Purpose: The aim of this study is to discuss the effect and outcome of a combined photodynamic therapy and intravitreal injection of ranibizumab (0.5 mg) in occult CNV with recent disease progression and in classic choroidal neovascularization (CNV) due to AMD. Methods: In a pilot study in 28 patients (17 classic, 11 occult CNV) an intravitreal injection of ranibizumab was administered within 12 to 24 hours after standard PDT, followed by 2 injections of ranibizumab after 1 and 2 months. Before as well as 3 and 6 months after treatment visual acuity, OCT examinations (retinal thickness) and fluorescein angiography were performed. Results: Mean visual acuity was significantly improved compared to baseline after 3 months (VA baseline 20 / 80, after 3 months 20 / 50, and 20 / 63 after 6 months). We found no choroidal hypoperfusion and no RPE rip. OCT and fluorescein angiography in patients with occult and classic choroidal neovascularisation after the combination therapy showed a reduced retinal thickness (baseline: 307 µm, after 1 month: 210 µm, after 3 months: 228 µm and after 6 months 281 µm) and a reduction of leakage compared to baseline. Conclusions: Photodynamic therapy combined with injection of intravitreal ranibizumab was well tolerated and is effective. We found a stabilisation of VA in 96 % of patients. Our short-term results are very promising. Further studies are necessary to show the long-term effect of the PDT and anti-VEGF combination therapy.

Schlüsselwörter

Retina - Glaskörper - AMD - PDT - Ranibizumab

Key words

retina - vitreous - AMD - PDT - ranibizumab

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