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

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 μ m, after 1 month: 210 μ m, after 3 months: 228 μ m and after 6 months 281 μ m) 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.