Ranibizumab in monotherapy and combined with photodynamic therapy for retinal angiomatous proliferation

Luis Arias,^1–3 Francisco Gómez-Ulla,^2–4 José M Ruiz-Moreno<sup>2,3,5

1</sup>Ophthalmology Department, Bellvitge University Hospital, C/Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, ²Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, ³RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, ⁴Gómez-Ulla Eye Institute, Santiago de Compostela, ⁵Department of Ophthalmology, Albacete University Hospital, Avenida de Almansa s/n, Albacete, Spain

Purpose: To compare the effects of intravitreal ranibizumab in monotherapy (group A) and combined with photodynamic therapy (PDT) with verteporfin (group B) in retinal angiomatous proliferation (RAP) treatment.
Methods: This was a multicentric, prospective, randomized clinical study conducted with parallel groups. The study eye in both groups received ranibizumab on days 1, 30, and 60 (loading dose); group B received PDT additionally on day 1. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) testing and optical coherence tomography were performed monthly, and fluorescein angiography and indocyanine green angiography were performed quarterly. Retreatment criteria were leakage in fluorescein angiography or indocyanine green angiography, mean foveal thickness increase ≥100 µm, or VA decrease ≥5 letters.
Results: Twenty patients were recruited (ten patients in each group). Six eyes had previous treatment (three eyes in group A and three eyes in group B), so only 14 eyes were naïve. At 12-month follow-up, mean VA improved +1.5 letters in group A and +5.6 letters in group B (analysis of variance test; P>0.05). Two patients (20%) in both groups gained ≥15 letters (chi-square test; P>0.05). Mean changes in greatest linear dimension and in foveal thickness were not statistically significant between groups of treatment (analysis of variance test; P>0.05). Mean retreatments per patient were 1.8 (group A) and 0.9 (group B) (Mann–Whitney U-test; P>0.05). One patient died due to underlying disease not related to study medication.
Conclusion: Intravitreal ranibizumab administered in monotherapy or combined with PDT was efficacious in terms of VA stabilization in patients with RAP.

Keywords: age-related macular degeneration, intravitreal injection, photodynamic therapy, ranibizumab, retinal angiomatous proliferation, verteporfin


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