Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD). Methods In this retrospective study, 34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT), 23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF). After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days. Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT (quot;dry macularquot;), or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension (GLD), type of CNV, SRF or IRF and posttreatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved (9.4plusmn;10.2) letters and reach 44.9plusmn;21.3 letters (t=5.438，P＜0.01) and CRT decreased (184.6plusmn;214.6) mu;m (t=4.810，P＜0.01) at 6 month visit. The average of injection number was 1.9plusmn;0.9 (including initial injection of combination therapy). With multiple lineal regression analysis, only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802.P＜0.01). The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA (r=0.053, -0.183, 0.139 and 0.053, respectively.P＞0.05). BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207，P=0.035). The change of BCVA after treatment (t=-0.076), change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05). The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05). The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P＞0.05). No severe complications were noticed during follow-up.Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short-term.
Objective To compare the clinic therapeutic effect of intravitreal ranibizumab injection versus photodynamic therapy (PDT) combined with intravitreal ranibizumab injection for idiopathic choroidal neovascularizatio (ICNV), and to investigate the clinical effect and safety of treatment. Methods A randomized controlled clinical prospective study was performed for 27 patients (27 eyes) diagnosed as ICNV. Fourteen patients were assigned to receive PDT and intravitreal ranibizumab injection (combination roup.n=14); the control group was treated with only intravitreal ranibizumab injection (single group, n=13).The combination group was treated with an intravitreal injection of ranibizumab (0.5 mg/0.05 ml) 1 week after PDT. The bestcorrected visual acuity (BCVA) (logMAR), examination of the ocular fundus, fluorescence fundus angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were performed respectively at 1, 2, 3, 6 and 12 months after treatment. If choroidal neovascularization (CNV) was only partially regressed or the leakage went on during follow-up, those patients were re-injected with ranibizumab. Results After 12 months, the average vision is 0.22plusmn;0.11 in single group, and 0.21plusmn;0.12 in combination group, and the differences were not significant (t=0.187, P=0.853). In single group FFA and ICGA showed completely closed CNV in 10 eyes (77.92%), and almost closed CNV in 3 eyes (23.08%) with obvious reduction of fluorescence leakage. In combination group FFA and ICGA showed completely closed CNV in 12 eyes (85.71%), and almost closed CNV in 2 eyes (14.29%) with obvious reduction of fluorescence leakage; OCT showed the subretinal fluid absorption and reduction of CNV. The average macular retinal thickness (MRT) in single groups is （167.96plusmn;10.69） m, and in combination groups is （171.64plusmn;11.30）m. In single and combination groups MRT decreased significantly at the final follow-up, but no significant differences in both groups (t=-0.887.P=0.389). The average number of intravitreal injection was （1.5plusmn;0.7） in combination group and （2.4plusmn;1.0） in single group (t=2.821，P=0.009). There were no ocular or systemic adverse events observed except for one patient with subconjunctival hemorrhage in the single group.Conclusions Intravitreal ranibizumab injection and PDT combined with intravitreal bevacizumab injection are both effective and safe for the patients with ICNV. The combined therapy can induce CNV regression, fundus hemorrhage and exudation absorption more effectively, and have less recurred CNV and side effects.
Objective To evaluate the efficacy and safety of intravitreal anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) vs. photodynamic therapy for polypoidal choroidal vasculopathy (PCV).Methods A computerized search was conducted in Pubmed, OVID, Chinese Biological Medicine Database（CBM）,China National Knowledge Infrastructure （CNKI） by using key words ldquo;polypoidal choroidal vasculopathy, photodynamic therapy, intravitreal anti-VEGFrdquo; in Chinese and/or English combined with manually searching of bibliographies of pertinent articles, journals and literature reference proceedings. Randomized controlled trials (RCT) and non-RCT were collected. The search time was ranged from establishment of each database to September, 2011. The search was no 1imitation in language. The best corrected visual acuity (BCVA),resolution and recurring of lesions, decrease or complete resolution of pigment epithelial detachment （PED）,visual extinction or blindness rate,the rate of subretinal hemorrhage were analyzed by RevMan 5.0 software. Results In total, one RCT and four non-RCTs (273 patients) were included in the meta-analysis involving 148 patients in single treatment group and 125 patients in combined treatment group. The results of metaanalyses showed that there was no significant difference between two groups in the mean logarithm of minimal angle of resolution BCVA at six months ［standard mean difference=0.01, 95% confidence interval (CI): -0.12- 0.14,P=0.84］and 12 months ［standard mean difference = 0.04, 95%CI: -0.16-0.25,P=0.69 after treatment. There was no significant difference between two groups in the resolution of lesions ［odds ratio (OR)=1.38,95%CI:0.74-2.55,P=0.31］ at the months after treatment and decrease or complete resolution of PED (OR=0.67,95%CI:0.12-3.69,P=0.65) at 12 months after treatment. There was no significant difference between two groups in the recurring of lesions (OR=1.14, 95% CI:0.58-2.24,P=0.71) and lost of ge; three lines vision or blindness rate (OR=1.20, 95%CI:0.34-4.18,P=0.78) at 12 months after treatment. The rate of subretinal hemorrhage in combine treatment group was significant lower than single treatment group (OR=0.41, 95%CI:0.18 -0.94,P=0.04). Conclusions The incidence of subretinal hemorrhage occurred in patients with PCV after intravitreal anti-VEGF combined with PDT is much lower than that after single PDT.But the visual improvement, resolution of lesions and recurring of lesions of combined treatment need further studied to see if it is better than single PDT.
Objective To observe the characteristics of optical coherence tomography（OCT）in polypoidal choroidal vasculopathy (PCV) before and after photodynamic therapy (PDT), and investigate its relationship with visual acuity. Methods Thirty-four PCV patients (40 eyes) diagnosed by fundus fluoresce angiography and indocyanine green angiography who had underwent the treatment of PDT, were enrolled in this study. The logMAR corrected visual acuity (CVA) were detected and the height and the base diameter of retinal pigment epithelium detachment (PED）and retinal detachment (RD), central subfield thickness (CST), macular volume (MV) were measured by OCT before and after treatment. Before the treatment, the mean logMAR CVA was 0.66plusmn;0.32 and visible PED and RD were seen on OCT images. The OCT characteristics and relationship with visual acuity were comparatively analyzed. Results One, three, six and 12 months after treatment, the mean logMAR CVA were 0.58plusmn;0.27, 0.48plusmn;0.38, 0.51plusmn;0.37 and 0.50plusmn;0.36. The differences of CVA were statistically significant between beforetreatment and three, 12 months after treatment(t=2.32,2.10; P＜0.05),but not between beforetreatment and one,six months after treatment (t=1.22,1.961;P＞0.05). The differences of the height and the base diameter of PED were statistically significant between before treatment and six,12 months after treatment (t=2.34,2.03;P＜0.05),but not between before treatment and one, three months after treatment (t=1.07,1.50;P＞0.05). The differences of the height (t=2.22,2.99,3.30,3.95) and the base diameter (t=2.55,3.33,3.11,3.92) of RD were statistically significant between before treatment and one, three, six and 12 months after treatment (P＜0.05). The differences of CST (t=2.71,3.55,3.81,3.21) and MV (t=2.10,3.30,3.62,4.18) were statistically significant between before treatment and one, three, six and 12 months after treatment (P＜0.05). CVA had negative correlation with the base diameter of PED, the height and the base diameter of RD, CST and MV (r=-0.88,-0.89,-0.92,-0.86,-0.94;P＜0.05), no correlation with the height of PED (r=-0.70,P＞0.05). Conclusions The height and the base diameter of PED and RD, CST, MV of PCV are decrease after PDT. There is a negative correlation between CVA and the base diameter of PED,the height and the base diameter of RD,CST and MV.
Objective To observe the efficacy of monotherapy and combination treatments of photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (VEGF) drugs for advanced exudative age-related macular degeneration (EAMD). Methods Thirty-two eyes from 28 patients with EAMD were enrolled in this study. Fifteen eyes were treated with PDT or intravitreal anti-VEGF drugs (monotherapy group), while 17 eyes were treated with combination treatments of PDT and intravitreal anti-VEGF drugs (combination group). The follow-up was ranged from 5 to 28 months with a mean of 21 months. Vision and intraocular pressure were measured and optical coherence tomography (OCT) was performed every month after treatment. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed every 3 months during follow-up period. The changes of visual acuity, leakage in macula lutea and central retinal thickness (CRT) before and after treatment, and adverse events during follow-up period were observed. The mean treatment times of monotherapy and combination group were compared and analyzed. Results Among 32 eyes, visual acuity improved in 20 eyes (62.5%), stabilized in 9 eyes (28.1%) and decreased in 3 eyes (9.4%). The leakage in macula lutea disappeared in 17 eyes (53.1%), decreased in 12 eyes (37.5%) and increased in 3 eyes (9.4%). CRT was reduced in 23 eyes (71.8%), increased in 9 eyes (28.2%). The mean treatment times of the combination group (2.3plusmn;0.2) was significantly less than that of monotherapy group (3.4plusmn;0.5)(P＜0.05). No adverse events such as secondary retinal hemorrhage, vitreous hemorrhage or endoophthalmitis were found during the follow-up duration. Conclusions Both monotherapy and combination treatments of PDT and intravitreal anti-VEGF drugs for EAMD may improve visual acuity, exudation and macular edema. Combination of PDT and anti-VEGF therapy decreases the frequency of retreatment.
Objective To observe the efficacy of intravitreal injection of ranibizumab (Lucentis) and combination treatments of photodynamic therapy (PDT) and intravitreal injection of ranibizumab for exudative age-related macular degeneration (eAMD). Methods Thirty eyes from 30 patients with eAMD were enrolled in this study. Fifteen eyes were treated with intravitreal injection of ranibizumab (ranibizumab group), while 15 eyes were treated with combination treatments of PDT and intravitreal injection of ranibizumab (combination group). The follow-up ranged from 6 to 17 months with a mean of 12.5 months. The patients in ranibizumab group received intravitreal injection of ranibizumab (0.5 mg) once a month for 12 consecutive months. Follow-up visits were performed monthly after the first injection. The patients in the combination group received intravitreal injection of ranibizumab (0.5 mg) within 24 hours after PDT. Then the same dose of intravitreal injection was given the 2nd and 3rd months. They were examined on follow-up visits monthly after the 3rd injection. Injections were repeated if necessary during followup period. The mean number of repetitive intravitreal injections of ranibizumab was (3.7plusmn;1.0) times/eye. Changes in best corrected visual acuity (BCVA), results of optic coherence tomography (OCT), fundus fluorescein angiography (FFA) and MP-1, injection times and complications were observed. Results The 1st, 3rd, 6th and 12th month after treatment, the average improvement value in mean light sensitivity (MS) were 1.9, 3.8, 5.0 and 5.5 dB in ranibizumab group; 2.0, 4.2, 3.7 and 4.8 dB in combination group respectively. The difference between two groups was not statistically significant (P＞0.05). The differences of improvement in BCVA and OCT between two groups also were not statistically significant (P＞0.05). The MS has positive relationship with BCVA (r=0.660,P＜0.05). No complications such as endophthalmitis, retinal pigment epithelial tear or vitreous hemorrhage were observed during the follow-up period. Conclusions Both intravitreal injection of ranibizumab and combination treatments of PDT and intravitreal injection of ranibizumab are effective for eAMD. Combination of PDT and ranibizumab therapy decreases the frequency of retreatment.
Objective To observe the clinical effect of half-dose photodynamic therapy (PDT) for chronic central serous chorioretinopathy. Methods Thirty-two eyes of 27 patients (22 males and 5 females) with chronic central serous chorioretinopathy, diagnosed by best corrected visual acuity (BCVA) of logMAR, direct ophthalmoscope, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography, were enrolled. The age was ranged from 31 to 63 years old, with a mean of 45 years. The course of the disease was ranged from 6 to 32 months, with a mean of 16.2 months. The logMAR BCVA was 1.6 -0.1. The serous neuroepithelium detachment was found in 28 eyes, and serous neuroepithelium detachment combined with retinal pigment epithelium detachment (PED) was found in 4 eyes. The central retinal thickness was ranged from 184 to 465 mu;m, with a mean of 318.6 mu;m. All of the patients were treated with half dose PDT according to the methods in literatures. The above examinations were performed every 3 months after the treatment to observe the BCVA, subretinal fluid and retinal thickness. Results OCT showed that subretinal fluid were absorbed completely and retina remained attached in 25 of 28 eyes (89.3%) and 2 of 4 eyes (50.0%) with PED, while subretinal fluid were absorbed partly and retina attached incompletely in 3 of 28 eyes (10.7%) and 2 of 4 eyes (50.0%) with PED at the last visit. Twenty-seven eyes with retina remained attached, the mean central retinal thickness (CRT) decreased from (321.4plusmn;88.2) to (150.4plusmn;22.3) mu;m (t=9.09, P＜0.05); the mean logMAR BCVA improved from 0.68plusmn;0.09 to 0.44plusmn;0.07 (t=2.65,P＜0.05). Among those, logMAR BCVA within 0.32 were found in 12 eyes. There was a significant positive association between the CRT and BCVA (r=0.96, P＜0.01）. No recurrence or side effect was observed at the last visit. Conclusion Half-dose PDT is a safe and effective approach for chronic central serous chorioretinopathy, especially for those without PED.
Objective To observe the therapeutic effects of photodynamic therapy（PDT）on choroidal neovascularization（CNV）with or without cystoid macular edema（CME）in patients with wet agerelated macular degeneration（AMD）. Methods The clinical data of 54 patients (54 eyes) with wet AMD who had undergone the standard PDT，including 16 patients（21 eyes）with CME and 28 patients（33 eyes）without CME were retrospectively analyzed. The visual acuity and BFT of patients were examined by early treatment diabetic retinopathy study (ETDRS) and optical coherence tomography（OCT）before and per three months after PDT. The follow up was 3-18 months with the mean of 8.3 months.Results At the last time of follow up, in CME group，ETDRS letter score was（29.429plusmn;17.907）and the BFT was （316.429plusmn;77.161）mu;m，compared with that before the treatment, the difference were statistically significant (t=-0.389，2.246；P＝0.701，0.019). In nonCME group, ETDRS letter score was (48.121plusmn;17.911) and the BFT was (244.667plusmn;37.619) mu;m, compared with that before the treatment, the difference were statistically significant (t=-3.424，6.880；P＝0.002，0.000). There were statistical significance for the change of ETDRS letter score and BFT between the two groups (t=-2.194，2.212；P＝0.033，0.031）). Conclusions Therapeutic effect of PDT on CNV with CME was better than without CME in patients with wet AMD.