Combination treatment of photodynamic therapy with verteporfin and intravitreal ranibizumab in patients with retinal angiomatous proliferation

Purpose: To investigate the efficacy and safety of initial photodynamic therapy (PDT) with a ranibizumab loading dose of three monthly intravitreal injections and a subsequent PRN ranibizumab regimen in the treatment of retinal angiomatous proliferation (RAP). Methods: In this 12-month prospective case series, 15 patients underwent PDT followed by 3 intravitreal ranibizumab injections at monthly intervals. At monthly follow-up examinations, further single ranibizumab injections were given in case of any intra- or subretinal fluid on optical coherence tomography (OCT), visual loss 5 letters or signs of activity on fluorescein or indocyanine green angiography. Results: Best-corrected visual acuity (BCVA) improved from 58.1 +/- 13.2 at baseline by 9.2 letters (SD +/- 8.5; p=0.004) at 6months and by 8.7 letters (SD +/- 11.4; p=0.017) at 12months. Neither at 6 nor at 12months, any patient had lost 15 letters. The mean number of injections per patient was 4.8 (SD +/- 1.4) in the first year of therapy after PDT. The average time to first retreatment was 3.7months (range 1-7months). No serious adverse events, such as endophthalmitis or retinal detachment, were noted. Conclusion: PDT with 3 ranibizumab loading injections and subsequent ranibizumab as needed resulted in a significant gain of 8.7 +/- 11.4 letters at month 12. This regimen is safe and efficacious, but even in a population of mostly early stages of RAP, retreatment rates remained high.