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

M. M. Maier; N. Feucht; B. Fiore; C. Winkler von Mohrenfels; P. Kook; C. Fegert; C. Lohmann

doi:10.1055/s-0028-1109463

Klinische Monatsblätter für Augenheilkunde, Inhaltsverzeichnis

Klin Monbl Augenheilkd 2009; 226(6): 496-502
DOI: 10.1055/s-0028-1109463

Klinische Studie

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

Photodynamic Therapy with Verteporfin Combined with Intravitreal Injection of Ranibizumab for Occult and Classic CNV in AMDM. M. Maier¹ , N. Feucht¹ , B. Fiore¹ , C. Winkler von Mohrenfels¹ , P. Kook¹ , C. Fegert¹ , C. Lohmann¹

¹Augenklinik der Technischen Universität München, Klinikum rechts der Isar

Abstract

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

Volltext

Referenzen

Literatur

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Mathias M. Maier

Augenklinik der TUM, Klinikum rechts der Isar

Ismaningerstr. 22

81675 Munich

Telefon: ++ 49/89/41 40 23 40

Fax: ++ 49/89/41 40 48 58

eMail: M.Maier@lrz.tum.de