Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration
Eric Chen, David M Brown, Tien P Wong, Matthew S Benz, Eric Kegley, Joel Cox, Richard H Fish, Rosa Y KimRetina Consultants of Houston, Texas, USAPurpose: Combination verteporfin photodynamic therapy (vPDT) and antivascular endothelial growth factor (anti-VEGF) therapy may decrease the need for injec...
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Dove Medical Press
2010
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oai:doaj.org-article:4098c9b961ed4472a236a8e99ec3b9712021-12-02T06:04:06ZLucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration1177-54671177-5483https://doaj.org/article/4098c9b961ed4472a236a8e99ec3b9712010-09-01T00:00:00Zhttp://www.dovepress.com/lucentisreg-using-visudynereg-study-determining-the-threshold-dose-flu-a5314https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Eric Chen, David M Brown, Tien P Wong, Matthew S Benz, Eric Kegley, Joel Cox, Richard H Fish, Rosa Y KimRetina Consultants of Houston, Texas, USAPurpose: Combination verteporfin photodynamic therapy (vPDT) and antivascular endothelial growth factor (anti-VEGF) therapy may decrease the need for injections while maintaining visual acuity in exudative age-related macular degeneration. This pilot study was designed to determine the threshold fluence dose of vPDT (the dose required to demonstrate an effect on choroidal perfusion) combined with ranibizumab.Methods: Seven patients were randomized to sham vPDT (two patients), 20% fluence vPDT (two patients), or 40% fluence vPDT (three patients) in combination with three-monthly intravitreal 0.5 mg ranibizumab injections. Intravitreal ranibizumab was reinjected if disease activity was seen on fluorescein angiography, optical coherence tomography, or clinical examination. Indocyanine green-determined choroidal hypoperfusion was graded in a masked fashion.Results: Patients with 20% vPDT had mild hypoperfusion defects at seven days that resolved by week 4 (threshold dose); patients with 40% fluence vPDT had marked hypoperfusion at seven days that persisted as long as 12 months. Recruitment was stopped after limited efficacy was observed. One patient with 20% fluence vPDT lost 19 letters at one year; no other patient lost or gained >10 letters. Central retinal thickness decreased in six of seven patients, but ranibizumab injections did not decrease.Conclusion: This pilot study shows that the threshold fluence dose of vPDT (when combined with ranibizumab) is approximately 20% standard fluence, and that mild and transient choroidal hypoperfusion can occur. Forty percent fluence vPDT causes a more prolonged and striking hypoperfusion. Despite hypoperfusion, no decrease in visual acuity or injections required was noted, suggesting that even higher fluence levels of vPDT may be necessary to decrease the number of anti-VEGF injections.Keywords: neovascular age-related macular degeneration, choroidal hypoperfusion, threshold dose, verteporfin photodynamic therapy Eric ChenDavid M BrownTien P Wonget alDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2010, Iss default, Pp 1073-1079 (2010) |
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DOAJ |
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EN |
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Ophthalmology RE1-994 |
| spellingShingle |
Ophthalmology RE1-994 Eric Chen David M Brown Tien P Wong et al Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| description |
Eric Chen, David M Brown, Tien P Wong, Matthew S Benz, Eric Kegley, Joel Cox, Richard H Fish, Rosa Y KimRetina Consultants of Houston, Texas, USAPurpose: Combination verteporfin photodynamic therapy (vPDT) and antivascular endothelial growth factor (anti-VEGF) therapy may decrease the need for injections while maintaining visual acuity in exudative age-related macular degeneration. This pilot study was designed to determine the threshold fluence dose of vPDT (the dose required to demonstrate an effect on choroidal perfusion) combined with ranibizumab.Methods: Seven patients were randomized to sham vPDT (two patients), 20% fluence vPDT (two patients), or 40% fluence vPDT (three patients) in combination with three-monthly intravitreal 0.5 mg ranibizumab injections. Intravitreal ranibizumab was reinjected if disease activity was seen on fluorescein angiography, optical coherence tomography, or clinical examination. Indocyanine green-determined choroidal hypoperfusion was graded in a masked fashion.Results: Patients with 20% vPDT had mild hypoperfusion defects at seven days that resolved by week 4 (threshold dose); patients with 40% fluence vPDT had marked hypoperfusion at seven days that persisted as long as 12 months. Recruitment was stopped after limited efficacy was observed. One patient with 20% fluence vPDT lost 19 letters at one year; no other patient lost or gained >10 letters. Central retinal thickness decreased in six of seven patients, but ranibizumab injections did not decrease.Conclusion: This pilot study shows that the threshold fluence dose of vPDT (when combined with ranibizumab) is approximately 20% standard fluence, and that mild and transient choroidal hypoperfusion can occur. Forty percent fluence vPDT causes a more prolonged and striking hypoperfusion. Despite hypoperfusion, no decrease in visual acuity or injections required was noted, suggesting that even higher fluence levels of vPDT may be necessary to decrease the number of anti-VEGF injections.Keywords: neovascular age-related macular degeneration, choroidal hypoperfusion, threshold dose, verteporfin photodynamic therapy |
| format |
article |
| author |
Eric Chen David M Brown Tien P Wong et al |
| author_facet |
Eric Chen David M Brown Tien P Wong et al |
| author_sort |
Eric Chen |
| title |
Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| title_short |
Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| title_full |
Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| title_fullStr |
Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| title_full_unstemmed |
Lucentis® using Visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| title_sort |
lucentis® using visudyne® study: determining the threshold-dose fluence of verteporfin photodynamic therapy combined with intravitreal ranibizumab for exudative macular degeneration |
| publisher |
Dove Medical Press |
| publishDate |
2010 |
| url |
https://doaj.org/article/4098c9b961ed4472a236a8e99ec3b971 |
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