Predictors of 1-year visual outcome in OCT analysis comparing ranibizumab monotherapy versus combination therapy with PDT in exsudative age-related macular degeneration

• Published in: Wiener Klinische Wochenschrift 2016-08, Vol.128 (15-16), p.560-565
• Main Authors: Weingessel, Birgit, Mihaltz, Kata, Vécsei-Marlovits, Pia Veronika
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Combined Modality Therapy - methods; Endocrinology; Gastroenterology; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Original Article; Outcome Assessment (Health Care) - methods; Patient Selection; Photochemotherapy - methods; Photosensitizing Agents - administration & dosage; Pneumology/Respiratory System; Porphyrins - administration & dosage; Prognosis; Ranibizumab - administration & dosage; Reproducibility of Results; Sensitivity and Specificity; Tomography, Optical Coherence - methods; Treatment Outcome; Visual Acuity - drug effects; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy
• ISSN: 0043-5325; 1613-7671
• DOI: 10.1007/s00508-015-0772-0

Summary Aim The aim of this study was to find predictive factors of 1-year visual outcome, analyzing novel optical coherence tomography (OCT) biomarkers in exsudative age-related macular degeneration (choroidal neovascularization (CNV)) in two groups of different treatment modalities. Methods In all, 34 consecutive patients with new-onset CNV were randomized 1:1 to receive either ranibizumab monotherapy or ranibizumab combined with photodynamic therapy (PDT) with verteporfin. After three initial injections with ranibizumab, re-treatment was performed according to an as-needed scheme; PDT was performed once at baseline. Best-corrected visual acuity (BCVA) and OCT parameters like central macular volume (CMV), central macular thickness (or central retinal thickness (CRT)), subretinal and intraretinal fluid, fibrovascular lesion thickness, or inner segment/outer segment (IS/OS) junction were analyzed. Results After 12 months, a visual gain of 6.1 letters was found in the monotherapy group, whereas patients in the combination therapy group lost − 4.8 letters from baseline to the 12-month visit. CMV and CRT decreased considerably between baseline and month 2–3 in both groups, with a following slight increase until month 12. Additional application of PDT had negative effect to 12-month BCVA, whereas higher baseline BCVA and integrity of the IS/OS junction at month 12 had positive effect to 12-month BCVA. Conclusions Better baseline BCVA and the integrity of IS/OS junction at 12-month visit were the most important predictive factors for final BCVA. Combination therapy caused worse final BCVA and a higher degree of IS/OS disruption.