Intravitreal ranibizumab therapy versus photodynamic therapy for idiopathic choroidal neovascularization： a comparative study on visual acuity, retinal and choroidal thickness

Background Photodynamic therapy （PDT） has been recommended as a main treatment for idiopathic choroidal neovascularization （I-CNV）.But the visual results of PDT were inconsistent and variable,and PDT may bring severe damage to the retinal pigment epithelium and choriocapillaries.In recent years,intravitreal ranibizumab therapy,showing favorable visual outcomes,has developed as an advanced treatment for choroidal neovascularization （CNV）.Although both methods have been reported to be effective in treating I-CNV,there is no detailed comparative report between the two methods.This study aimed to compare visual outcomes,retinal and choroidal thickness between intravitreal ranibizumab therapy and PDT in the treatment of I-CNV,and investigate the correlation of visual outcomes with retinal and choroidal thickness in each of the two groups.Methods Thirty-seven eyes of 37 patients with I-CNV were involved in this study; 19 eyes were treated with intravitreal ranibizumab therapy and 18 eyes were treated with PDT.The best corrected visual acuity （BCVA） was recorded before and at each follow-up visit after treatments （IogMAR）.Enhanced-depth imaging optical coherence tomography （EDI-OCT） was used to evaluate the retinal structural changes,and to measure central retinal thickness （CRT） and central choroidal thickness （CCT）.Results Mean BCVA was 0.64±0.27 in PDT group and 0.69±0.22 in ranibizumab group at baseline （P=0.55）.When compared with the baseline,mean BCVA in PDT group was improved significantly at 3-month after PDT （0.41±0.16,P=0.002）,then changed little （0.42±0.25 at 12-month,P=0.88）.Whereas mean BCVA in Ranibizumab group was improved significantly at each follow-up visit.It improved much more obviously in the first month and then remained stable.The mean BCVA in the ranibizumab group was significantly better at each follow-up visit than that in PDT （P ＜0.05）.When compared with the baseline,mean CRT in PDT group decreased significantly since 3-month visit,whereas mean CRT in ranibizumab group decreased significantly from 1-month visit.Mean CRT at 1-month and 3-month decreased much more in ranibizumab group than that in PDT group,almost in the same period as BCVA improving.When compared with the baseline,mean CCT did not change significantly at each follow-up visit in each group （P ＞0.05）.The CCT difference was not statistically significant between the two groups at each same time visit （P ＞0.05）.Mean BCVA was correlated with CRT,but was not correlated with CCT.Conclusions Both intravitreal ranibizumab therapy and PDT are effective for the treatment of I-CNV.It is obvious that ranibizumab therapy is significantly superior to PDT in improving BCVA and decreasing CRT.CRT decreases much more rapidly in ranibizumab group than in PDT group,simultaneously with visual improvement.CRT reduction has significant correlation with the visual outcomes in the recovery of I-CNV,whereas BCVA prognosis may have no correlation with CCT.CCT is not changed significantly after each of the treatments.Both PDT and ranibizumab therapy may have no significant effect on choroid.

Evaluation of visual functional and morphology change in young patients with idiopathic choroidal neovascularization

Background Idiopathic choroidal neovascularization （ICNV） is an uncommon disorder affecting primarily individuals younger than the age of 50 years. In CNV patients, no apparent cause can be determined. This study aimed to evaluate the functional and morphological change of the retina with ICNV in young adults. Methods In this retrospective study, 32 eyes of 32 patients with subfoveal or juxta/extra foveal ICNV had been admitted into the Shanghai First People＇s Hospital from January 2009 to July 2010. The functional changes were evaluated using the best corrected visual acuity （BCVA） and the microperimetry in the macular area.

Small laser spot versus standard laser spot photodynamic therapy for idiopathic choroidal neovascularization： a randomized controlled study

Background Idiopathic choroidal neovascularization （ICNV） affects young patients and thus may have a significant impact on vision and life quality over a patient＇s lifespan. This study was designed to compare the visual outcome and retinal pigment epithelium （RPE） damage after photodynamic therapy （PDT） with small laser spot and PDT with standard laser spot for idiopathic choroidal neovascularization （ICNV）. Methods This was a randomized controlled study. Fifty-two patients with ICNV were enrolled and randomly divided into a study group （small laser spot PDT, n=27） and a control group （standard laser spot PDT, n=25）. Best corrected visual acuity （BCVA）, optic coherence tomography （OCT） and fluorescein angiography （FA） findings were the main measurements. The patients were followed up 1 week, 1, 3, 6, 9 months and 1 year after PDT. Results BCVA improvement was statistically significantly higher in the study group than the control group at 6-month （（25.53±15.01） letters vs. （14.71±11.66） letters, P=-0.025） and 9-month follow-ups （（27.53±17.78） letters vs. （15.59±12.21） letters, P=0.039）. At 3- and 6-month follow-ups, the quadrants of RPE damage between the two groups varied significantly （P 〈0.001 and P=0.023, respectively）. In each follow-up, the number of cases with decreased or unchanged leakage of choroidal neovascularization by FA and reduced subretinal fluid by OCT did not vary significantly between the two groups. Ten cases （37.0%） in the study group and eight cases （32.0%） in the control group suffered from recurrent CNV （P=-0.703）. Conclusions Better visual improvements, less RPE damage, a similar recurrent rate of CNV and change of subretinal fluid were observed in the small laser spot PDT group than in the standard laser spot PDT group for ICNV.