First Author: B.Gorodetskiy RUSSIA
Co Author(s): Y. Gorodetskaya
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Demonstration the clinical case of treatment of the exudative form of AMD with ranibizumab in combination with photodynamic therapy with verteporfin.
Ophthalmological centre 'VISION', Moscow, Russia
The patient M., 1957 born, had complaints of decreased vision of the left eye, loss of contrast, the presence of a 'grey' translucent spot in front of the eye. These symptoms bother her for about a year. The disease began with the appearance of distortions of straight lines. BCVA OD = 1,0; BCVA OS = 0.3-0.4; IOP OD/OS = 16/18 mm Hg With fluorescent angiography of the retina of both eyes in the right eye pathology is not revealed. In the left eye, hyperfluorescence of the sections of the classical subfoveal choroidal neovascular membrane was detected, and in the late phase there was a massive outflow of fluorescein from the periphovial retinal capillaries, characteristic of cystic edema of the macula. As a treatment, a combined method was chosen: intravitreal administration of the VEGF blocker and photodynamic therapy(PDT) with verteporfin. The first stage was an intravitreal injection of ranibizumab. Two weeks after injection, PDT with verteporfin was performed (dose of 6mg/1m2 of the body surface, 15min after the administration of the solution, laser irradiation with a spot within the boundaries of the neovascular membrane with a wavelength of 689nm at a power density of 500-600mW/cm2 for 83sec, the laser 'Quantel Medical').
On the fifth day after the administration of ranibizumab, a decrease in the height of the edema and a decrease in its area were revealed in OCT. After 2 weeks according to OCT, the edema was 317 microns (originally 446 microns). One month after PDT, there was a continued decrease in the area and height of the edema, the manifestation of the macular profile. BCVA OS = 0,6. The patient noted that the stain in front of the left eye became more transparent. On the control images of OCT 2.5 months after the injection and 2 months after PDT, there was no edema and signs of the neovascular membrane. A pronounced macular profile remains. The thickness of the central zone is 242 microns. BCVA OS = 0.85.
This clinical case confirms the advisability of a combined method for the treatment of AMD, when the introduction of the VEGF blocker stops neoangiogenesis and reduces the height of the macular edema, which creates optimal conditions for effective ablation of the classical neovascular membrane by PDT with verteporfin. These two methods supplemented each other and gave an optimal and persistent effect of treating this type of retinal pathology.