Combined ranibizumab and stereotactic X-ray therapy shows promise in polypoidal choroidal vasculopathy
HAMBURG — Preliminary data of a pilot study on combined ranibizumab and stereotactic X-ray therapy for polypoidal choroidal vasculopathy showed encouraging anatomical and visual acuity outcomes, according to a speaker here.
“PCV is frequently present in patients with neovascular AMD. Intravitreal injection of anti-VEGF has been shown to effectively reduce exudation, but does not lead to regression of polyps. We used [photodynamic therapy] to address this component, but results were poor and we had complications,” Ugo Introini, MD, said at the Euretina meeting.
Low-voltage stereotactic radiotherapy (IRay, Oraya Therapeutics) was combined with ranibizuma as-needed in a pilot, single-center, 1-year clinical trial including 10 eyes of 10 patients. At baseline, all the eyes received an intravitreal injection of ranibizumab, followed on the same day by a single dose of 16 Gy radiation in the macular area. During monthly follow-up visits, further anti-VEGF injections were performed as-needed.
“Primary outcomes were BCVA and central retinal thickness (CRT) changes, but we specially observed the [indocyanine green] angiography changes of the polypoidal lesion,” Introini said.
At 12 months, visual acuity showed improvement from 62 to 68 letters.
“Not a huge gain,” Introini said, “ but mean CRT decreased significantly from 358µ to 198µ. Mean additional injections were 2.9, ranging between 0 and 7.”
The polypoidal choroidal vasculopathy (PCV) aneurysmal bulge component included in the irradiation area was obliterated in all the cases, but no effect was observed in the branching vessel component.
In one eye, PCV recurred at 12 months, but no local or systemic adverse events occurred.