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Macular degeneration: photodynamic therapy, even ranibizumab for some patients

In some patients with age-related macular degeneration, the first-choice treatment is verteporfin, despite its modest efficacy. If it fails, ranibizumab is a second resort, as long as there is no risk of stroke.

The macula, the area of the retina that is responsible for precise vision and colour perception, deteriorates with age: this is known as age-related macular degeneration (AMD). Only some so-called "visible" forms can be treated with photodynamic therapy, i.e. intravenous injection of a photosensitiser, verteporfin, followed by the ocular laser application of a red light. This makes it possible to stabilise sight loss in around 50% of patients for 2 years, at the cost of acceptable adverse effects.

Ranibizumab, now available for this indication, is more effective that verteporfin. Clinical trials have shown that, after intraocular injection of ranibizumab, vision loss is halted in more than 90% of patients (confirmed after 2 years), and sometimes vision even improves. However, the risks associated with the injection and the occurrence of serious events, especially stroke, restrict the use of this drug chiefly to patients for whom verteporfin has proved ineffective.

©Prescrire June 2007

Source: "Ranibizumab-Lucentis°. Dégénérescence maculaire : en 2e ligne à causes des risques" Rev Prescrire 2007 ; 27 (284) : 414-417.

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