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Characterization of Vascular Morphology of Neovascular Age-Related Macular Degeneration by Indocyanine Green Angiography
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Port Delivery System Vs Monthly Ranibizumab in VEGF-Driven Macular Disease: A Systematic Review and Meta-Analysis
Edhem Dogru1, Matheus Pedrotti Chavez2, Otávio Toth2
1Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Seminars in Ophthalmology
|June 26, 2026
Summary
The ranibizumab Port Delivery System (PDS) offers comparable visual and anatomical outcomes to monthly ranibizumab injections for neovascular age-related macular degeneration. However, PDS is linked to a higher risk of ocular complications.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Pharmacology
Background:
- Vascular Endothelial Growth Factor (VEGF)-driven macular diseases, including neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), are leading causes of vision loss.
- The ranibizumab Port Delivery System (PDS) offers an alternative to frequent intravitreal injections for sustained ranibizumab delivery.
- Comparative data on the efficacy and safety of PDS versus monthly ranibizumab injections are crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) comparing the efficacy and safety of the ranibizumab Port Delivery System (PDS) with monthly intravitreal ranibizumab.
- To evaluate visual acuity and anatomical changes in patients with nAMD and DME.
- To assess the incidence of ocular and systemic adverse events associated with both treatment modalities.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane databases for relevant RCTs.
- Studies included adults with nAMD or DME treated with PDS (100 mg/mL) or monthly intravitreal ranibizumab (0.5 mg).
- Data on best-corrected visual acuity (BCVA), central retinal thickness (CRT), and adverse events (AEs) were pooled using a random-effects model.
Main Results:
- Three RCTs with 1,149 eyes were included; 688 received PDS and 461 received monthly ranibizumab.
- No significant differences in BCVA or CRT were observed between PDS and monthly ranibizumab for nAMD or DME.
- The incidence of ocular AEs was significantly higher with PDS (RR 1.80), including bleb leaks, erosion, vitreous hemorrhage, and hyphema. Systemic AEs were comparable.
Conclusions:
- The ranibizumab Port Delivery System (PDS) demonstrates comparable visual and anatomical efficacy to monthly ranibizumab in nAMD patients.
- Evidence for PDS in DME is limited, requiring further investigation.
- PDS is associated with an increased risk of procedure- and device-related ocular complications compared to monthly injections.
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