Abstract
BackgroundTo evaluate the efficacy and safety of half-dose photodynamic therapy (PDT combined with ranibizumab for polypoidal choroidal vasculopathy (PCV). PCV is commonly treated with a combination of anti-vascular endothelial growth factor and standard-dose photodynamic therapy (PDT). Choroidal ischemia and visual loss can be resulted from the standard-dose PDT. Half-dose PDT has proved to produce similar results and safety profile in treating central serous chorioretinopathy. Half-dose PDT may offer an alternative for PCV cases where the damage to choroidal vasculature maybe less. Here, we report the efficacy of treating PCV cases with combination of ranibizumab and half-dose PDT.MethodsIn this prospective, non-comparative, interventional case series, 19 treatment-naive eyes were treated with combined half-dose PDT and ranibizumab. All subjects were followed up for 12 months with measurement of best-corrected visual acuity (BCVA), central foveal thickness (CFT) by optical coherence tomography. Indocyanine green angiogram (ICG) was performed every 3-monthly, and subjects assessed in terms of polyp regression rates, changes in vision and central foveal thickness, need to repeat half-dose PDT. Subgroup analysis was performed based on ICG features.ResultsThe mean logMAR BCVA improved from 0.64 at baseline to 0.41 at 12 months. The mean CFT improved from 459.6mum at baseline to 384.2mum at 12 months. The difference between baseline BCVA and CFT and that at 12 months were statistically significant (both P = 0.03). Polyp regression rate after one half-dose PDT was 42.1 %. This was 61.5 % in the polyp-only group, while that in the branching-vascular-network (BVN) group was 0 % (P = <0.01).ConclusionHalf-dose PDT combined with intravitreal ranibizumab was able to induce high polyp regression rate in PCV cases that had one single polyp.
Highlights
To evaluate the efficacy and safety of half-dose photodynamic therapy (PDT combined with ranibizumab for polypoidal choroidal vasculopathy (PCV)
Polypoidal choroidal vasculopathy (PCV) is characterized by polypoidal lesions originating beneath the retinal pigment epithelium (RPE) [1, 2]
The standard PDT dosage had been shown in studies to cause choroidal ischaemia, RPE atrophy, secondary Choroidal neovascularization (CNV) [18] and fibrous scarring [18] that limit the visual gain despite PCV regression
Summary
To evaluate the efficacy and safety of half-dose photodynamic therapy (PDT combined with ranibizumab for polypoidal choroidal vasculopathy (PCV). Polypoidal choroidal vasculopathy (PCV) is characterized by polypoidal lesions originating beneath the retinal pigment epithelium (RPE) [1, 2]. It is still being debated whether it is a subtype of wet age-related macular degeneration or an independent pathology [3, 4]. Its reported prevalence is higher in Asian population than Caucasians, and the rate varies between 22.3 % and 54.7 % among Asian countries [5] These polyps appear as protruding elevated orange red lesions. It gives rise to subretinal fluid (SRF) with detachments of neurosensory retina [5, 6]
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