ADJUSTED RETREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY AFTER COMBINATION THERAPY

Abstract

The purpose of this study was to evaluate the 3-year outcome of adjusted retreatment with photodynamic therapy (PDT), thermal laser, and intravitreal bevacizumab (IVB) after their initial PDT/IVB combination therapy for polypoidal choroidal vasculopathy. Data on 40 treatment-naive eyes of 38 patients with polypoidal choroidal vasculopathy were reviewed, all initially subjected to whole-lesion PDT/IVB. When retreating persistent or recurrent exudation, the aim was to reduce PDT frequency and spot size, avoiding whole-lesion PDT when feasible. Distinct polyps were thus selectively targeted using PDT and/or laser, routinely combined with IVB. If polyps were absent or questionable, IVB monotherapy was given. At Year 3, the mean logarithm of minimal angle of resolution best-corrected visual acuity improved from 0.67 (Snellen equivalent of 20/93) to 0.55 (Snellen equivalent of 20/70), but the improvement was not statistically significant (P = 0.076). Best-corrected visual acuity remained stable or improved in 33 eyes (82.5%). The mean number of combination treatments and total IVB courses were 1.66 (range, 1-4) and 5.92 (range, 1-18), respectively. Five eyes (12.5%) required focal laser treatment for extrafoveal polypoidal lesions during follow-up. Compared with reported 3-year outcomes of PDT as monotherapy for polypoidal choroidal vasculopathy, this approach proved favorable in improving or stabilizing visual acuity and reducing cumulative PDT exposure.