Comparing efficacy of reduced-fluence and standard-fluence photodynamic therapy in the treatment of polypoidal choroidal vasculopathy

Wei Kiong Ngo,Tock Han Lim,Colin S Tan,Wai Kitt Chee

doi:10.1186/s12886-020-01419-8

Abstract

BackgroundThe EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV). The optimal PDT protocol remains controversial and it is postulated that less intensive PDT strategies may reduce complications. We aimed to compare the efficacy of reduced and standard-fluence PDT.MethodsCase-control review of 38 consecutive PDT-naïve macular PCV patients who underwent verteporfin PDT using one of two PDT regimens at a tertiary referral centre in an Asian population. Comparison of outcomes between standard-fluence PDT (light dose, 50 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 83 s) and reduced-fluence PDT (light dose, 25 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 42 s). Primary outcome measure was best corrected LogMAR visual acuity (VA). Secondary outcome measures included OCT measurements such as central retinal thickness (CRT), height of subfoveal sub-retinal fluid (SRF), central choroid thickness (CCT), mean number of PDT treatments needed, mean number of anti-VEGF injections needed, polyp closure and recurrence rates.ResultsOf these 38 eyes of 38 patients, an equal number of eyes (19 in each arm) were treated with standard-fluence and reduced-fluence PDT. Mean letter gain at 12 months for the standard-fluence group was 6.0 compared to 4.3 letters for the reduced-fluence group (p = 0.61). Similar results were observed at all time points. There was no statistically significant difference between the retinal and choroidal anatomical OCT outcomes, rates of polyp closure and recurrences between the two PDT regimens.ConclusionsReduced-fluence PDT was comparable to standard-fluence PDT in the treatment of PCV in terms of visual gains, clinical and anatomical OCT outcomes.

Highlights

The EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV)
While typical age-related macular degeneration (AMD) is treated with anti-vascular endothelial growth factors (VEGF) monotherapy, the EVEREST study reported superior rates of complete polyp regression among eyes with PCV when verteporfin photodynamic therapy (PDT) was administered, either as monotherapy or in combination with intravitreal ranibizumab, compared to intravitreal ranibizumab alone [3]
These findings were confirmed in the subsequent EVEREST II study, [4] which reported superior visual gains in the group treated with combination PDT and intravitreal ranibizumab

Summary

Introduction

The EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV). While typical AMD is treated with anti-VEGF monotherapy, the EVEREST study reported superior rates of complete polyp regression among eyes with PCV when verteporfin photodynamic therapy (PDT) was administered, either as monotherapy or in combination with intravitreal ranibizumab, compared to intravitreal ranibizumab alone [3]. These findings were confirmed in the subsequent EVEREST II study, [4] which reported superior visual gains in the group treated with combination PDT and intravitreal ranibizumab. In the EVEREST study, verteporfin was dosed at 6 mg/m2, with standard (light dose, 50 J/cm; dose rate, 600 mW/cm; wavelength, 689 nm) PDT applied to the treatment eye for 83 s [3, 5]

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