Comparison of one-year results of photodynamic therapy combined with ranibizumab or aflibercept for treating polypoidal choroidal vasculopathy.

Shin Yamane,Arisa Ito,Demetrios G. Vavvas,Tatsuya Inoue,Maiko Maruyama-Inoue,Shimpei Sato,Yoko Kitajima,Kazuaki Kadonosono

doi:10.1371/journal.pone.0235213

Shin Yamane, Arisa Ito + Show 6 more

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https://doi.org/10.1371/journal.pone.0235213

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Abstract

PurposeTo compare the 1-year visual outcomes and anatomical responses of patients who received photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) injections with those of patients who received PDT combined with intravitreal aflibercept (IVA) injections for treating polypoidal choroidal vasculopathy (PCV).MethodsWe retrospectively studied all treatment-naïve patients with PCV who received PDT combined with either IVR or IVA. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), the number of additional injections, and the presence of polypoidal lesions, as indicated by indocyanine green angiography (ICGA), during 1 year were evaluated.ResultsForty-four eyes were assessed at the 1-year follow-up examination. Of these, 23 were treated with PDT combined with IVR (PDT/IVR group), and 21 were treated with PDT combined with IVA (PDT/IVA group). In both groups, BCVA was shown to be significantly improved 1 year after the initial treatment. CMT and CCT were also significantly decreased after 1 year. There were no significant differences in the changes in BCVA or CMT between the two groups. However, the change in CCT in the PDT/IVA group was significantly larger than that of the PDT/IVR group (P < 0.001). The mean number of additional injections was 0.78 ± 0.21 in the PDT/IVR group and 0.57 ± 0.21 in the PDT/IVA group with no significant difference between the two groups (P = 0.45). The polyp regression rate at 12 months was 78.2% in the PDT/IVR group and 78.9% in the PDT/IVA group with no significant difference between the two groups.ConclusionsPDT combined with either IVR or IVA was well tolerated and appeared to improve both vision and anatomy in patients with PCV. PDT/IVA may have a more pronounced effect on macular choroidal thickness at 1-year follow-up.

Highlights

Polypoidal choroidal vasculopathy (PCV) is first reported by Yanuzzi et al [1,2] as a distinct subtype of wet age-related macular degeneration (AMD)
23 were treated with Photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) (PDT/IVR group), and 21 were treated with PDT combined with intravitreal aflibercept (IVA) (PDT/IVA group)
There were no significant differences in the changes in Best-corrected visual acuity (BCVA) or central macular thickness (CMT) between the two groups

Summary

Introduction

Polypoidal choroidal vasculopathy (PCV) is first reported by Yanuzzi et al [1,2] as a distinct subtype of wet age-related macular degeneration (AMD). [5,6,7] previous studies report that anti-vascular endothelial growth factor (VEGF) agents, such as ranibizumab (Lucentis, Genentech, Inc., South San Francisco, CA, USA) and aflibercept (Eylea, Bayer Health Care, Berlin, Germany) have favorable effects in patients with PCV, a large number of injections are required to maintain patients’ visual acuity with a lower polyp regression rate than that of PDT. The EVEREST II study has reported that combination therapy using ranibizumab and PDT showed more favorable visual outcomes and required fewer injections than ranibizumab monotherapy. Several studies have reported preferable visual outcomes as a result of PDT combined with either intravitreal ranibizumab (IVR) [16,17,18] or intravitreal aflibercept (IVA). The purpose of this study is to compare the 1-year visual outcomes and anatomical responses of patients with PCV who received PDT combined with IVR with those of patients who received PDT combined with IVA

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