Abstract
Purpose: To compare the two-year visual and anatomical outcomes of combination therapy of photodynamic therapy (PDT) with intravitreal aflibercept (IVA) or intravitreal ranibizumab (IVR) for patients with polypoidal choroidal vasculopathy (PCV), and to investigate the clinical factors with final visual outcome and retreatment. Methods: A retrospective medical chart review was performed for 55 eyes from 55 patients with PCV treated by a combination therapy of prompt PDT with either IVA (n = 30) or IVR (n = 25). Baseline data and treatment outcomes during the 24-month follow-up were compared between the two groups. Primary outcomes were the changes in best-corrected visual acuity (BCVA) and the rate of complete polyp regression. Secondary outcomes were the changes in central retinal thickness (CRT) and the rate of dry macula. Retreatment was administered in cases with persistent or recurrent submacular or intramacular fluid. Results: The BCVA significantly improved in the IVA/PDT group at every 6-month visit compared to the baseline. In the IVR/PDT group, there was a significant improvement of BCVA only at 6-months and 12-months, but not at 18-months and 24-months compared to the baseline. There were no significant differences in the BCVA change or CRT change between the two groups at every 6-month visit. A complete polyp regression rate at 3-months was 53.3% in IVA/PDT, and 52.0% in IVR/PDT. Significantly higher dry macula rate in Month 6 and 18 in the IVA/PDT group than in IVR/PDT group. Retreatment was performed in 26.7% patients in IVA/PDT, and in 60.0% patients in the IVR/PDT group. There were significantly lower retreatment rates in the IVA/PDT group than those in the IVR/PDT group. Better final BCVA was associated with better baseline BCVA and a younger age. Retreatment was associated with complete polyp regression at 3-months. Conclusions: Significant visual improvement was demonstrated in the IVA/PDT group at every 6-month visit, but only at a 6-month and a 12-month follow-up in the IVR/PDT group. Although changes of the BCVA/CRT and complete polyp regression rate were comparable between two groups, the IVA/PDT group required less retreatment and attained more dry macula results. Better baseline BCVA and younger age were associated with a better visual outcome.
Highlights
Polypoidal choroidal vasculopathy (PCV) is a distinct phenotype of exudative agerelated macular degeneration (AMD) and is characterized by polyp-like nodules and branching vascular networks, which are hyperfluorescent on indocyanine-green angiography (ICGA) [1,2]
There were no significant differences in baseline characteristics between the two groups except for gender since there were more male patients in the intravitreal aflibercept (IVA)/photodynamic therapy (PDT) group than those in the intravitreal ranibizumab (IVR)/PDT group
Sakurada Y. et al and Ito A. et al reported no significant differences in changes in best-corrected visual acuity (BCVA) or central retinal thickness (CRT) between the two groups 12 months after treatment [20,21], which were similar to our results at the 12-month follow-up
Summary
Polypoidal choroidal vasculopathy (PCV) is a distinct phenotype of exudative agerelated macular degeneration (AMD) and is characterized by polyp-like nodules and branching vascular networks, which are hyperfluorescent on indocyanine-green angiography (ICGA) [1,2]. A previous study reported better visual prognosis in patients with. PCV than in patients with other forms of exudative AMD [3]. Other studies demonstrated that the best-corrected visual acuity (BCVA) deteriorated significantly in the natural course and half of the patients who experienced repeated bleeding and leakage, resulting in chorio-retinal atrophy and vision loss [4,5]. There are two main treatment modalities for PCV, including photodynamic therapy (PDT) and intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF). VEGF plays an important role in exudative AMD and PCV, and VEGF levels in aqueous solution elevated in patients with PCV [6]. Anti-VEGF agents, such as ranibizumab and aflibercept, have a favorable visual outcome for treating PCV, but a large number of injections are required to maintain the vision. In three initial monthly injections followed by an as-needed reinjection regimen, the mean number of injections ranged from 4.2 to
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