Five-year outcomes of photodynamic therapy combined with intravitreal injection of ranibizumab or aflibercept for polypoidal choroidal vasculopathy.

Kikushima Wataru,Mio Matsubara,Yoichi Sakurada,Yoshiko Fukuda,Atsushi Sugiyama,Seigo Yoneyama,Ravi Parikh,Michael R Hamblin

doi:10.1371/journal.pone.0229231

Abstract

We report 5-year visual and anatomical outcomes after combination therapy of photodynamic therapy (PDT) and intravitreal injection of ranibizumab or aflibercept for polypoidal choroidal vasculopathy (PCV) and predictive factors for visual outcomes at 5-year and time to recurrence. Medical charts were retrospectively reviewed for 43 consecutive eyes with PCV treated with combination therapy of PDT and intravitreal injection of ranibizumab(n = 13) or aflibercept(n = 30) and completed 5-year follow-up. The variants of ARMS2 A69S and CFH I62V were genotyped using TaqMan assay. Best corrected visual acuity (BCVA) significantly improved at 5-year (P = 0.01) with 20% reduction of subfoveal choroidal thickness irrespective of presence or absence of recurrence. Visual improvement was associated with baseline shorter greatest linear dimension (GLD) (P = 1.0×10-4). Mean time to recurrence was 28.6±23.1 months (95% CI: 21.5-35.7, Median:18.0) and time to recurrence was associated with G allele (protective allele) of ARMS2 A69S and GLD (P = 4.0×10-4 and 1.0×10-2, respectively). Multiple regression analysis revealed that time to recurrence extended by 15.5 months when the G allele of ARMS2 A69S increased by one allele (TT: 15.7±17.0, TG: 30.8±23.5, GG: 41.1±22.6 months). The combination therapy resulted in a favorable visual outcome for PCV during 5-year follow-up.

Highlights

We report 5-year visual and anatomical outcomes after combination therapy of photodynamic therapy (PDT) and intravitreal injection of ranibizumab or aflibercept for Polypoidal choroidal vasculopathy (PCV) and the predictive factors for visual outcomes at 5 years and time to recurrence during the follow-up
Factors at 60 months multivariate linear regression analysis revealed that shorter greatest linear dimension (GLD) (p = 1.0×10−4) were associated with better Best corrected visual acuity (BCVA) at 60 months while other factors such as age, type of anti-vascular endothelial growth factor (VEGF) agent, and central retinal thickness were not associated with improved BCVA (Table 3)
T allele of ARMS2 A69S was the only variable associated with recurrence of exudation from PCV (P = 0.002, Table 5)

Summary

Introduction

Polypoidal choroidal vasculopathy (PCV) often exhibits serosanguinous detachment of retinal pigment epithelium and neurosensory retina and is characterized by aneurysmal dilation with or without branching vascular network on indocyanine green angiography (ICGA).[1, 2]. Several treatment options have been reported to treat PCV including photocoagulation, photodynamic therapy (PDT), intravitreal injection of anti- vascular endothelial growth factor (VEGF) agent and combination therapy of PDT and intravitreal injection of anti-VEGF agent. Five-year results of the combination therapy for polypoidal choroidal vasculopathy

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Conclusion