Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept.

Alessandra Casuccio,Salvatore Cillino,Giovanni Cillino,Giulia Guarrasi,Massimo Castellucci,Vincenza Maria Elena Bonfiglio,Maria Vadalà

doi:10.1007/s10792-021-02032-4

Alessandra Casuccio, Salvatore Cillino

Open Access

https://doi.org/10.1007/s10792-021-02032-4

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Journal: International ophthalmology	Publication Date: Jan 16, 2022
Citations: 1	License type: cc-by

Affiliation: University of Palermo

Abstract

To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV). Patients with PPCV were treated with PDT combined with 3 IVA injections on a monthly basis, followed by pro re nata criteria. The 12-month follow-up consisted of multiple revaluations of visual acuity and SS-OCT parameters of clinical activity. Nineteen eyes were included in the study; mean age was 65.5years. Visual acuity improved after 12months (0.35 ± 0.25 to 0.2 ± 0.20 logMAR, p = 0.005). Percentage of eyes with intraretinal and subretinal fluid reduced from baseline to the 12-month follow-up (from 52.6 to 10.5%, p = 0.12, and from 89.5 to 5.3% p = 0.0009, respectively). Central retinal and mean macular thicknesses reduced (258 ± 39.6 to 204.8 ± 38.8μm p = 0.04 and 293.8 ± 32.1 to 248.1 ± 29.6μm p = 0.017, respectively). Central choroidal and mean choroidal thicknesses also displayed a reduction (328.6 ± 54.9 to 289.8 ± 44.6μm p = 0.001 and 314.5 ± 55.3 to 287.9 ± 47.6μm p = 0.015, respectively). The mean number of injections was 4.6/year. The results support the use of a combined therapy with Aflibercept and PDT in PPCV. This treatment would act in synergy, with anti-VEGF controlling exudation and PDT closing the aneurysmal vessel and reducing choroidal congestion.

Highlights

To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV)
The results support the use of a combined therapy with Aflibercept and PDT in PPCV
We examined visual and morphological changes in a cohort of naive patients affected by PPCV and treated with a combination of vPDT and intravitreal injections of Aflibercept (IVA), based on the pathogenetic hypothesis of this peculiar neovascularization

Summary

Introduction

To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV). The definition of pachychoroid includes several clinical features such as a thicker choroid, dilated and straight choroidal vessels that end abruptly, choroidal hyperpermeability on ICGA, compression of Sattler’s layer due to dilated choroidal vessels in Haller’s layer and choriocapillaris thinning visible on OCT, RPE changes and atrophy, and serous RPE detachment [2,3,4,5].The hyperpermeability of choriocapillaris and pachyvessels causes fluid and lipoproteins to move toward the choroidal stroma. The pachychoroid disease spectrum includes several clinical entities: central serous chorioretinopathy (CSC), pachychoroid pigment epitheliopathy (PPE), neovascularization in pachychoroid (PNV), pachychoroid-related polypoidal choroidal vasculopathy (PPCV), focal choroidal excavation (FCE) and peripapillary pachychoroidal syndrome (PPS). The overlapping and concomitance of conditions are described as well as the progression or evolution from one manifestation to another, supporting the hypothesis of a common pathogenesis [7, 8]

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