Abstract
The purpose of this study was to compare 6-year visual outcomes of antivascular endothelial growth factor (anti-VEGF) monotherapy and initial combination therapy of photodynamic therapy (PDT) and anti-VEGF therapy for polypoidal choroidal vasculopathy (PCV) in a Chinese population and to investigate imaging biomarkers associated with visual outcomes. Forty-eight treatment-naive PCV eyes of 46 patients were reviewed retrospectively, which underwent anti-VEGF monotherapy or initial combination therapy. PCV was classified into 2 subtypes. Mean best-corrected visual acuity (BCVA) using logarithm of minimal angle resolution and imaging morphological features was compared. No significant differences of mean BCVA changes were noticed between anti-VEGF monotherapy and combination therapy in either subtype 1 PCV or subtype 2 PCV during 6-year period (all P values >0.05). Compared with BCVA at baseline, the mean BCVA at 72 months deteriorated significantly in eyes with subtype 1 PCV (P < 0.001), while the mean BCVA at 72 months remained stable in eyes with subtype 2 PCV (P=0.941). In subtype 2 PCV eyes with continuous retina pigment epithelium, the mean changes of BCVA in eyes treated with anti-VEGF monotherapy were better than those in eyes treated with combination therapy (P=0.020). Anti-VEGF monotherapy and combination therapy for various subtypes of PCV had comparable long-term visual outcomes in most cases in real world. Imaging biomarkers which correlate with visual outcomes and treatment response should be included in the classification of PCV and validated in real world.
Highlights
Polypoidal choroidal vasculopathy (PCV) is characterized by polypoidal hyperfluorescence with or without a branching vascular network (BVN) in indocyanine green angiography (ICGA), which is the gold standard for diagnosing PCV [1, 2]
The baseline greatest linear dimension (GLD) was greater in eyes treated with combination therapy than that in eyes treated with anti-VEGF monotherapy (3554.9 versus 2378.5, P 0.018), while baseline subretinal fluid was more common in the eyes treated with anti-VEGF monotherapy than that in the eyes treated with combination therapy significantly (79.2% versus 43.5%, P 0.017)
Multiple linear regression analysis showed that the mean changes of best-corrected visual acuity (BCVA) during the follow-up period were significantly related to the configuration of polyps (β 0.723; P < 0.001) and the continuity of retina pigment epithelium (RPE) at baseline (β − 1.185; P < 0.001)
Summary
Polypoidal choroidal vasculopathy (PCV) is characterized by polypoidal hyperfluorescence with or without a branching vascular network (BVN) in indocyanine green angiography (ICGA), which is the gold standard for diagnosing PCV [1, 2]. Several clinical trials compared various treatment regimens [3,4,5,6,7]. The EVEREST-II study compared the intravitreal injection (IVT) of ranibizumab (IVT-R) and combination of PDT and IVT-R and concluded that combination therapy is preferred to IVR monotherapy [8]. The PLANET study compared IVT aflibercept without and with rescue PDT after 3 months and suggested that no additional benefit was gained in combining with PDT as a rescue therapy [4]. These inconsistent conclusions reveal that more further studies are needed for management of PCV
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