Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy

Gomi, Fumi; Sawa, Miki; Sakaguchi, Hirokazu; Tsujikawa, Motokazu; Oshima, Yusuke; Kamei, Motohiro; Tano, Yasuo

doi:10.1136/bjo.2007.122283

Cited by 230 publications

(167 citation statements)

References 34 publications

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“…18 This difference in the response to the anti-VEGF therapy may be one reason for the low rate of polyp regression after anti-VEGF therapy for PCV. 25,26 Further investigations are needed to address the issue.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of fine vascular network pattern associated with recurrence of polypoidal choroidal vasculopathy

Oishi

Mandai

Kimakura

et al. 2011

Eye

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Objective To characterize an irregular capillary-like structure in the vascular network of eyes with polypoidal choroidal vasculopathy (PCV), and to determine whether its presence after photodynamic therapy (PDT) can be used to predict the clinical course of PCV. Methods We reviewed the clinical records of 29 eyes of 29 patients with PCV, who underwent PDT and confocal retinal angiographic examinations every 3 months. The images obtained before the PDT were compared with those after the PDT. The correlations between angiography findings and recurrences were evaluated. Results An area of fine, densely packed capillary-like vessels, named the fine vascular network, was identified within the polypoidal vascular network in 25 of 29 cases at the initial examination. The fine vascular network regressed in 23 cases (92%) after the first PDT. Thereafter, the fine vascular network remained or enlarged in 19 eyes, and 17 (84.5%) of these eyes had a recurrence of the polypoidal lesions or had exudative changes. In contrast, recurrences were found in only 2 of 10 (20%) eyes, whose fine network had regressed without a subsequent enlargement (Po0.001 compared with the former group). Conclusions A fine irregular vascular network is present in the majority of eyes with PCV before PDT. Its presence or expansion after PDT was significantly associated with a recurrence of PCV. Thus, we recommend that this network be monitored after treatment to determine whether a polypoidal vascular network will recur.

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Section: Discussionmentioning

confidence: 99%

Characteristics of fine vascular network pattern associated with recurrence of polypoidal choroidal vasculopathy

Oishi

Mandai

Kimakura

et al. 2011

Eye

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“…Anti-VEGF was reported to have a lower efficacy in eradicating the polypoidal choroidal structure in eyes with PCV, given the persistence of polypoidal lesions or branching vascular networks in previous reports using anti-VEGF as sole treatment. [12][13][14][15][16] However, the high anatomic conversion rate by verteporfin PDT is not without costs. PDT may cause putative damages to the PRE by causing choriocapillary hypoperfusion and retinal pigment epithelium atrophy.…”

Section: Discussionmentioning

confidence: 99%

Outcome of polypoidal choroidal vasculopathy at 1 year by combined therapy of photodynamic therapy with ranibizumab and predictive factors governing the outcome

Young

et al. 2014

Eye

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Aim To report the visual outcome of polypoidal choroidal vasculopathy receiving combined treatment with photodynamic therapy using Visudyne and intravitreal ranibizumab injections, and to analyze the predictive factors of visual outcome at 1 year post treatment. Methods Seventy-four consecutive patients with newly diagnosed polypoidal choroidal vasculopathy were treated with photodynamic therapy using Visudyne and three loading doses of intravitreal ranibizumab. The final visual outcome and polyp eradication rate at 1 year were reported. A stepwise regression model was used to estimate the baseline clinical factors predictive of better visual outcome and polyp eradication.Results Visual acuities at 12-months followup improved significantly compared with baseline from 0.828 logMAR to 0.728 logMAR (P ¼ 0.026). The mean foveal thickness decreased from 380±175 to 278±117 mm. In all 29.7% of eyes improved at least by 0.3 logMAR, and 55.4% remained stable in visual acuity with less than 0.3 logMAR change. Overall, 85% of eyes achieved at least stable vision, 20.2% (15/74) cases achieved polyp eradication on angiogram, and 60.8% (45/74) achieved polyp size reduction on angiogram at 1 year. Regarding predictive factors, the baseline visual acuity (P ¼ 0.003), no foveal involvement by abnormal choroidal vasculature (Po0.0001), absence of hard exudates (0.001) or subretinal fluid (o0.0001) are important clinical factors affecting the final visual outcome. Conclusions Combination therapy with photodynamic therapy using Visudyne and three loading doses of intravitreal ranibizumab injections resulted in 85% success rate on visual stabilization and 81% success rate in polypoidal lesion control.

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“…8,9 Considering the molecular weight (ranibizumab is a 48-kDa Fab fragment, whereas bevacizumab is a complete 149-kDa antibody), ranibizumab may be more effective in treatment of PCV because of its smaller molecular weight and possible deeper penetration to choroidal vascular abnormality lesions of PCV. 17 In addition, ranibizumab is affinity matured and may provide better VEGF inhibition through stronger molecular binding, compared with bevacizumab.…”

Section: Intravitreal Bevacizumabmentioning

confidence: 99%

“…10 Bevacizumab (a humanized full-length anti-VEGF antibody) also appears to have a treatment effect in PCV eyes. 8,9 Kokame et al 13 reported that continuous monthly intravitreal ranibizumab injection was well tolerated in PCV patients; in addition, patients showed stabilized vision and decreased macular edema.…”

Section: Introductionmentioning

confidence: 99%

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Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy

Cho

Kim

Lee

et al. 2011

Eye

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Purpose To compare the effectiveness of intravitreal injection of bevacizumab and ranibizumab in patients with treatment-naïve polypoidal choroidal vasculopathy (PCV). Methods A total of 66 and 60 eyes of 121 consecutive patients who received intravitreal bevacizumab (1.25 mg) or ranibizumab (0.5 mg) injection for treatment of PCV were retrospectively reviewed. After initial three loading injections by month, injection was performed as needed. Main outcome measures included best corrected visual acuity (BCVA), foveal center thickness (FCT) as assessed by spectral domain optical coherence tomography (SD-OCT), and change in polypoidal lesion on indocyanine green angiography (ICGA). Results At 12 months, average number of injections was 4.72±1.84 in the bevacizumab group and 5.52±1.54 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline at 12 months after injection improved by 0.11 in the bevacizumab group (P ¼ 0.02) and by 0.14 in the ranibizumab group (P ¼ 0.01). Average FCT decreased from 368±62.48 to 298±40.77 lm in the bevacizumab group (P ¼ 0.01) and from 371±50.79 to 286±36.93 lm in the ranibizumab group (P ¼ 0.01). Polyp regression rate was 24.2% (16 eyes out of 66 eyes) in the bevacizumab group and 23.3% (14 eyes out of 60 eyes) in the ranibizumab group. There was no statistically significant difference in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups. Conclusion Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilization of visual acuity, macular edema, and regression of polypoidal complex with PCV eyes.

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Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy

Abstract: Intravitreal injection of bevacizumab may reduce the fluid from PCV but seems to be ineffective for diminishing its choroidal vascular changes.

Cited by 230 publications

References 34 publications

Characteristics of fine vascular network pattern associated with recurrence of polypoidal choroidal vasculopathy

Characteristics of fine vascular network pattern associated with recurrence of polypoidal choroidal vasculopathy

Outcome of polypoidal choroidal vasculopathy at 1 year by combined therapy of photodynamic therapy with ranibizumab and predictive factors governing the outcome

Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy

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