Long‐term results of rescue photodynamic therapy for type 1 neovascularization refractory to anti‐vascular endothelial growth factor

Abstract

Purpose To evaluate long‐term results of photodynamic therapy (PDT) as a rescue treatment in patients with type 1 neovascularization refractory to intravitreal anti‐vascular endothelial growth factor (VEGF). Methods Patients who underwent reduced‐fluence PDT for refractory type 1 neovascularization, which showed persistent subretinal and/or intraretinal fluid after three or more consecutive anti‐VEGF treatments, and were followed up for ≥24 months were reviewed. Results Seventy‐eight eyes of 78 patients were included, and 37 (47%) were classified as polypoidal choroidal vasculopathy (PCV). The mean number of anti‐VEGF injections before rescue PDT was 8.5 ± 5.4, and the mean follow‐up period after rescue PDT was 74.0 ± 29.4 months. At 3 months after rescue PDT, exudation completely resolved in 55 (71%) patients and vision significantly improved (p = 0.021). Resolution of exudation was associated with choroidal vascular hyperpermeability [odds ratio (OR), 3.82; p = 0.031] and lower maximal height of pigment epithelial detachment (OR, 0.69; p = 0.018). In these patients, exudation recurred in 49 (89%) after mean period of 13.5 months. Vision significantly worsened at 24 months after rescue PDT, and thereafter, and the vision decrease was more prominent in patients with PCV. Rescue PDT could be repeated for recurrent or persistent exudation without increasing the risk of complications. Conclusion In patients with type 1 neovascularization refractory to anti‐VEGF, reduced‐fluence PDT is an effective and safe rescue treatment. Therapeutic efficacy wore off during long‐term follow‐up, but rescue PDT may be repeated safely.

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

“…Multiple studies have evaluated various PDT protocols in the treatment of anti-VEGF-resistant eAMD. Park et al retrospectively evaluated 78 eyes with anti-VEGF-resistant eAMD treated with reduced fluence PDT (laser delivered for a shorter period of time resulting in a 20% reduction in energy density delivered from standard therapy) [ 77 ]. All enrolled eyes initially received PDT as “rescue therapy” based on a lack of resolution of subretinal and/or intraretinal fluid along with macular thickening despite a series of three anti-VEGF injections.…”

Short-Term Outcomes of Switching to Ranibizumab in Polypoidal Choroidal Vasculopathy Resistant to Aflibercept Therapy

“…However, a recent study has demonstrated different results. In the study by Park et al, rescue PDT was beneficial in resolving fluid and improving visual acuity in refractory Type 1 neovascularization, including PCV [17]. This suggests that PDT can be considered as an alternative to aflibercept-resistant PCV.…”

Sustained Biweekly Aflibercept for Refractory Neovascular Age-Related Macular Degeneration

“…16 The typically small and retrospective studies examining the use of combination therapies for refractory NVAMD demonstrated anatomical benefits and reduced anti-VEGF treatment burden without corresponding improvements in BCVA. [10][11][12][13]15,16 Tozer et al 14 reported both anatomical and functional improvements with combined anti-VEGF therapy and photodynamic therapy, but this study used a less stringent definition of "refractory NVAMD" including patients with as few as three prior anti-VEGF injections (mean prior injections: 4.9).…”

“…8,9 A variety of alternative treatment strategies have been investigated in the attempt to achieve complete macular drying in eyes with refractory NVAMD. These include increasing the dose of the anti-VEGF agent injected 10,11 and combining anti-VEGF therapy with intravitreal steroids, 12,13 photodynamic therapy, 14,15 and topical aqueous humor suppressants. 16 The typically small and retrospective studies examining the use of combination therapies for refractory NVAMD demonstrated anatomical benefits and reduced anti-VEGF treatment burden without corresponding improvements in BCVA.…”