One-year efficacy of “rescue photodynamic therapy” for patients with typical age-related macular degeneration, polypoidal choroidal vasculopathy, and pachychoroid neovasculopathy refractory to anti-vascular endothelial growth factor therapy

Wada, Iori; Shiose, Satomi; Ishikawa, Keijiro; Kano, Kumiko; Notomi, Shoji; Mori, Kenichiro; Akiyama, Masato; Nakao, Shintaro; Sonoda, Koh-Hei

doi:10.1007/s00417-022-05553-5

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…Therefore, the PDT may have reduced the necessity for anti-VEGF therapy. Wada et al [21] retrospectively analyzed 23 patients with NV-AMD who underwent rescue PDT and reported that the number of anti-VEGF injections decreased from 5.8 times/year before rescue PDT to 2.6 times/year after PDT; central macular thickness improved from 319 µm to 226 µm and the VA changed from 0.16 to 0.11, which is not significant. Their results are similar to those of the current study as PDT decreased the number of additional treatments and improved the CRT but only maintained the VA. Liu and Chhabra [22] retrospectively analyzed the three-year outcomes of patients with PCV who had received combination therapy consisting of rescue PDT with either IVR or intravitreal aflibercept (IVA).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Prognosis of Patients with Polypoidal Choroidal Vasculopathy Treated with Photodynamic Therapy

Sakaeda,

Kato,

Kuwayama

et al. 2023

JCM

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We evaluated the long-term prognosis of the eyes of patients with polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT). In total, 60 eyes of 57 patients diagnosed with PCV and treated with PDT were reviewed retrospectively in real-world settings. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), anatomical findings (vision-threatening findings), and treatment history were assessed. In total, 38 eyes underwent PDT as the initial treatment (initial PDT group) and 22 eyes underwent PDT as a rescue treatment (rescue PDT group). In the initial PDT group, 11 eyes (29%) did not require additional therapy throughout the observation period and maintained good BCVA. A total of 27 eyes (71%) underwent additional treatments and the mean BCVA was only stabilized for 2 years; thereafter, decreased vision occurred even with additional treatments. In the rescue PDT group, 22 eyes (95%) required additional treatment. Hard exudate, serous pigment epithelial detachment, and the total vision-threatening score were related to worse BCVA. Initial PDT may be effective in about 30% of cases with preservation of good vision and no need for additional treatment. However, patients with received rescue PDT needed additional treatment in most cases and the vision decreased in many cases.

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Section: Discussionmentioning

confidence: 99%

Long-Term Prognosis of Patients with Polypoidal Choroidal Vasculopathy Treated with Photodynamic Therapy

Sakaeda,

Kato,

Kuwayama

et al. 2023

JCM

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“…However, resistance to anti-VEGF therapy is observed in certain cases of PCV [ 10 – 12 ]. These cases are associated with suboptimal functional outcomes due to recurrent and persistent exudative changes, demanding frequent and semi-permanent administration of expensive anti-VEGF drugs.…”

Section: Introductionmentioning

confidence: 99%

“…Identifying efficacious second-line treatments is essential for patients unresponsive to anti-VEGF therapy, with the goal of preserving vision and alleviating the financial impact on both individuals and society [ 13 ]. The standard approach to treating refractory nAMD at present includes switching to other anti-VEGF medications and combination therapies utilizing PDT [ 10 – 12 , 14 – 17 ]. Brolucizumab, recently approved, exhibits considerable effectiveness when employed as second-line treatment for nAMD [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Brolucizumab, recently approved, exhibits considerable effectiveness when employed as second-line treatment for nAMD [ 14 , 15 ]. In comparison, PDT outperformed anti-VEGF drugs monotherapy in treatment-naïve eyes with PCV, and also showed potential benefits for patients resistant to anti-VEGF therapy [ 7 , 10 – 12 , 18 ]. Both treatments would serve as effective second-line treatments for PCV.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating photodynamic therapy versus brolucizumab as a second-line treatment for polypoidal choroidal vasculopathy

Funatsu,

Terasaki,

Mihara

et al. 2024

Int J Retin Vitr

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Background To compare the one-year outcomes between intravitreal brolucizumab (IVBr) monotherapy and photodynamic therapy (PDT) as a second-line treatment in patients with polypoidal choroidal vasculopathy (PCV) who did not respond to first-line therapy. Methods This case–control study included eyes with PCV that do not respond to aflibercept or ranibizumab. The patients were retrospectively registered. We compared outcomes, including best-corrected visual acuity (BCVA), anatomical results, and the need for additional treatments, between IVBr and a combination therapy using PDT as second-line treatments for refractory PCV, after adjusting for potential confounders. We analyzed E-values to evaluate the robustness of the results against unmeasured confounders. Results Twenty-two eyes received IVBr, and twenty-four underwent PDT. No apparent differences were observed in BCVA and central macular thickness (CMT) changes from baseline between the groups (IVBr vs. PDT: BCVA, 0.01 ± 0.47 logMAR vs. 0.04 ± 0.18 logMAR, P-value = 0.756; CMT: − 36.3 ± 99.4 μm vs. − 114.7 ± 181.4 μm, P-value = 0.146). Only in the PDT group, five eyes (20.8%) did not require additional treatment after the second-line treatment, the adjusted odds ratio indicating no further treatment needed was 11.98 (95% confidence interval: 1.42–2070.07, P-value = 0.019). The E-value for the adjusted odds ratio was 23.44. Conclusions Both second-line treatments for PCV exhibited similar visual and anatomical outcomes. Only in the PDT-treated eyes were there some patients who did not require further treatment after second-line therapy.

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Optical coherence tomography-based misdiagnosis and morphological distinction in pachychoroid neovasculopathy vs. polypoidal choroidal vasculopathy

Klaas

Keidel

Asani

et al. 2023

Eye

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Purpose To evaluate the rate of misdiagnosis of aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV) among cases diagnosed as non-aneurysmatic pachychoroid neovasculopathy (PNV) and to define optical coherence tomography (OCT) features facilitating their distinction. Methods The database of the Department of Ophthalmology, Ludwig-Maximilians University Munich, was screened for patients diagnosed with PNV. Multimodal imaging was screened for the presence of choroidal neovascularization (CNV) and aneurysms/polyps. Imaging features facilitating the diagnosis of PAT1/PCV were analysed. Results In total, 49 eyes of 44 patients with a clinical PNV diagnosis were included, of which 42 (85.7%) had PNV and 7 (14.3%) represented misdiagnosed PAT1/PCV. SFCT was comparable (PNV: 377 ± 92 vs. PAT1/PCV: 400 ± 83 µm; p = 0.39). Whereas no difference was detected in total pigment epithelium detachment (PED) diameter (p = 0.46), maximum PED height was significantly higher in the PAT1/PCV group (199 ± 31 vs. 82 ± 46, p < 0.00001). In a receiver operating characteristic (ROC) analysis, the optimum cutoff for defining “peaking PED” was 158 µm with an area under the curve of 0.969, a sensitivity of 1.0 (95% CI: 0.59–1.0), and a specificity of 0.95 (95% CI: 0.84–0.99). Sub-retinal hyperreflective material (SHRM; p = 0.04), sub-retinal ring-like structures (SRRLS; p < 0.00001), and sub-RPE fluid (p = 0.04) were significantly more frequent in eyes with PAT1/PCV. Conclusion A relevant percentage of eyes diagnosed with PNV might instead suffer from PAT1/PCV. The detection of a maximum PED height (“peaking PED”) exceeding approximately 150 µm, SHRM, SRRLS, and sub-RPE fluid might greatly aid in the production of a more accurate diagnosis.

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One-year efficacy of “rescue photodynamic therapy” for patients with typical age-related macular degeneration, polypoidal choroidal vasculopathy, and pachychoroid neovasculopathy refractory to anti-vascular endothelial growth factor therapy

Cited by 4 publications

References 25 publications

Long-Term Prognosis of Patients with Polypoidal Choroidal Vasculopathy Treated with Photodynamic Therapy

Long-Term Prognosis of Patients with Polypoidal Choroidal Vasculopathy Treated with Photodynamic Therapy

Evaluating photodynamic therapy versus brolucizumab as a second-line treatment for polypoidal choroidal vasculopathy

Optical coherence tomography-based misdiagnosis and morphological distinction in pachychoroid neovasculopathy vs. polypoidal choroidal vasculopathy

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