Photodynamic Therapy Combined with Intravitreal Injection of Vascular Endothelial Growth Factor Antibody for Polypoidal Choroidal Vasculopathy

Abstract

Background/Aims: To evaluate the efficacy of photodynamic therapy (PDT) combined with intravitreal injection of anti-vascular-endothelial-growth-factor (anti-VEGF) antibody in patients with polypoidal choroidal vasculopathy (PCV). Methods: Twenty-two eyes of 22 patients with PCV followed for 12 months after combination therapy with PDT and anti-VEGF were retrospectively reviewed. Patients received intravitreal anti-VEGF (1.25 mg bevacizumab or 0.5 mg ranibizumab) within 7 days after PDT. Retreatment with PDT and intravitreal anti-VEGF injections, or with intravitreal anti-VEGF alone, was performed when indicated. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results: Mean logMAR BCVA was 0.43 at baseline and 0.45, 0.36, 0.30 and 0.28 at 1, 3, 6 and 12 months, respectively, after the initial combination therapy. Mean BCVA was significantly improved at 6 and 12 months after treatment (p < 0.05). Mean CFT was 269.4 µm at baseline and 180.1, 136.7, 127.5 and 139.6 µm at 1, 3, 6 and 12 months, respectively, after the initial combination therapy. CFT decreased significantly throughout the follow-up period. At 12 months, mean BCVA improved by 1.5 lines, and mean CFT decreased by 129.8 µm. Polypoidal lesions disappeared in 7 of the 13 eyes in which indocyanine green angiography was performed at 12 months. No changes in the branching vascular network were observed in any of these 13 eyes. Patients were treated with PDT a mean of 1.3 times and injected with intravitreal anti-VEGF a mean of 3.4 times over the 12-month period. Conclusion: Combined PDT and intravitreal anti-VEGF may improve visual acuity and decrease CFT at 12 months. Large long-term prospective studies are needed to evaluate the efficacy and safety of combination therapy.

Two-Year Results of Photodynamic Therapy Combined with Intravitreal Anti-Vascular Endothelial Growth Factor for Polypoidal Choroidal Vasculopathy

“…Approval for this retrospective review was obtained from the Institutional Review Board of our institution. The inclusion criteria for this study were the same as in our previous study [17], that is: (1) symptomatic macular PCV; (2) presence of exudative or haemorrhagic features involving the macula on fundus examination, and (3) presence of polypoidal lesions and BVNs in indocyanine green angiography (ICGA). Exclusion criteria were: (1) any systemic contraindications for verteporfin or angiographic dyes; (2) previous treatment for PCV, such as focal laser photocoagulation; (3) presence of other diseases such as age-related macular degeneration or pathological myopia (spherical equivalent, ≤–6 dpt); (4) retinal pigment epithelial tears, and (5) other maculopathies, such as diabetic maculopathy or retinal vascular occlusion.…”

“…Previously, we reported the results of a 12-month follow-up of PCV patients who underwent PDT combined with anti-VEGF [17]. As an extension of that study, the present one investigated whether the efficacy of this treatment extended beyond 1 year.…”

“…However, intravitreal injections of anti-VEGF as a monotherapy have limitations in preventing the aggravation of polypoidal lesions [14,15,16]; thus, a combination of anti-VEGF injection and PDT has been attempted as an alternative treatment. A few studies have confirmed the efficacy of PDT combined with anti-VEGF agents on the treatment of PCV [17,18,19], but the follow-up has been limited to only 1 year.…”

Salient Features of New Therapies in Ophthalmology

“…A survey was done to evaluate the effect of low-fluency Photodynamic Therapy (PDT) [51,69,70] on central retinal sensitivity and fixation stability as compared with standard-fluency PDT for treating chronic central serous chorioretinopathy (CSC). The study shows a significant improvement in macular sensitivity after PDT in eyes with chronic CSC, with greater efficacy in low-fluency-treated eyes.…”

Pre-treatment With Ranibizumab Aggravates PDT Injury and Alleviates Inflammatory Response in Choroid-Retinal Endothelial Cells

“…Although anti-VEGF antibodies have a much longer history of application in combined therapy, the optimal time of antibodies before or after PDT is still controversial. Most of those studies utilized intravitreal antibodies before PDT ( Gomi et al, 2010 , 2015 ; Nowak-Sliwinska et al, 2010 ; Park and Kim, 2012 ; Sagong et al, 2012 ; Saito et al, 2012 , 2014 ; Tomita et al, 2012 ; Jeon et al, 2013 ; Sato et al, 2013 ; Yoshida et al, 2013 ; Sakurai et al, 2014 ), and a few studies applied antibodies after PDT ( Lai et al, 2011 ; Ho et al, 2014 ; Zhao et al, 2017 ) or in the same day ( Kim et al, 2011 ; Moon et al, 2011 ; Ricci et al, 2012 ; Hata et al, 2015 ). Due to that there are great differences among them in regarding to anti-VEGF antibodies, time interval between PDT and intravitreal antibodies, PDT protocol and retreatment protocols, it is unable to conduct sub-group analysis and determine the best option.…”