Reduced-fluence photodynamic therapy and anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy in an Indian population

Abstract

Aims:The aim was to study the efficacy of combined therapy with reduced-fluence photodynamic therapy (RFPDT) and intravitreal bevacizumab/ranibizumab from the Indian subcontinent.Settings and Design:This was a single-center, retrospective interventional study.Methods:Thirty-five eyes of 34 patients diagnosed with polypoidal choroidal vasculopathy were included. All the patients underwent RFPDT, followed by intravitreal bevacizumab/ranibizumab.Statistical Analysis Used:SPSS software, version 17.0 (SPSS Inc., Chicago, IL, USA) was used to compare the logarithm of the minimal angle of resolution visual acuity at presentation and final follow-up. P < 0.05 was considered statistically significant.Results:Regression of polyps after a single session of RFPDT was seen in five eyes; multiple sessions of treatment were required in thirty eyes. An average number of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections given were 4 ± 1.9 and average number of PDT sessions were 1.2 ± 0.5. Visual acuity improvement was seen in 21 (60%) eyes (P < 0.001), decrease in visual acuity was seen in 7 (20%) eyes (P = 0.016), and in 7 eyes (20%), vision remained stable. Regression of polypoidal lesions was seen in 80% of cases. No complications of massive subretinal hemorrhage or breakthrough vitreous hemorrhage were noted in our patients. The mean follow-up period was 18 months (range, 12–24 months).Conclusions:RFPDT with anti-VEGF is safe and effective treatment with polyp regression and vision improvement in 80% of cases, without any complication of subretinal hemorrhage/vitreous hemorrhage.

Comparing efficacy of reduced-fluence and standard-fluence photodynamic therapy in the treatment of polypoidal choroidal vasculopathy

“…Wong et al reported LogMAR VA improvement of 0.23 and polyp regression rate of 42.1% in the use of half-dose verteporfin PDT [17]. Other authors have reported the use of reduced dose rate for PDT resulting in LogMAR VA improvements ranging from 0.13-0.3, mean central foveal thickness decreases of 87-281 μm, and polyp regression rates between 71.4-92.8% [14,[16][17][18][19][20]. These results are comparable to those reported in our study.…”

“…To mitigate the risk of complications using standard PDT, less intensive protocols for PDT treatment have been suggested. They include reducing the dose of verteporfin administered or reducing one of the laser parameters (dose rate or duration of laser application) to achieve a reduction in the laser fluence (light dose) [13][14][15][16][17][18][19][20]. Various authors have described treatment success with these less intensive protocols which theoretically reduces the risk of complications [13][14][15][16][17][18][19][20].…”

“…They include reducing the dose of verteporfin administered or reducing one of the laser parameters (dose rate or duration of laser application) to achieve a reduction in the laser fluence (light dose) [13][14][15][16][17][18][19][20]. Various authors have described treatment success with these less intensive protocols which theoretically reduces the risk of complications [13][14][15][16][17][18][19][20]. Several studies have reported the success of reduced-fluence PDT in the treatment of PCV [13][14][15][16][18][19][20].…”

“…Several studies have reported the success of reduced-fluence PDT in the treatment of PCV [13][14][15][16][18][19][20]. However, all except one of these reports are single-arm interventional series involving only the reduced-fluence arm, without the inclusion of a standard-fluence arm for comparison [14][15][16][18][19][20]. Only Fan et al compared the outcomes between reduced-fluence and standard-fluence PDT [13].…”

Long-term efficacy and safety of verteporfin photodynamic therapy in combination with anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy

“…Sen et al . [ 24 ] showed that reduced-fluence PDT with anti-VEGF is safe and effective with polyp regression with visual improvement seen in 80% of cases. In their study, none of the patients developed subretinal hemorrhage.…”