Reduced Vascular Density in the Choroid After Treatment With Photodynamic Therapy Combined With Aflibercept in Patients With Polypoidal Choroidal Vasculopathy

Abstract

Purpose: To investigate changes of vascular density in the choroid of patients with polypoidal choroidal vasculopathy treated with photodynamic therapy (PDT) combined with intravitreal aflibercept. Methods: This study examined 12 eyes of 12 patients, who were diagnosed as polypoidal choroidal vasculopathy. All patents underwent optical coherence tomography before and at 3 months after PDT combined with intravitreal aflibercept treatment. Using en face optical coherence tomography images, we analyzed vascular density of the area outside the polypoidal choroidal vasculopathy lesion and within the PDT exposure area at the level of the choriocapillaris and middle layer of the choroid. In the outer layer of the choroid, the thickest vessel was selected in the area exposed to PDT, with the diameter of the vessel analyzed. Results: The vascular density in the choriocapillaris and middle layer of the choroid significantly decreased from 0.54 ± 0.09 before treatment to 0.44 ± 0.07 after PDT treatment in the choriocapillaris and from 0.53 ± 0.10 to 0.47 ± 0.08 in the middle layer of the choroid, respectively. There was also a significant reduction in the diameter of the largest vessel from 309 ± 85 µm at baseline to 220 ± 52 µm. Conclusion: Photodynamic therapy may cause occlusion of the choriocapillaris and middle vessels in the choroid, as well as stenosis of the large vessels.

Occlusion of a Vortex Vein After Treatment With Half-Fluence Photodynamic Therapy Combined With Intravitreal Aflibercept Injection for Pachychoroid Neovasculopathy

“…Vascular occlusion at the level of the choroidal capillary plate after PDT has been reported previously [9,10]; however, occlusion of large vessels, as observed in this study, has not been reported before.…”

“…On the other hand, PDT also affected normal choroidal vessels, specifically both normal choriocapillaris and middle and large choroidal vessels [10,14,15]. As mentioned in the introduction, the circumscribed hypofluorescent area where the PDT had been exposed was detected in IA after PDT treatment, and the area contained both normal and abnormal choroidal vessels [9].…”

Choroidal Volume Evaluation after Photodynamic Therapy Using New Optical Coherence Tomography Imaging Algorithm

“…The mechanism of PDT in CSC is presumably based on the formation of free radicals upon illuminated treatment area, which leads to vascular endothelium damaging, choriocapillaris narrowing, hypoperfusion and subsequent choroidal vascular remodeling [4,[10][11][12]. The mean diameter of the dilated choroidal vessel decreases after the PDT [4], and PDT reduces the vascular density in the choriocapillaris and middle layer of the choroid [31]. This study revealed that the choroidal volume and thickness decreased even in non-irradiated area of PDT eyes.…”