Two-Thirds Dose Photodynamic Therapy for Pachychoroid Neovasculopathy

Abstract

Pachychoroid neovasculopathy (PNV) is treated with antivascular endothelial growth factor (VEGF) injection and photodynamic therapy (PDT), but no curative treatment has yet been established. We aimed to clarify the treatment results of a reduced dose of PDT for PNV. The subjects were 27 eyes of 27 patients (male:female = 20:7, mean age 58.9 years). PDT, at 2/3 of the conventional dose (2/3PDT), was administered once. The patients were then observed for one year. Eyes with polypoidal choroidal vasculopathy (PCV) were excluded. We investigated the associations among the central retinal thickness, choroidal thickness, and visual acuity changes before treatment and one, three, six and 12 months after PDT. When serous retinal detachment was increased or unchanged or new hemorrhages were observed, as compared with pretreatment findings, intravitreal injection of an anti-VEGF agent was performed. Visual acuity was significantly improved, as compared to before treatment, at three, six, and 12 months after 2/3PDT. Foveal retinal thickness was significantly decreased after versus before treatment in the 2/3PDT group (p < 0.001). Foveal choroidal thickness was also significantly reduced in the 2/3PDT group (p = 0.001). Additional intravitreal anti-VEGF agent injections were administered to three patients (11%), while 24 (89%) required no additional treatment during the one-year follow-up period. For PNV without polyps, 2/3PDT appears to be effective.

Relationship between Pachychoroid and Polypoidal Choroidal Vasculopathy

“…The reported prevalence of polypoidal lesions was 48–56% ( Table 7 ) [ 60 , 61 , 62 , 63 ]. However, several other studies from Japan have performed their analysis, limiting their study target only to PNV without polypoidal lesions [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Among these studies, one study considered that PNV included both PNV with and those without polypoidal lesions, and they performed their analysis only on PNV without polypoidal lesions [ 64 ].…”

“…However, several other studies from Japan have performed their analysis, limiting their study target only to PNV without polypoidal lesions [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Among these studies, one study considered that PNV included both PNV with and those without polypoidal lesions, and they performed their analysis only on PNV without polypoidal lesions [ 64 ]. Other studies considered PNV without polypoidal lesions as PNV, and PNV with polypoidal lesions as PCV [ 67 , 68 , 69 , 70 , 71 ].…”

“…This group suggested no clear difference in fluid control and visual acuity change after anti-VEGF treatment for PNV and nAMD [ 72 , 77 ]. Other studies on PNV without polypoidal lesions have reported that PDT and anti-VEGF treatment were effective for PNV without polypoidal lesions [ 64 , 65 , 66 , 73 , 80 , 81 , 85 , 86 ]. In 2019 and 2021, studies from Japan compared the 5-year treatment outcomes after PDT or anti-VEGF treatment for PCV with and without pachychoroid ( Table 10 ) [ 87 , 88 ].…”

Cuticular drusen presenting with central serous chorioretinopathy in both eyes: A case report

“…Recently, Tanaka et al demonstrated that two-third dose PDT is effective for the resolution of exudation in eyes with pachychoroid diseases. [12] Therefore, we administered two-third dose verteporfin when performing PDT for eyes with CSC.…”

“…As persistent SRF involved the fovea in the left eye, photodynamic therapy (PDT) was administered. Two-third dose PDT was administered as previously described by Tanaka et al, [12] and the greatest linear dimension and spot size were found to be 3500 and 4500 μm, respectively, to cover the leakage points.…”