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

Abstract

Background/Aims: To evaluate the 2-year efficacy of photodynamic therapy (PDT) combined with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in patients with polypoidal choroidal vasculopathy (PCV). Methods: Twenty-two eyes of 22 patients with PCV followed up for ≧24 months after PDT and anti-VEGF combination therapy were retrospectively reviewed. The patients received intravitreal anti-VEGF (1.25 mg bevacizumab or 0.5 mg ranibizumab) within 7 days after PDT. Eyes were retreated with PDT and anti-VEGF injection, or with only anti-VEGF injection, when indicated. Main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results: The mean baseline BCVA (0.43 ± 0.33 logarithm of the minimum angle of resolution, logMAR) was 0.28 ± 0.24 at 12 months (p < 0.05 vs. baseline) and 0.39 ± 0.28 at 24 months (not significant). At 24 months, BCVA improved by ≧0.3 logMAR in 27.3% of the eyes, did not significantly decrease in 59.1%, and decreased by ≧0.3 logMAR in 13.6%. The mean CFT was 269.4 ± 134.5 µm at baseline and significantly decreased to 139.6 ± 45.8 µm (12 months) and 199.6 ± 72.9 µm (24 months). PDT was administered 1.45 ± 0.86 times and anti-VEGF injected 4.45 ± 1.36 times over the 24-month period. Conclusion: Combined PDT and anti-VEGF injection were effective for 2 years in PCV patients. Visual acuity significantly improved during year 1, but the benefit diminished in year 2. Further investigations are required to determine how to prolong the therapeutic effect of combination therapy for PCV.

Two-year follow-up of ranibizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy

“…In these studies, significant improvement of visual acuity was obtained in the first year; however, treatment efficacy was decreased in year 2 15,16. Our study on combined PDT and IVR treatment showed similar results to combined PDT with intravitreal bevacizumab injection.…”

“…However, little information is available regarding the long-term efficacy of this combination. In the 2-year results for the combination of PDT and intravitreal bevacizumab injection, regression of the treatment effect was reported in year 2 15,16. For PDT with intravitreal injection of ranibizumab (IVR), follow-up time was limited to only one year;17,18 hence, long-term results for combination of PDT with IVR are not clear.…”

Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy

“…[26][27][28][29] However, in our institution, it was difficult to compare these patients because recurrent patients of combined therapy were changed into IVR monotherapy within 2 years. Although combined therapy could be also the main therapeutic choice in the present, Kim et al 29 described that the benefit of combined therapy diminished in year 2 with no significant difference compared with baseline. Further investigations are needed to compare combined therapy and IVR monotherapy during the long follow-up periods.…”

Polypoidal Choroidal Vasculopathy

“…135 Vision in eyes with recurrence after previous verteporfin PDT therapy stabilized but did not improve: a finding supported by the small study by Romano et al 130 The need for determining how to maximize the durability of the benefits of combination therapy is highlighted by findings that benefits in visual acuity after 1 year were substantially diminished at 2 years (mean BCVA: 0.43 ± 0.33 [baseline], 0.28 ± 0.24 [12 months], and 0.39 ± 0.28 [24 months]), with mean retreatment rates of 36.4% and 77.3% in the first and second years, respectively. 116 Recent genetic studies have demonstrated an association between genotype and outcomes in the treatment of PCV. 110,127,134 Clinical response to verteporfin PDT has differed significantly between patients with different variants of the SERPINF1 gene, which encodes pigment epithelium-derived factor.…”