Journal List > J Korean Ophthalmol Soc > v.58(6) > 1010782

TOOLS
Han, Kim, and Oh: Long-term Results of Reduced-fluence Photodynamic Therapy Combined with Intravitreal Anti-Vascular Endothelial Growth Factor for Polypoidal Choroidal Vasculopathy
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(6): 646-652.

Published online: 16 June 2017

DOI: https://doi.org/10.3341/jkos.2017.58.6.646

Long-term Results of Reduced-fluence Photodynamic Therapy Combined with Intravitreal Anti-Vascular Endothelial Growth Factor for Polypoidal Choroidal Vasculopathy

Ji Yun Han, MD, Seong-Woo Kim, MD, PhD, Jaeryung Oh, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

Address reprint requests to Seong-Woo Kim, MD, PhD. Department of Ophthalmology, Korea University Ansan Hospital, #123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: 82-31-412-5160, Fax: 82-31-412-4267, ksw64723@korea.ac.kr

Received 26 January 2017       Revised 24 April 2017       Accepted 20 May 2017

©2017 The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term effects of reduced-fluence photodynamic therapy (RF-PDT) combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF) for polypoidal choroidal vasculopathy (PCV).

Methods

Twenty-two eyes of 21 patients with PCV that were followed up for more than 24 months after RF-PDT and anti-VEGF combination therapy were retrospectively reviewed. The patients received intravitreal anti-VEGF (bevacizumab 1.25 mg, ranibizumab 0.5 mg, or aflibercept 2.0 mg) within 7 days of PDT. Patients were retreated with either RF-PDT and anti-VEGF injection, or with only anti-VEGF injection, as indicated. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT), which were measured before and after combination therapy.

Results

During follow-up, the mean logMAR BCVA significantly improved from 0.75 at baseline to 0.54 at 12 months and 0.52 at 24 months (p=0.009 and p=0.032, respectively). The mean CFT significantly decreased from 409.8 µm at baseline to 234.1 µm at 12 months and 245.9 µm at 24 months (p<0.001 and p=0.001, respectively). In 20 eyes (90.9%), the BCVA remained stable or improved.

Conclusions

The efficacy of this combination therapy for 24 months resulted in stabilized vision and anatomical improvement. RF-PDT combined with intravitreal anti-VEGF injection could be an effective treatment modality for patients with PCV.

Keywords: Polypoidal choroidal vasculopathy, Reduced fluence photodynamic therapy, Vascular endothelial growth factor

Figures and Tables

Figure 1

The changes in mean logMAR best-corrected visual acuity (BCVA) over time after combination therapy. The mean logMAR BCVA significantly improved at 6, 12 and 24 months after combination therapy. *Paired t-test (p<0.05).

jkos-58-646-g001
Figure 2

The changes in mean central foveal thickness (CFT) on optical coherence tomography over time after combination therapy. The mean CFT significantly decreased at 3, 6, 12 and 24 months after combination therapy. *Paired t-test (p<0.05).

jkos-58-646-g002
Table 1

Patient clinical characteristics at baseline, 3, 6, 12, 24 months

jkos-58-646-i001

BCVA = best corrected visual acuity; CFT = central foveal thickness; PDT = photodynamic therapy; VEGF = vascular endothelial growth factor; VA = visual acuity; F = female; M = male.

Table 2

Results of various treatment regimens for treatment of polypoidal choroidal vasculopathy in published studies compared with RF-PDT combined with intravitreal anti-VEGF injection in this study

jkos-58-646-i002

RF-PDT = reduced-fluence photodynamic therapy; anti-VEGF = anti-vascular endothelial growth factor; PDT = photodynamic therapy; BCVA = best corrected visual acuity.

References

1. Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990; 10:1–8.
2. Ciardella AP, Donsoff IM, Huang SJ, et al. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004; 49:25–37.
3. Uyama M, Matsubara T, Fukushima I, et al. Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol. 1999; 117:1035–1042.
4. Uyama M, Wada M, Nagai Y, et al. Polypoidal choroidal vasculopathy: natural history. Am J Ophthalmol. 2002; 133:639–648.
5. Lee WK, Kwon SI. Polypoidal choroidal vasculopathy. J Korean Ophthalmol Soc. 2000; 41:2573–2584.
6. Gomi F, Sawa M, Sakaguchi H, et al. Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2008; 92:70–73.
7. Koh A, Lee WK, Chen LJ, et al. EVEREST Study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina. 2012; 32:1453–1464.
8. Ojima Y, Tsujikawa A, Otani A, et al. Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy. Am J Ophthalmol. 2006; 141:958–960.
9. Hirami Y, Tsujikawa A, Otani A, et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy. Retina. 2007; 27:335–341.
10. Tsujikawa A, Hirami Y, Nakanishi H, et al. Retinal pigment epithelial tear in polypoidal choroidal vasculopathy. Retina. 2007; 27:832–838.
11. Lai TY, Chan WM, Liu DT, et al. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2008; 92:661–666.
12. Yamashita A, Shiraga F, Shiragami C, et al. Two-year results of reduced-fluence photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013; 155:96–102.e1.
13. Ricci F, Calabrese A, Regine F, et al. Combined reduced fluence photodynamic therapy and intravitreal ranibizumab for polypoidal choroidal vasculopathy. Retina. 2012; 32:1280–1288.
14. Sagong M, Lim S, Chang W. Reduced-fluence photodynamic therapy combined with intravitreal bevacizumab for polypoidalchoroidal vasculopathy. Am J Ophthalmol. 2012; 153:873–882.e2.
15. Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol. 2009; 148:43–58.e1.
16. Imamura Y, Engelbert M, Iida T, et al. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol. 2010; 55:501–515.
17. Wong CW, Yanagi Y, Lee WK, et al. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res. 2016; 53:107–139.
18. Wakabayashi T, Gomi F, Sawa M, et al. Marked vascular changes of polypoidal choroidal vasculopathy after photodynamic therapy. Br J Ophthalmol. 2008; 92:936–940.
19. Lee PY, Kim KS, Lee WK. Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy. J Korean Ophthalmol Soc. 2004; 45:216–227.
20. Silva RM, Figueira J, Cachulo ML, et al. Polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2005; 243:973–979.
21. Schmidt-Erfurth U, Laqua H, Schlötzer-Schrehard U, et al. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol. 2002; 120:835–844.
22. Tzekov R, Lin T, Zhang KM, et al. Ocular changes after photo dynamic therapy. Invest Ophthalmol Vis Sci. 2006; 47:377–385.
23. Tatar O, Adam A, Shinoda K, et al. Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy. Am J Ophthalmol. 2006; 142:95–104.
24. Tatar O, Shinoda K, Adam A, et al. Effect of verteporfin photodynamic therapy on endostatin and angiogenesis in human choroidal neovascular membranes. Br J Ophthalmol. 2007; 91:166–173.
25. Gomi F, Sawa M, Wakabayashi T, et al. Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2010; 150:48–54.e1.
26. Yoshida Y, Kohno T, Yamamoto M, et al. Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2013; 57:283–293.
TOOLS
Similar articles