BackgroundThe optimal treatment for polypoidal choroidal vasculopathy (PCV) is still under debate. Little knowledge is known about the treatment effect of “1+pro re nata(PRN)” treatment regimen for PCV. The aim of this study was to compare the outcomes of photodynamic therapy (PDT), intravitreal ranibizumab injection (IVR) and combination therapy under the “1 + PRN” treatment regimen for PCV.MethodsFifty-seven eyes of 57 patients completed the 12 months’ follow-up in this prospective study. The patients in the PDT arm(n = 23), ranibizumab arm(n = 18), or combination arm(n = 16) underwent a session of PDT, IVR or combination of both at baseline followed by additional IVR as needed. Mean change of logarithm of the minimal angle of resolution (logMAR) visual acuity (VA), central foveal thickness (CFT) and the regression rate of polyps were evaluated. Cost-benefit analysis was also performed.ResultsAt Month 12, the mean logMAR VA improved from 0.90 ± 0.52 to 0.75 ± 0.57 in the PDT group (P < 0.05), from 0.96 ± 0.58 to 0.77 ± 0.41 in the IVR group (P < 0.05), and from 0.94 ± 0.55 to 0.72 ± 0.44 in the combination group (P < 0.05), respectively. The CFT decreased from 478.04 ± 156.70 μm, 527.5 ± 195.90 μm, and 522.63 ± 288.40 μm at the baseline to 366.43 ± 148.28 μm, 373.17 ± 134.88 μm and 328.44 ± 103.25 in the PDT group (P < 0.05), IVR group (P < 0.01), and the combination group (P < 0.05), respectively. However, no statistical difference was found between groups (P > 0.05). PDT treatment (60.87%) was superior to the IVR therapy (22.22%) in achieving complete regression of polyps (P < 0.05). Cost-benefit analysis showed that IVR treatment cost the least money for improving per 0.1logMAR units and the combination therapy demanded the least money for reducing per 100 μm of CFT.ConclusionsPDT, IVR and the combination therapy have similar efficacy in the VA improvement as well as the reduction of CFT under the “1 + PRN” treatment regimen.Trial registrationCurrent Controlled Trials NCT03459144. Registered retrospectively on March 2, 2018.
Photodynamic- and photocoagulation-based therapies are both reasonably effective against most RCH tumor bodies, but PDT carries lower risks of bleeding and subretinal fluid refraction. Formation of subretinal fluid may predict poor vision outcome in RCH.
BACKGROUND AND OBJECTIVE: To investigate the morphological difference of choroidal vasculature between polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) on optical coherence tomography (OCT). PATIENTS AND METHODS: One hundred eighty-nine patients with macula-involved PCV (n = 107) or nAMD (n = 82) were retrospectively reviewed. The subfoveal choroidal thickness (SFCT) and thickness of the Haller's layer were determined on enhanced depth imaging optical coherence tomography (EDI-OCT). The mean diameters of subfoveal large choroidal vessels were also calculated. RESULTS: Both the SFCT (257.31 μm ± 100.50 μm vs. 209.95 μm ± 97.51 μm) ( P < .01) and the thickness of the Haller's layer (213.68 μm ± 82.65 μm vs. 159.67 μm ± 79.86 μm) ( P < .01) were greater in PCV patients than nAMD patients. The ratio of thickness of the Haller's layer to the SFCT was higher in the PCV group (0.83 ± 0.07) than the nAMD group (0.7 5± 0.11) ( P < .01). The mean diameter of subfoveal large choroidal vessels was greater in PCV patients (163.55 μm ± 62.23 μm vs. 112.81 ± 58.87 μm) ( P < .01). CONCLUSION: Choroidal thickening and dilation of large choroidal vessels were commonly seen in PCV patients, supporting that PCV belongs to the pachychoroid spectrum disorders and might be a different entity from nAMD. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:e114–e121.]
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