Comparative Assessment of Photodynamic Therapy for Typical Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A Multicenter Study in Hyogo Prefecture, Japan

Abstract

Purpose: We aimed to evaluate the effects of photodynamic therapy (PDT) on different phenotypes of age-related macular degenerations (AMD): typical AMD (tAMD) and polypoidal choroidal vasculopathy (PCV). Procedures: 246 eyes from 242 patients (tAMD: 139, PCV: 107 eyes) were recruited. Gender, age, best-corrected visual acuity (BCVA) before treatment, greatest linear dimension before treatment, lesion phenotype and PDT frequency were evaluated for predicting the BCVA at 12 months after PDT using stepwise multiple regression analyses. Additionally, 125 eyes with tAMD and 97 eyes with PCV followed up for more than 12 months after the final PDT were compared for the recurrence period. Results: In the stepwise analysis, a younger age, better pretreatment BCVA, lower PDT frequency, lesions with PCV and a smaller pretreatment greatest linear dimension were all significantly beneficial for a better BCVA at 12 months after PDT. PCV showed a significantly lower PDT frequency and greater improvement in the BCVA than tAMD. The recurrence period of PCV was significantly later than that of tAMD. Conclusions: The phenotype of AMD is significantly correlated with its prognosis after PDT. PCV showed a significantly better response to PDT in terms of BCVA improvement and effect durability.

Polypoidal choroidal vasculopathy: an angiographic discussion

“…Most studies quoted 1-year avoidance of moderate visual loss of more than 80% and three-line visual improvement of 25-55%. The response of PCV to PDT is significantly better than CNV in both visual acuity 27 and electrophysiology outcome, 28 especially among cases presenting with serous PED. 29 However, clinical experience suggests that a subgroup of PCV patients respond poorly to verteporfin PDT monotherapy.…”

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

“…PCV is often found in the extramacular area, whereas tAMD always exists within the macular area [7,8]. In addition, the natural course and response to treatment are often different between tAMD and PCV [9,10,11,12,13,14,15,16,17]. Moreover, recent genetic studies suggested a possible difference in the genetic background between tAMD and PCV [18,19,20,21,22,23,24,25], as well as the existence of heterogeneity among PCV cases [26,27].…”

Positive Association of Complement Factor H Gene Variants with the Effect of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

“…However, they failed to demonstrate an association of the Y402H variants in CFH with the lesion size in AMD or PCV [32]. Therefore, the initial lesion size, which may influence the response to PDT [8], was unlikely to be responsible for the outcome of PDT associated with the CFH variants. In fact, we did not find any difference in the initial GLD between PDT responders and non-responders in the present study.…”

“…PCV is known to have a better response to photodynamic therapy (PDT) than typical neovascular AMD, but the reason for this is not understood [7,8]. Moreover, there is some heterogeneity in the response to PDT among PCV patients [8,9].…”

“…Moreover, there is some heterogeneity in the response to PDT among PCV patients [8,9]. Recently, genetic variants in the complement factor H (CFH) gene on chromosome 1q32 have been tested to explain the response to PDT [10][11][12][13][14].…”