Comparing efficacy of reduced-fluence and standard-fluence photodynamic therapy in the treatment of polypoidal choroidal vasculopathy

Abstract

Background: The EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV). The optimal PDT protocol remains controversial and it is postulated that less intensive PDT strategies may reduce complications. We aimed to compare the efficacy of reduced and standard-fluence PDT. Methods: Case-control review of 38 consecutive PDT-naïve macular PCV patients who underwent verteporfin PDT using one of two PDT regimens at a tertiary referral centre in an Asian population. Comparison of outcomes between standard-fluence PDT (light dose, 50 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 83 s) and reduced-fluence PDT (light dose, 25 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 42 s). Primary outcome measure was best corrected LogMAR visual acuity (VA). Secondary outcome measures included OCT measurements such as central retinal thickness (CRT), height of subfoveal sub-retinal fluid (SRF), central choroid thickness (CCT), mean number of PDT treatments needed, mean number of anti-VEGF injections needed, polyp closure and recurrence rates. Results: Of these 38 eyes of 38 patients, an equal number of eyes (19 in each arm) were treated with standardfluence and reduced-fluence PDT. Mean letter gain at 12 months for the standard-fluence group was 6.0 compared to 4.3 letters for the reduced-fluence group (p = 0.61). Similar results were observed at all time points. There was no statistically significant difference between the retinal and choroidal anatomical OCT outcomes, rates of polyp closure and recurrences between the two PDT regimens. Conclusions: Reduced-fluence PDT was comparable to standard-fluence PDT in the treatment of PCV in terms of visual gains, clinical and anatomical OCT outcomes.

Efficacy of Initial vs. Delayed Photodynamic Therapy in Combination With Conbercept for Polypoidal Choroidal Vasculopathy

“…PDT can reduce the thickness of the macula in the early stage of treatment, although it has been reported to result in sight threatening complications such as subretinal, vitreous and suprachoroidal hemorrhage, as well as tears and rips of the RPE. While a recently study showed none of the patients in either the standard-fluence PDT group nor the reduced-fluence PDT group suffered from any major complication, and the effect in each group was comparable ( 12 ). On the other hand, the intravitreal injection of anti-VEGF agents can significantly improve vision in the long term.…”

Multicentre, randomised clinical trial comparing intravitreal aflibercept monotherapy versus aflibercept combined with reduced-fluence photodynamic therapy (RF-PDT) for the treatment of polypoidal choroidal vasculopathy

“…20 29 30 A recent case-control review comparing reduced and standard fluence PDT in 38 patients with macular PCV showed a comparable visual gain and anatomical outcome with a polyp closure rate of 77.8% in the RF-PDT group. 30 Although the effects of RF-PDT have been studied in context of PCV, the evidence comes from small sampled cases series and this study will give us the opportunity to evaluate the effect of RF-PDT more formally in a clinical trial setting.…”

Clinical features and outcomes of breakthrough vitreous hemorrhage secondary to polypoidal choroidal vasculopathy

“…However, hemorrhagic complications after PDT or anti-VEGF injection are not uncommon. The incidence of hemorrhagic complications such as subretinal hemorrhage or breakthrough VH are reported to range from 0% to 33% after PDT monotherapy and 0.6% to 23% after combination therapy of PDT and anti-VEGF injections [6,[13][14][15][16][17][18][19][20][21][22][23]. Hirami et al suggested that laser irradiation during PDT may occlude choroidal vessels,…”