Comparison of visual outcomes between therapy choices and subtypes of polypoidal choroidal vasculopathy (PCV) in Taiwan: a real-world study

Abstract

Polypoidal choroidal vasculopathy (PCV) is a distinctive type of neovascular age-related macular degeneration prevalent in many Asian countries. However, there is still some controversy in how the subtypes of PCV are classified. This post-hoc study redefined the branching vascular network (BVN) and PCV subtypes through retrospective review of indocyanine green angiography (ICGA) and fluorescein angiography images from two observational studies (RENOWNED/REAL). Of the visual outcomes for each angiographic subtype and treatment pattern investigated, BVN was identified in 56.3% of PCV patients. The proportions and features of the re-defined PCV subtypes were 43.8%, 10.4%, and 45.8% for subtype A (without distinctive features of BVN), B (with BVN but no leakage), and C (with BVN and leakage), respectively. Subtype A had better visual outcomes when compared to subtype C. This possibly resulted from a better baseline visual acuity in subtype A. Moreover, combination therapy [photodynamic therapy plus anti-vascular endothelial growth factor (VEGF)] may lead to better visual improvement than mono-anti-VEGF treatment alone. This study provides the prevalence of PCV subtypes in Taiwan and may serve as a reference for PCV treatment strategies in a real-world setting, especially for the combination therapy and patients without distinctive features of BVN.

Real world experience of the treatment outcome between photodynamic therapy combined with ranibizumab and aflibercept monotherapy in polypoidal choroidal vasculopathy

“…Therefore, non-pachychoroid patients may be more vulnerable. The effects of combination therapy are well documented, and numerous different combination regimens have been proposed 8 , 14 , 16 – 21 , 35 . In the EVEREST II study, the PDT combination group showed greater improvement in VA and regression of polypoidal lesions than the IVR monotherapy group.…”

“…In our study, after the initial treatment (i.e., one PDT session plus two monthly IVR injections and three monthly IVA injections, respectively), further administration of drug was performed on a pro re nata basis. Given the National Health Insurance reimbursement plan and the compliance of patients, the overall number of injections was low, and this effect has been observed in almost all real-world treatment studies in Taiwan 21 , 44 . This could have affected the final VA of the cohort to a certain extent.…”

“…Treatment with anti-VEGF therapy alone is effective in reducing the fluid from PCV lesions and improving visual acuity (VA); however, it is less efficient against polypoidal lesions 13 – 15 . Combination therapy, with two or three combined protocols, has also been suggested by various research groups 8 , 14 , 16 – 21 . The EVEREST II study revealed a higher rate of polyp regression at 6 months post treatment with PDT combined with injection of ranibizumab 22 .…”

“…Despite using VA as a subjective indicator of disease activity, the other disease manifesting foci may be the choroidal thickness and fluid accumulation presented and measured using optical coherence tomography (OCT) in patients with PCV. The effects of choroidal characteristics, such as choroidal hyperpermeability, subfoveal choroidal thickness and the treatment effects with anti-VEGF or with PDT have been discussed extensively 21 , 25 , 26 . Based on these data, we investigated the prognosis of VA in patients receiving various treatments using different OCT biomarkers.…”

Fluid Biomarkers in Optical Coherence Tomography for Visual Outcome in Polypoidal Choroidal Vasculopathy

“…Treatment with anti-VEGF therapy alone is effective in eliminating the fluid from macular area and improving visual acuity; however, it is less effective against closing the polypoidal lesions [ 15 , 16 , 17 ]. Combination therapy, with various combination protocols, has also been suggested by different research groups [ 10 , 16 , 18 , 19 , 20 , 21 , 22 , 23 ]. Our group has also published the visual prognosis between two different treatment protocols, with similar outcomes.…”