Five-year real-world outcomes of anti-vascular endothelial growth factor monotherapy versus combination therapy for polypoidal choroidal vasculopathy in a Chinese population: a retrospective study

Abstract

BackgroundTo evaluate 5-year outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy and combination therapy of anti-VEGF agents and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) in a real-world Chinese population.MethodsRetrospective study. Fifty-three eyes of 46 patients with subtype 1 and 2 PCV followed up for at least 60 months were grouped into three regimens: anti-VEGF monotherapy, PDT combining with anti-VEGF therapy initially, and PDT combining with deferred anti-VEGF therapy. Main outcome measure was best-corrected visual acuity (BCVA) using logarithm of minimal angle of resolution (logMAR).ResultsThe mean BCVA of eyes with subtype 1 PCV (n = 28) deteriorated from 0.69 logMAR at baseline to 1.25 logMAR at months 60 (P = 0.001), while the mean BCVA of eyes with subtype 2 PCV (n = 25) sustained stable from 0.62 logMAR at baseline to 0.57 at months 60 (P = 0.654). No significant differences of visual outcomes were found between the 3 treatment regimens for subtype 1 PCV. Anti-VEGF monotherapy and initial combination treatment had better visual outcomes in eyes with subtype 2 PCV than deferred combination group during part of follow-up significantly. Initial combination group needed a less number of PDT than deferred combination group (P < 0.001).ConclusionsCompared with subtype 1 PCV, subtype 2 PCV has a more favorable visual outcome in real world. All the regimens presented unfavorable visual outcomes for subtype 1 PCV. Anti-VEGF monotherapy and initial combination therapy should be superior to deferred combination therapy in the long-term management of subtype 2 PCV. Prospective randomized studies of larger size are needed to determine the long-term efficacy and safety of various treatment for PCV in real world.

Five-year outcomes of photodynamic therapy combined with intravitreal injection of ranibizumab or aflibercept for polypoidal choroidal vasculopathy

“…Several studies reported long-term results of the combination therapy involving PDT and anti-VEGF agents for PCV. [13,16,17] Miyata et al reported 5-year results after combination therapy involving PDT and intravitreal injection of ranibizumab for 20 eyes with PCV. In their report, BCVA significantly improved at 1 year, but thereafter BCVA declined and returned to baseline value at 5 year.…”

Association Between the Degree of Inclusion of Components Identified on Fluorescein or Indocyanine Green Angiography in Target Spots and Relapse of Exudate in Eyes with Polypoidal Choroidal Vasculopathy and Typical Age-Related Macular Degeneration After Photodynamic Therapy

“…The presence of feeder vessels per se defined that the subject had type 1 PCV; therefore, our findings indicated differences in outcome between type 1 PCV and type 2 PCV, in agreement with existing reports. 28 , 29 However, the use of margins ≥500 μm tended to yield better outcomes than using margins <500 μm. Moreover, a similar tendency was observed for classic lesions and occult lesions on FA.…”

Systemic Risk Factors for Vitreous Hemorrhage Secondary to Polypoidal Choroidal Vasculopathy

“…The relevance of our study on systemic risk factors for VH in patients with PCV lies in the suggestion that patients with PCV with high WBC and impaired coagulation function should pay more attention to the probability of VH. With the help of our nomogram, high-risk patients with PCV should actively cooperate with ophthalmologists in adhering to a treatment plan before the occurrence of VH, such as prompt anti-vascular endothelial growth factor (VEGF) therapy or combined therapy, with the aim to effectively limit the progression of PCV [ 22 – 25 ].…”