Six-Year Real-World Outcomes of Antivascular Endothelial Growth Factor Monotherapy and Combination Therapy for Various Subtypes of Polypoidal Choroidal Vasculopathy

Abstract

The purpose of this study was to compare 6-year visual outcomes of antivascular endothelial growth factor (anti-VEGF) monotherapy and initial combination therapy of photodynamic therapy (PDT) and anti-VEGF therapy for polypoidal choroidal vasculopathy (PCV) in a Chinese population and to investigate imaging biomarkers associated with visual outcomes. Forty-eight treatment-naive PCV eyes of 46 patients were reviewed retrospectively, which underwent anti-VEGF monotherapy or initial combination therapy. PCV was classified into 2 subtypes. Mean best-corrected visual acuity (BCVA) using logarithm of minimal angle resolution and imaging morphological features was compared. No significant differences of mean BCVA changes were noticed between anti-VEGF monotherapy and combination therapy in either subtype 1 PCV or subtype 2 PCV during 6-year period (all P values >0.05). Compared with BCVA at baseline, the mean BCVA at 72 months deteriorated significantly in eyes with subtype 1 PCV (P<0.001), while the mean BCVA at 72 months remained stable in eyes with subtype 2 PCV (P=0.941). In subtype 2 PCV eyes with continuous retina pigment epithelium, the mean changes of BCVA in eyes treated with anti-VEGF monotherapy were better than those in eyes treated with combination therapy (P=0.020). Anti-VEGF monotherapy and combination therapy for various subtypes of PCV had comparable long-term visual outcomes in most cases in real world. Imaging biomarkers which correlate with visual outcomes and treatment response should be included in the classification of PCV and validated in real world.

How do polypoidal choroidal vasculopathy patients fare long term - A real world data

“…The deterioration of visual acuity at the end of five years was significantly more in eyes with poor baseline vision <o.60 log MAR (<0.001) and type 1 PCV compared to type 2(<0.001). Our results were similar to another study by Jingyuan Yang et al 5 who also reported a better outcome in type 2 PCV at 1 year.…”

“…Long-term outcomes of various management options in real world have been reported. 5 Our present study aims to know the biomarkers predicting the long-term outcomes of PCV in Indian population and evaluate various factors that correlate with better visual outcomes in PCV patients.…”

Evaluation of the First-Dose Anti-VEGF Anatomical Response in Polypoidal Choroidal Vasculopathy Patients: Correlation with the Third-Dose Response and Risk Factor Analysis

“…Of the risk factors for good first-dose anatomical response to anti-VEGF therapy in non-pachy-PCV patients, higher CMT reflects retinal edema, morphological abnormalities in the PED indicate the activeness of the PL, and a high percentage of IRF possibly indicates that anti-VEGF drugs promote the alleviation of macular edema. Previous studies showed that other OCT features, such as PED height [20], SFCT [21,22], and continuous RPE [23], are potential risk factors for the anti-VEGF response to PCV, which was partially consistent with our study. During follow-up of patients, CMT showed a significant decrease from baseline at all periods of follow-up (V1-V6) in the good first-dose anatomical response group, whereas the poor first-dose anatomical response group showed significant improvements at only a few periods.…”

“…Of the risk factors for good first-dose anatomical response to anti-VEGF therapy in non-pachy-PCV patients, higher CMT reflects retinal edema, morphological abnormalities in the PED indicate the activeness of the PL, and a high percentage of IRF possibly indicates that anti-VEGF drugs promote the alleviation of macular edema. Previous studies showed that other OCT features, such as PED height [20], SFCT [21, 22], and continuous RPE [23], are potential risk factors for the anti-VEGF response to PCV, which was partially consistent with our study.…”

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

“…For anti-VEGF monotherapy, the PLANET study showed good visual and functional response in > 85% of treated patients, with few number of patients requiring adjunct PDT. In a real-world study, anti-VEGF monotherapy and combination therapy had comparable long-term visual outcomes after a follow-up of 6 years 36 . Another study reported comparable visual outcome, but fewer intravitreal injections and longer time of recurrence in the combination group 31 .…”