Three-year visual outcome of photodynamic therapy plus intravitreal bevacizumab with or without subtenon triamcinolone acetonide injections for polypoidal choroidal vasculopathy

Sakai, Tsutomu; Ohkuma, Yasuhiro; Kohno, Hideo; Hayashi, Takaaki; Watanabe, Akira; Tsuneoka, Hiroshi

doi:10.1136/bjophthalmol-2014-305189

Cited by 13 publications

(6 citation statements)

References 35 publications

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“…Previous studies have demonstrated the efficacy of photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of eyes with PCV [8–12]; in particular, combination therapy can exert synergistic effects on regressing polyps and better maintain visual acuity and retinal morphology when compared with PDT or anti-VEGF monotherapy. In addition, the great advantage of triple combination therapy composed of anti-VEGF injection, PDT, and subtenon steroid injection had been reported [13, 14]. Therefore, combination therapy should be considered as the first-line treatment for eyes with PCV [15, 16].…”

Section: Introductionmentioning

confidence: 99%

Comparison between 1-year outcomes of aflibercept with and without photodynamic therapy for polypoidal choroidal vasculopathy: Retrospective observation study

et al. 2017

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Polypoidal choroidal vasculopathy (PCV) is characterized by polyp-like choroidal neovascularization and a branching vascular network. Intravitreal aflibercept injection (IAI) or photodynamic therapy (PDT) is used for treatment. We retrospectively compared the 1-year outcomes of IAI monotherapy and its combination with initial PDT for PCV. Twelve eyes with naïve PCV received three IAIs and a single PDT after the first IAI and as needed injection (combination group); 11 eyes with naïve PCV received three IAIs and as needed injections (IAI group). Significant improvements in visual acuity after 2 months and in CRT after 1 month were maintained at 12 months in both groups (both P < 0.05); groups did not differ significantly at any time point. CCT significantly reduced after 3 and 12 months in the combination group (both P < 0.05) but not in the IAI group. A mean of 3.7 ± 0.9 and 5.6 ± 2.0 injections was administered to the combination and IAI groups, respectively (P = 0.013). Within a 1-year period, combination therapy was found to yield similar visual acuity and retinal structure improvements and maintenance as IAI monotherapy while requiring fewer IAIs.

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Section: Introductionmentioning

confidence: 99%

Comparison between 1-year outcomes of aflibercept with and without photodynamic therapy for polypoidal choroidal vasculopathy: Retrospective observation study

et al. 2017

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“…We elected to use combination treatment with bevacizumab and PDT to target the type 2 component with anti-VEGF, and PDT to decrease the size and flow and prevent maturation of the extrafoveal, type 1 lesion. Successful combined treatment has been similarly observed in myopic classic CNV [11] and in PCV [3] . Type 1 NV has been shown to be quite extensive on OCTA and may represent a more chronic, mature neovascular complex resistant to repetitive anti-VEGF therapy [9] , [12] .…”

Section: Discussionmentioning

confidence: 77%

“…The discovery of anti-vascular endothelial growth factor (VEGF) has revolutionized the management of nAMD and provided unprecedented gains in visual acuity since their development. Prior to anti-VEGF, photodynamic therapy with Verteporfin (PDT) was used to treat classic CNV (Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) investigations) [2] , and more recently, PDT combined with anti-VEGF treatments including bevacizumab or ranibizumab have been utilized to successfully treat polypoidal choroidal vasculopathy (PCV) [3] and retinal angiomatous proliferation [4] . Although combination treatment remains effective, the immediate and long-term effects of PDT including the extent of choroidal vascular thrombosis and possible collateral choroidal damage has not been clearly imaged.…”

Section: Introductionmentioning

confidence: 99%

Swept-source optical coherence tomography angiography for choroidal neovascularization after bevacizumab and photodynamic therapy

Jung

Chen²,

Chung

et al. 2016

American Journal of Ophthalmology Case Reports

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PurposeTo report the swept-source optical coherence tomography angiography (SS-OCTA) findings after bevacizumab anti-vascular endothelial growth factor (anti-VEGF) and full-fluence photodynamic therapy (PDT) for choroidal neovascularization.DesignCase report.MethodsAn 87-year-old, Chinese male presented with a shadow and decreased vision to 20/160 in his left eye (OS). Clinical examination, color photographs, swept-source optical coherence tomography (SS-OCT), widefield dye-fluorescein angiography (FA) and SS-OCTA revealed an extrafoveal, subretinal choroidal neovascularization (CNV) in the superior macula. Bevacizumab anti-VEGF and full-fluence PDT was initiated.ResultsInitial imaging with conventional color photography and FA demonstrated a classic CNV with significant early hyperfluorescence and late leakage. SS-OCT demonstrated subretinal hyperreflective material, fluid and hemorrhage emanating from a subretinal, type 2 neovascularization (NV). SS-OCTA showed a mixed lesion with a type 2, subretinal component with segmentation above the retinal pigment epithelium (RPE) and a type 1, sub-RPE component below. Treatment with anti-VEGF and PDT led to immediate regression of the CNV. One month after treatment, SS-OCTA demonstrated significant resolution of the type, 2 subretinal component and decreased flow and size of the type 1 sub-RPE lesion.ConclusionWe report the first SS-OCTA images of successfully treated extrafoveal NV after combination PDT and ant-VEGF therapy. Early treatment of extrafoveal NV may improve our ability to treat mixed type 1 and 2 NV before these neovascular complexes mature from repetitive anti-VEGF treatment.

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“…Triple therapy by using PDT, anti-VEGF agents and subtenon steroid therapy has been reported previously. Sakai et al showed that using subtenon steroid injection in addition to combined PDT and anti-VEGF reduced the total number of anti-VEGF injections from a mean of 5.26 to 3.95 in the first year of treatment43. Beneficial results by triple therapy when compared to PDT alone were also shown by Nakata et al in a study of 40 retrospective cases.…”

Section: Discussionmentioning

confidence: 89%

Treatment of polypoidal choroidal vasculopathy by photodynamic therapy, aflibercept and dexamethasone triple therapy

Woo²,

Chan

et al. 2016

Sci Rep

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Polypoidal choroidal vasculopathy is a relatively common type of degenerative macular disease among the Chinese population. This study aims to describe the therapeutic responses to combination therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone in patients with polypoidal choroidal vasculopathy. A prospective series of 17 eyes of 13 patients suffering from treatment-naïve polypoidal choroidal vasculoapathy were recruited. All cases received triple therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone and one year outcomes were reported. The baseline visual acuity was 0.65logMAR +/− 0.38 (Snellen 20/80 to 20/100). The visual acuity at 1 week, 3 months, 6 months and one year after treatment were significantly improved to 0.522logMAR+/− 0.365 (P < 0.04) (Snellen 20/70), 0.363logMAR+/−0.382 (Snellen 20/50;P < 0.001), 0.377logMAR +/− 0.440 (Snellen 20/50;p = 0.005), and 0.35logMAR +/− 0.407 (Snellen 20/40;P < 0.001), respectively. The baseline central foveal thickness (CFT) on optical coherence tomography (OCT) was 394.7 +/− 70.6 μm. CFT at 6 months and 1 year after treatment were significantly reduced to 259 +/− 54 μm (p = 0.004) and 271 +/− 49.7 μm(p = 0.016), respectively. Triple therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone is an effective treatment for polypoidal choroidal vasculopathy. The majority of cases responded well with significant responses observed as early as 1 week after initiation of therapy.

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Three-year visual outcome of photodynamic therapy plus intravitreal bevacizumab with or without subtenon triamcinolone acetonide injections for polypoidal choroidal vasculopathy

Abstract: Initial therapy consisting of a single session of PDT combined with IVB and STTA improves vision in treatment-naive subfoveal PCV. Compared with double therapy, this triple therapy may be more effective for PCV.

Cited by 13 publications

References 35 publications

Comparison between 1-year outcomes of aflibercept with and without photodynamic therapy for polypoidal choroidal vasculopathy: Retrospective observation study

Comparison between 1-year outcomes of aflibercept with and without photodynamic therapy for polypoidal choroidal vasculopathy: Retrospective observation study

Swept-source optical coherence tomography angiography for choroidal neovascularization after bevacizumab and photodynamic therapy

Treatment of polypoidal choroidal vasculopathy by photodynamic therapy, aflibercept and dexamethasone triple therapy

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