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

Abstract

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.

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

“…Matumiya et al [ 21 ] demonstrated outcomes of initial three IAI with PDT, and Kikushima et al [ 23 ] demonstrated the comparison of initial three IAI versus one IAI with PDT. Ho et al [ 24 ] reported triple therapy with IAI, PDT, and subtenon steroid injection. To the best of our knowledge, it is the first report of the comparison of three IAI versus three IAI with PDT.…”

“…Intravitreal aflibercept injection (IAI) improves both visual acuity and retinal morphology in eyes with PCV, similar to other anti-VEGFs [ 18 – 20 ]. Recently, combination therapy of IAIs and PDT or triple therapy of IAI [ 21 – 23 ], PDT, and dexamethasone [ 24 ] have been reported to have preferable outcomes; however, to the best of our knowledge, studies which compare the outcomes of this combination therapy with or without PDT have not been previously reported. Therefore, the objective of this study was to compare the 1-year outcomes of IAI treatment with or without initial PDT for PCV.…”

Polypoidal choroidal vasculopathy treatment options: A meta‐analysis

“…Intraocular inflammatory cytokines are likely to be elevated in PCV eyes, especially in the presence of subretinal haemorrhage or macular oedema . Ho et al reported that the majority of patients responded well to corticosteroid treatment, with significant responses observed as early as 1 week after initiation of triple therapy including photodynamic therapy, intravitreal aflibercept, and intravitreal dexamethasone. Liang et al also evaluated the efficacy and adverse effects of treatment with low‐dose intravitreal triamcinolone acetonide (IVTA).…”

Choroidal Neovascularization: Mechanisms of Endothelial Dysfunction

“…Photodynamic therapy could cause secondary subretinal hemorrhage, retinal pigmented epithelium tears, and choroidal ischemia, resulting in further visual deficit (Lai et al, 2004; Lee et al, 2008; Teo et al, 2018). Administration of photodynamic therapy may also exacerbate existing intraocular inflammation in PCV (Ho et al, 2016). Secondly, photodynamic therapy does not entirely occlude the branching vascular network in PCV eyes, allowing new active polyps to emerge from persistent networks and hence triggering disease recurrence (Akaza et al, 2007; Lee et al, 2008).…”

“…Despite the rising prevalence of this debilitating condition, current treatment strategies for wet AMD mostly revolve around inhibitors of vascular endothelial growth factor and photodynamic therapy. Both have considerable limitations such as lack of long-term improvement on visual acuity (Rofagha et al, 2013; Fernández-Robredo et al, 2014; Bracha et al, 2017; Dunn et al, 2017; Jaffe et al, 2017; Malek et al, 2018) and secondary inflammatory side effects (Ho et al, 2016). These bring to light the necessity for a deeper understanding of the disease (Fernández-Robredo et al, 2014; Bracha et al, 2017; Malek et al, 2018).…”