Purpose: Compare the effect of Combination therapy (PDT+Anti-VEGF) and Anti-VEGF monotherapy on choroidal
vascularity indices and morphological parameters in Polypoidal Choroidal Vasculopathy (PCV).
Methods: Retrospective, cohort study involving 33eyes with a diagnosis of PCV and had visible sclerochoroidal
boundary on enhanced depth imaging. Cases were treated either with combination (n=17) or Anti-VEGF monotherapy
(n=16). Demographic details, visual acuity assessment, OCT analysis was considered from baseline to the 3rd and 6th
month follow-up visits. Choroidal vascularity analysis including choroidal thickness, Total Choroidal Surface Area
(TCSA), Total Stromal area (TSA), Total Luminal Area (TLA) and Choroidal Vascularity Index (CVI) assessment were done
with ImageJ software using the technique of image binarization.
Results: Disease activity was significantly higher in the Anti-VEGF monotherapy arm compared to the combination
therapy arm both at 3 and 6 months. When compared to baseline values, there was statistically significant decrease in
choroidal thickness, Double layer sign (DLS) width, TCSA, TSA and TLA (P<0.05) in the combination therapy arm.
Whereas, Anti-VEGF monotherapy arm showed an increase in the mean sub foveal choroidal thickness and DLS width at
both visits. Complete collapse of PED, reduction in DLS width which was achieved only in combination therapy arm
showed significant positive correlation with the resolution of the disease. CVI did not show a statistically significant
reduction in both the arms.
Conclusion: In view of better outer retinal and choroidal morphological changes and vascular remodelling, our study
strongly supports the superiority of combination therapy over Anti-VEGF monotherapy in PCV
Subfoveal choroidal thickness in polypoidal choroidal vasculopathy after switching to intravitreal aflibercept injection
