scholarly journals Combination of half-dose photodynamic therapy and anti-VEGF versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy

2021 ◽  
Vol 3 (3) ◽  
pp. 81-91
Author(s):  
Jun Yong Chow ◽  
Poh Fong She ◽  
Mae-Lynn Catherine Bastion ◽  
Wan Norliza Binti Wan Muda
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Post Treatment ◽  
Secondary Outcome ◽  
Combination Group ◽  
Monotherapy Group ◽  
Intravitreal Ranibizumab ◽  
Anti Vegf ◽  
Half Dose ◽  
Choroidal Vasculopathy

Introduction: Polypoidal choroidal vasculopathy (PCV) is an abnormality of the inner choroidal vasculature. The recommended treatment for PCV is a combination of standard verteporfin photodynamic therapy (PDT) with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). There have been reports ofsuccess with combination of half-dose PDT (hd-PDT) and anti-VEGF in the treatment of PCV. hd-PDT might be a cost-effective method with favourable outcome in the treatment of PCV and fewer side effects.Purpose: To explore the efficacy of hd-PDT combined with anti-VEGF and anti-VEGF monotherapy in PCV.Study design: Retrospective nonrandomized comparative study.Material and methods: We conducted a retrospective nonrandomized comparative records review of all patients with PCV received a combination of hd-PDT and anti-VEGF vs anti-VEGF monotherapy from November 2017 to November 2019 at Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Patients received a half-dose of verteporfin over 10 minutes and were irradiated by the standard fluence combined with intravitreal ranibizumab or aflibercept injections. The monotherapy group received either intravitreal ranibizumab or aflibercept. Primary outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 6 months post-treatment. Secondary outcome measure was documentation of sideeffects.Results: The study included a total of 16 patients, with 8 patients (8 eyes) in the combination group and 8 patients (10 eyes) in the monotherapy group. At 6 months post-treatment, the BCVA changes in logarithm of the minimum angle of resolution (logMAR) were -0.06 in the combination group and +0.02 in the monotherapy group (p = 0.928). The average CST reduction was 51.6 μm in the combination group and 106.1 μm in the monotherapy group (p = 0.214). One eye developed subretinal haemorrhage after hd-PDT and one eye developed retinal atrophy in the monotherapy group.Conclusion: hd-PDT combined with anti-VEGF was able to produce similar functional outcomes in terms of BCVA when compared to anti-VEGF monotherapy. However, monotherapy is shown to be superior to combination treatment for anatomical improvement.

scholarly journals Visual Parameters and Retinal Morphology for Polypoidal Choroidal Vasculopathy Pre- and Post-Intravitreal Ranibizumab with or without Photodynamic Therapy: A Short-Term Prospective Study

2021 ◽  
Vol 18 (5) ◽  
pp. 2581
Author(s):  
Rituparna Ghoshal ◽  
Sharanjeet Sharanjeet-Kaur ◽  
Norliza Mohamad Fadzil ◽  
Somnath Ghosh ◽  
Nor Fariza Ngah ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Prospective Study ◽  
Polypoidal Choroidal Vasculopathy ◽  
Reading Speed ◽  
Pigment Epithelium ◽  
Post Treatment ◽  
Base Line ◽  
Intravitreal Ranibizumab ◽  
Pre Treatment ◽  
Choroidal Vasculopathy

The objective of this study was to compare visual parameters and retinal layers’ morphology pre-treatment (baseline) and 6 months post-treatment in polypoidal choroidal vasculopathy (PCV) eyes. A single centre, longitudinal, prospective study was conducted at a public tertiary hospital of Malaysia. Visual parameters including distance and near visual acuity (DVA and NVA), contrast sensitivity (CS), reading speed (RS), and different qualitative and quantitative optical coherence tomography (OCT) parameters were evaluated pre- and 6 months post-treatment. Thirty-three naïve PCV eyes of 32 patients (mean age of 67.62 years) were evaluated pre- and post-treatment of intravitreal ranibizumab with and without photodynamic therapy. After treatment, sub retinal fluid decreased from 27 eyes (84.35%) at baseline to 7 eyes (21.88%) at 6 months while pigment epithelium detachment decreased from 32 eyes (100%) at base line to 15 eyes (46.87%) at 6 months. Mean pre-treatment quantitative morphological OCT retinal parameters including thickness and volume of central sub field, center thickness, center minimum, and maximum thickness reduced significantly. Similarly, all visual parameters including DVA, NVA, CS, and RS showed statistically significant improvement. While 89% of the eyes showed improvement in CS, 78%, 71%, and 65% of the eyes showed improvement in NVA, RS, and DVA, respectively. Thus, CS was the most treatment responsive visual parameter.

scholarly journals Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy

2018 ◽  
Vol 103 (5) ◽  
pp. 617-622 ◽  
Author(s):  
Manabu Miyata ◽  
Sotaro Ooto ◽  
Kenji Yamashiro ◽  
Hiroshi Tamura ◽  
Masayuki Hata ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Fundus Photography ◽  
Combination Group ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Choroidal Vasculopathy

Background/aimsTo evaluate the 5-year visual and anatomical outcomes after anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy (PDT), followed by pro re nata (PRN) anti-VEGF therapy with or without PDT, for polypoidal choroidal vasculopathy (PCV).MethodsThis retrospective, observational study included 61 consecutive patients with treatment-naïve symptomatic PCV who were followed for 5 years. Twenty eyes (20 patients) initially received PDT and intravitreal injection of ranibizumab (IVR), followed by a PRN regimen of anti-VEGF therapy with or without PDT (combination group), while 41 eyes (41 patients) initially received only IVR every 3 months, followed by a PRN regimen of anti-VEGF monotherapy (IVR group). Macular atrophy including the fovea was confirmed using colour fundus photography and spectral-domain optical coherence tomography.ResultsIn both groups, the visual acuity (VA) at 1 year was better than the baseline VA, whereas the 3-year, 4-year and 5-year VA values were similar to the baseline VA. There was no significant difference in the 5-year VA, 5-year central retinal thickness and incidence of macular atrophy between the two groups (p=0.63, 0.72 and 0.06, respectively). In the combination group, the 5-year VA was correlated with the 5-year incidence of macular atrophy (p=0.02, r=0.51).ConclusionsA PRN regimen for PCV may have a limited effect for the long-term maintenance of improved VA. Macular atrophy may occur more frequently with combination therapy and is possibly associated with the 5-year VA. Thus, combination therapy should be carefully selected for patients susceptible to macular atrophy.

scholarly journals One-Year Outcome of Aflibercept and Photodynamic Therapy in a Caucasian Patient with Polypoidal Choroidal Vasculopathy Refractory to Ranibizumab and Photodynamic Therapy

2018 ◽  
Vol 9 (1) ◽  
pp. 172-178 ◽  
Author(s):  
Marta Medina-Baena ◽  
María Jesús Huertos-Carrillo ◽  
Laura Rodríguez ◽  
Juan Ignacio García-Pulido ◽  
Carlos Cornejo-Castillo ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Age Related Macular Degeneration ◽  
Vascular Lesions ◽  
Caucasian Woman ◽  
Intravitreal Ranibizumab ◽  
Asian Populations ◽  
Anti Vegf ◽  
Age Related ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration characterised by an abnormal branching vascular network with aneurysmal polypoidal choroidal vascular lesions. PCV is more prevalent in Asian populations than in Caucasians, which may explain its underdiagnosis in Western countries. Evidence regarding the efficacy of different anti-vascular endothelial growth factor (anti-VEGF) agents on PCV is scarce, with most of these studies being conducted in Asian treatment-naïve patients. Ranibizumab was the first anti-VEGF agent to demonstrate the superiority of a combination of photodynamic therapy (PDT) and anti-VEGF over PDT or anti-VEGF monotherapy for inducing polyp regression in Asian patients with PCV. The efficacy of other anti-VEGF agents has been less studied. Resistance to ranibizumab has been described. Aflibercept offers another mechanism of targeting choroidal neovascular lesions. A 75-year-old Caucasian woman presenting to our office was diagnosed with PCV using indocyanine green angiography. Combination therapy with a loading dose of 0.5 mg intravitreal ranibizumab followed by PDT at standard fluence at month 4 and a fourth dose of ranibizumab at month 5 yielded no visual or anatomic outcomes. Treatment was switched to intravitreal aflibercept at month 6 (3 monthly loading doses of 2.0 mg) followed by half-fluence PDT (month 9). Optical coherence tomography revealed remission of the anatomic lesions. Right-eye visual acuity increased to 0.6. Aflibercept injections were administered bimonthly afterwards. Follow-up during 1 year has shown functional and anatomic stability.

scholarly journals Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sheng-Chu Chi ◽  
Yi-No Kang ◽  
Yi-Ming Huang
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Evaluation Methodology ◽  
Combination Group ◽  
Anti Vegf ◽  
Searching Strategy ◽  
Early Combination Therapy ◽  
Choroidal Vasculopathy

AbstractPolypoidal choroidal vasculopathy (PCV) is a vision-threatening disease common in Asian populations. However, the optimal treatment for PCV remains under debate. We searched the databases with optimal searching strategy. The study included randomized clinical trials and prospective studies that recruited patients with active PCV who had received interventions, including PDT, anti-VEGF, or a combination of PDT and anti-VEGF. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used for rating the quality of evidence. Our study included 11 studies involving 1277 patients. The network meta-analysis of RCTs revealed the anti-VEGF group, early combination group, and late combination group had significant BCVA changes compared with the PDT group. Early combination therapy led to a significant decrease in CRT compared with PDT, anti-VEGF, and late combination therapy. Additionally, the early combination group had a significantly higher complete polyp regression rate than the anti-VEGF group. No significant differences were detected in the analysis of the number of anti-VEGF injections and safety profile. This network meta-analysis revealed that early combination therapy exhibited better efficacy related to anatomical outcomes than other therapies. Nonetheless, no significant differences related to BCVA change could be detected between anti-VEGF and late combination therapy.

INTRAVITREAL RANIBIZUMAB COMBINED WITH VERTEPORFIN PHOTODYNAMIC THERAPY FOR TREATING POLYPOIDAL CHOROIDAL VASCULOPATHY

Retina ◽  
2011 ◽  
Vol 31 (7) ◽  
pp. 1287-1293 ◽  
Author(s):  
Yeon Hee Lee ◽  
Eun-Kyoung Lee ◽  
Kyung Sup Shin ◽  
Kyung-Mu Lee ◽  
Jung Yeul Kim
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Intravitreal Ranibizumab ◽  
Choroidal Vasculopathy

Stereotactic Radiotherapy for Polypoidal Choroidal Vasculopathy: A Pilot Study

2014 ◽  
Vol 233 (2) ◽  
pp. 82-88 ◽  
Author(s):  
Ugo Introini ◽  
Giuseppe Casalino ◽  
Giacinto Triolo ◽  
Denis O''Shaughnessy ◽  
E. Mark Shusterman ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stereotactic Radiotherapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Low Voltage ◽  
Secondary Outcome ◽  
Intravitreal Ranibizumab ◽  
Foveal Thickness ◽  
X Ray ◽  
The Mean ◽  
Choroidal Vasculopathy

Purpose: To evaluate low-voltage X-ray stereotactic radiotherapy (SRT) delivered in conjunction with intravitreal ranibizumab for the treatment of active macular polypoidal choroidal vasculopathy (PCV). Methods: At baseline, all eyes received an intravitreal injection of ranibizumab, followed by 16-Gy X-ray SRT to the macula. Further ranibizumab injections were given pro re nata. The primary outcome measure was regression of the polyps assessed by indocyanine green angiography. Secondary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) changes on optical coherence tomography. Local or systemic adverse events were evaluated as well. Results: We examined 12 eyes of 12 patients with PCV. At month 12, an angiographic regression of the polyps was observed in 10 of the 12 eyes. The mean BCVA improved by 7.6 letters: from 65.08 ± 11.4 to 72.7 ± 14.75 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The mean CFT decreased from 372.3 ± 79.6 to 215.9 ± 57.9 µm (p < 0.01). No local or systemic adverse events were reported. Conclusions: The preliminary data support the safety of low-voltage X-ray SRT for the treatment of macular PCV and show polyp closure, reduction in CFT and improvement in the mean BCVA. Additional research is warranted to confirm the efficacy and longer-term safety of this therapy in this population.

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