CHOROIDAL VASCULARITY INDICES AND COEXISTING MORPHOLOGICAL CHANGES IN POLYPOIDAL CHOROIDAL VASCULOPATHY. A COMPARATIVE ANALYSIS BETWEEN TWO TREATMENT STRATEGIES

Choroidal Thickness ◽

Morphological Changes ◽

Treatment Strategies ◽

Enhanced Depth Imaging ◽

Anti Vegf ◽

Luminal Area ◽

Imagej Software ◽

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

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

Scientific Reports ◽

10.1038/s41598-021-82316-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sheng-Chu Chi ◽

Yi-No Kang ◽

Yi-Ming Huang

Keyword(s):

Combination Therapy ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Evaluation Methodology ◽

Combination Group ◽

Anti Vegf ◽

Searching Strategy ◽

Early Combination Therapy ◽

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.

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

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-311963 ◽

2018 ◽

Vol 103 (5) ◽

pp. 617-622 ◽

Cited By ~ 4

Author(s):

Manabu Miyata ◽

Sotaro Ooto ◽

Kenji Yamashiro ◽

Hiroshi Tamura ◽

Masayuki Hata ◽

...

Keyword(s):

Photodynamic Therapy ◽

Combination Therapy ◽

Fundus Photography ◽

Combination Group ◽

Macular Atrophy ◽

Anti Vegf ◽

Significant Difference ◽

Treatment Naïve ◽

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.

Structural and vascular changes of the choroid in polypoidal choroidal vasculopathy after intravitreal anti-VEGF therapy

Ophthalmologica ◽

10.1159/000521071 ◽

2021 ◽

Author(s):

Daniela Montorio ◽

Mariapaola Giordano ◽

Marina Concilio ◽

Gilda Cennamo

Keyword(s):

Functional Response ◽

Visual Outcome ◽

Predictive Biomarker ◽

Structural Features ◽

Intravitreal Injections ◽

Enhanced Depth Imaging ◽

Control Group ◽

Anti Vegf ◽

Introduction: To identify the changes in vessel density (VD) of choriocapillaris (CC) and in subfoveal choroidal thickness (SFCT) and to evaluate their correlation with functional response after three monthly intravitreal injections of Ranibizumab (loading phase) in patients affected by Polypoidal Choroidal Vasculopathy (PCV). Methods: A total of 30 eyes of 30 PCV patients and 30 eyes of 30 healthy subjects as control group were enrolled in this prospective study. The best corrected visual acuity (BCVA) was measured at baseline and after one month from third intravitreal injections in each patient. The VD of CC was evaluated in macular area by means of Optical Coherence Tomography Angiography (OCTA). Central macular thickness (CMT) and SFCT were analyzed by Enhanced Depth Imaging (EDI)-OCT. Results: The VD of CC showed statistically lower values in PCV patients at baseline respect to after loading phase (LP) and normal eyes (p<0.001). CMT and SFCT revealed a statistically significant reduction after LP (p<0.001). Multiple regression analysis revealed a significant negative correlation between the reduced SFCT, CMT at baseline and the improvement of BCVA after LP (p<0.05). Conclusion: The close relationship between the thinner SFCT and better visual outcome after LP reveals the role of the EDI-OCT assessment of choroid as predictive biomarker of functional response to anti-VEGF therapy. This tool could provide a quantitative evaluation of structural features of choroid avoiding mistakes of evaluation at OCTA.

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-04957-5 ◽

2020 ◽

Author(s):

Marco Pellegrini ◽

Federico Bernabei ◽

Andrea Mercanti ◽

Stefano Sebastiani ◽

Enrico Peiretti ◽

...

Keyword(s):

Macular Degeneration ◽

Choroidal Thickness ◽

Age Related Macular Degeneration ◽

Enhanced Depth Imaging ◽

Vascular Changes ◽

Age Related ◽

Luminal Area ◽

Treatment Naïve ◽

Pharmacologic Effect ◽

Imagej Software

Abstract Introduction The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period. Methods Enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA. Results After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05). Conclusion Choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid.

Cost and Outcomes Analysis of Polypoidal Choroidal Vasculopathy (Aneurysmal Type 1 Neovascularization) Treatment Strategies

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420946599 ◽

2020 ◽

pp. 247412642094659

Author(s):

Paula W. Feng ◽

James Lin ◽

Yoichi Sakurada ◽

Nicolas A. Yannuzzi ◽

William E. Smiddy ◽

...

Keyword(s):

Photodynamic Therapy ◽

Combination Therapy ◽

Treatment Strategies ◽

Cost Utility ◽

Efficacy And Safety ◽

Outcomes Analysis ◽

Life Years ◽

The Cost ◽

Purpose: This work compares the relative cost utility of ranibizumab and aflibercept with and without verteporfin photodynamic therapy (vPDT) for the treatment of polypoidal choroidal vasculopathy. Methods: A retrospective cost and outcomes analysis of the PLANET (Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy) and EVEREST II (Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy) studies was performed. Clinical utilization and outcomes were based on data from these clinical trials, and costs were obtained from Medicare fee schedules. Cost utility was derived from published visual outcomes and expressed as quality-adjusted life-years (QALYs). Cost per QALY and cost per line of vision gained for each treatment strategy (in US dollars) were assessed as the main outcome measure. Results: The 1-year facility (nonfacility) costs per QALY were $295,744.41 ($260,088.19), $209,574.09 ($182,831.77), $211,072.63 ($188,425.33), and $212,275.22 ($189,703.05) for ranibizumab as-needed monotherapy, ranibizumab as-needed with combination therapy, aflibercept monotherapy, and aflibercept with delayed vPDT combination therapy, respectively. Conclusions: Ranibizumab as-needed monotherapy was the least clinically effective and least cost efficient over 1 year. Ranibizumab as-needed with combination therapy, aflibercept monotherapy, and aflibercept with deferred vPDT combination therapy all had similar overall cost utility at 1 year. If bevacizumab were to be substituted for ranibizumab, the cost per QALY could be reduced by approximately a factor of 5, showing the benefit of bevacizumab for increasing the cost utility of polypoidal choroidal vasculopathy treatment.