First Author: K.Takayama JAPAN
Co Author(s): H. Kaneko Y. Ito H. Shimizu A. Suzumura E. Ra H. Terasaki
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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, although any comparison the outcomes of IAI with / without PDT have not been reported. We retrospectively compare the 1-year outcomes of IAI monotherapy and its combination with initial PDT for PCV.
This retrospective chart review was conducted at Nagoya University Hospital in Nagoya, Japan. Consecutive patients with naïve subfoveal PCV between December 2012 and December 2014 and were able to complete follow-up visits arranged at 1-month intervals for a 12-month observation period were enrolled in the study.
Consecutive patients, who visited the hospital from December 2013 to December 2014, received three initial monthly IAIs and a single PDT session 3 days after the first IAI, followed by as needed treatment regimen (Combination group). Consecutive patients, who visited the hospital from December 2012 to December 2013, also received three initial monthly IAIs, followed by as needed treatment regimen (IAI group). Retreatment criteria of disease activity according to the parameters recommended in the PRONTO study. In every month follow-up visit, visual acuity, central retinal thickness (CRT), and central choroidal thickness (CCT) were measured and compared. The numbers of IAIs administered during the 12-month period were compared between the groups
Twelve eyes with naïve PCV received three IAIs and a single PDT after the first IAI and as needed injection (combination group); eleven eyes with naïve PCV received three IAIs and as needed injection (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 3.6 ± 0.9 and 5.0 ± 2.3 injections was administered to the combination and IAI groups, respectively (P = 0.010).
Our results demonstrate that for eyes with PCV, IAI with PDT and IAI monotherapy yielded similar improvements in visual acuity and retinal structure, and the former required fewer injections. We believe that our results demonstrate the efficacy of this combination therapy, although additional studies with longer observation periods are needed for confirmation.