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Gustavo S. Figueiredo, Alexandros-Athanasios Stangos, Yalin Zheng, Michael C. Briggs, Simon P. Harding, Jayashree Sahni; Combined Ranibizumab And Photodynamic Therapy For Late-diagnosis Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2060. doi: https://doi.org/.
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Neovascular age-related macular degeneration (nAMD) refractory to VEGF inhibitors can be associated with polypoidal choroidal vasculopathy (PCV). Photodynamic therapy (PDT) adjunction could be beneficial. We report 12-month anatomical and functional outcomes in patients with nAMD attributed to PCV, treated with combination photodynamic therapy and anti-VEGF treatment following failed anti-VEGF monotherapy.
Retrospective cohort study of patients diagnosed with PCV in the period May 2009 to Sept 2010 following failed anti-VEGF treatment for nAMD in a tertiary medical retina service in the UK.
Eyes refractory to anti-VEGF were evaluated with indocyanin green angiography (ICGA) and were noted to have PCV. We identified 11 patients for this study; 5 were previously diagnosed with fibrovascular pigment epithelial detachment, 2 with a retinal angiomatous proliferation, 4 with occult/minimally classic neovascular membranes. Mean number of intravitreal injections prior to the diagnosis of PCV was 12.4 (SD 3.91, range 4-18). Mean time to diagnosis was 33.0 months (SD 17.3, range 14-80). Mean visual acuity (VA) at diagnosis was 55.5 letters (SD 15.9, range 27-80), and central foveal thickness (CFT) was 410.4 (SD 224.1, range 195-948). Nine lesions were extrafoveal and 2 were juxtafoveal; 10 occurred in clusters, 5 of which had associated branching vascular networks on ICGA. Patients had received a mean of 1.5 courses of PDT combined with 3.2 ranibizumab injections at 6 months; and 1.9 courses of PDT and 4.3 ranibizumab injections at 12 months. Compared with baseline there was no statistically significant change in terms of VA (p=0.74) or CFT (p=0.077) at 6 months or at 12 months for VA (p=0.539) and for CFT (p=0.863). On ICGA at 6 months, 3 patients had responded to treatment whilst 4 did not; of these 7 patients, 4 patients developed new polyps. A further 4 patients did not have ICGA at 6 months. At 12 months, 3 had responded, and 2 had new polyps, 6 did not have ICGA at 12 months.
Combined photodynamic therapy and intravitreal ranibizumab in patients newly-diagnosed with PCV who were refractory to anti-VEGF treatment appears to stabilise vision and CFT. However, it appears as if when one polypoidal lesion closes on ICGA, further lesions develop.
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