Abstract
Purpose: :
To investigate the natural history of polypoidal choroidal vasculopathy(PCV) and the clinical course of photodynamic therapy (PDT) for PCV.
Methods: :
The protocol of this research is conducted in compliance with the "Declaration of Helsinki". This research has been registered as a clinical trial in UMIN Clinical Trials Registry (ID: UMIN000000922). Our study comprised 64 eyes in 64 patients with PCV. The medical records of the patients were retrospectively reviewed. The diagnosis of PCV was based on the findings by indocyanine green angiography and fundus examination. We investigated the natural history before PDT (Group I: 25 eyes of 25 patients) and the effects of PDT (Group II: 39 eyes of 39 patients). Outcome measures were moderate vision loss (a loss of at least 0.3 units of LogMAR) and aggravation of fundus findings, including increase of PCV lesions, appearance of hemorrhage, PED or retinal detachment. The time course was analyzed using Kaplan-Meier life-table analysis and Cox model.
Results: :
In Group I, the cumulative probability of moderate vision loss was 21% through 12 month examination, 39%-18 months and 54%-24 months, respectively. The cumulative probability of fundus finding aggravation was 26%-12 months, 38%-18 months, and 59%-24 months. The fundus finding aggravation was more severe in male (P= 0.035: Log Rank test) and in the eyes with the subfoveal lesions (P=0.020). In Group II, the cumulative probability of moderate vision loss was 21% through 12 month examination, 31%-18 months and 52%-24 months, respectively. The cumulative probability of fundus finding changes was 49%-12 months, 63%-18 months, and 81%-24 months. In Group II, Cox model hazard ratio of moderate vision loss was 3.6 for multiple PCV lesions vs. solitary lesions (P=0.065).
Conclusions: :
In our present study of the PCV eyes in Japanese, the visual acuity decrease and the fundus finding aggravation occurred more than 50% after 2 year follow-up both in the natural history and after the PDT. The relevant factors were male gender, location of lesions and multiple lesions.
Clinical Trial: :
www.umin.ac.jp/ctr/index/htm 000000922
Keywords: age-related macular degeneration • photodynamic therapy • clinical (human) or epidemiologic studies: natural history