Photodynamic Therapy Increases Macular Atrophy more than Intravitreal Aflibercept at Two-Year follow-up of Pachychoroid Neovasculopathy

Abstract

Purpose : To compare the therapeutic outcomes of intravitreal aflibercept (IVA) and reduced-fluence photodynamic therapy (RFPDT) for pachychoroid neovasculopathy (PNV) over two years.

Methods : In this single-center retrospective study, 39 eyes with PNV (18 treated with IVA monotherapy and 21 treated with RFPDT monotherapy) were evaluated. Post-treatment changes in the best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and macular atrophy (MA) area were compared.

Results : The IVA group received 8.94±4.77 injections, whereas the PDT group received RFPDT 1.05±0.22 times. Changes in logMAR BCVA were from 0.166±0.216 to 0.088±0.224 (p=0.031) and from 0.282±0.279 to 0.165±0.286 (p<0.001) in the IVA and PDT groups, respectively. Both groups exhibited improvement; however, the difference between the groups was not significant. The CRT was reduced in both groups, but the difference between the groups was not significant. The decrease in SFCT was significantly higher in the PDT group (p<0.001). The MA area changed from 0.163±0.418 mm² to 0.227±0.480 mm² (p=0.011) and from 0.138±0.378 mm² to 0.547±0.880 mm² (p<0.001) in the IVA and PDT groups, respectively; thus, the MA area increased more in the PDT group (p=0.032).

Conclusions : Comparison of outcomes revealed no differences in BCVA or CRT; however, the decrease in the SFCT and increase in the MA area were greater in the PDT group.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Mean MA areas during the 2 years of treatment, significantly increased after 2 years in the IVA group and after 1 and 2 years in the PDT group

 

Changes in the MA area during the 2 years of treatment, the increase was significantly greater in the PDT group at all measurement points