Sameer Iqbal

Abstract

Purpose:   To evaluate and compare the efficacy of reduced-fluence photodynamic therapy (PDT) with standard-fluence photodynamic therapy in treating polypoidal choroidal vasculopathy. Materials and Methods:   Twenty-eight eyes (27 patients) with polypoidal choroidal vasculopathy were retrospectively analysed; 14 eyes received Indocyanine green angiography-guided standard-fluence (SF) PDT (50 J/cm) and 14 eyes received Indocyanine green angiography-guided reduced-fluence (RF) PDT (25 J/cm). Primary outcome measured after 6 months of treatment were the changes in mean BCVA, polyp regression, polyp PED height, central choroidal thickness (CCT), post PDT intravitreal anti VEGF injection need and complications. Results: Results of both the groups were comparable at 6 months follow up. Mean change in log mar visual acuity at 6 months for the SF PDT group was 0.12 compared to 0.13 for the RF PDT group (p?=?0.919).  Mean change in PED height at 6 months for the SF PDT group was 159 ?m compared to 172 ?m for the RF PDT group (p?=?0.06). Mean change in CCT at 6 months for the SF PDT group was 45?m compared to 10?m for the RF PDT group (p?=?0.96). While the SF PDT group needed a mean of 2 injections post PDT, the RF PDT group required a mean of 3 injections during the course of 6 months follow up. Neither of the group reported any adverse effects following the procedure. Conclusions:  Our study demonstrated that reduced-fluence PDT is at least on par with standard-fluence PDT in management of PCV.   Keywords: Polypoidal choroidal vasculopathy, Photodynamic therapy, Reduced fluence PDT, Standard fluence PDT.

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Abstract

The objective of this 5-year retrospective study of PCV eyes was to assess the clinical presentation and long-term real world visual and anatomical outcomes following therapy. Data included the baseline clinical and demographic profile, visual acuity and treatment details. Main outcome measured were anatomical and visual outcomes with treatment, treatment compliance and complications. Out the 45 PCV eyes (51 patients), 76.4% lesions occurred predominantly at the macula. Clinical presentations were variable though visible polyps (16.6%) and massive subretinal hemorrhage (17.7%) were less frequent. DLS with diffuse PEDs or thumb shaped PEDs were the most common finding in SD-OCT. OCTA was sensitive in identifying BVNs compared to ICGA but were poor in identifying polyps. Vision improvement was achieved in 42% eyes, while loss occurred in 26.6% eyes, with deterioration more in type 1 PCV. Baseline good vision, thicker CCT, smaller lesions and minimum recurrences at year 1 were risk factors associated with good outcomes. Mean number of injections was 18.7. 22% received primary PDT while 11% eyes received rescue PDT. Low fluence PDT was found to be as effective as standard fluence. Though not significant, PDT eyes required lesser injections than monotherapy. As an agent Aflibercept seemed to be better than Ranibizumab and was the most preferred switching agent (55% needed switch). Loading dose followed by PRN was the only feasible regimen with relatively reasonable compliance. Complications included RIP (11%) and 2 eyes requiring Vitrectomy for breakthrough vitreous hemorrhage. The superiority of aflibercept and the feasibility of a PRN approach is underlined in this study. In spite of suboptimal compliance this study reveals that nearly half the eyes demonstrated visual gains and anatomic stability.   Keywords: Polypoidal choroidal vasculopathy, Real world data, Aflibercept, Ranibizumab, PCV.

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