Purpose: To report one-year outcomes of rescue photodynamic therapy (PDT) combined with intravitreal aflibercept (IVA) injection for polypoidal choroidal vasculopathy (PCV).
Subjects and methods: The study sample included 18 eyes of 17 patients (9 men and 8 women; mean age, 73 years) with PCV who underwent rescue PDT with IVA between August 2015 and February 2019. We investigated dry macula percentage, additional treatment after rescue PDT, visual acuity (VA), central choroidal thickness (CCT), and adverse events.
Results: The mean number of anti-VEGF therapies before rescue PDT was 7.1 (range, 3-14). The mean greatest linear dimension (SD) was 2,713 (950) μm. Pigment epithelial detachment was observed in 14 eyes (78%) and dry macula was achieved at 3 months in 12 eyes (67%). Furthermore, 8 eyes (44%) required additional IVA and/or rescue PDT after 3 months and 12 eyes (67%) showed dry macula at 12 months. The mean logarithmic minimum angle of resolution (logMAR) VA at baseline, 1 month, 3 months, and 12 months was 0.23,0.21,0.15, and 0.16, respectively, with no significant improvement of VA (p> 0.05, repeated ANOVA). The mean CCT at baseline, 1 month, 3 months, and 12 months was 256,231,220, and 235 μm, respectively, with a significant reduction from the baseline at 3 months (p< 0.05, repeated ANOVA). Macular atrophy developed in 4 eyes, and the mean CCT of these 4 eyes decreased by 33% from 193 μm before rescue PDT to 131 μm at 3 months.
Conclusions: Dry macula was achieved in 67% of the eyes with PCV following rescue PDT with IVA at 3 months. Thereafter, additional treatments were needed to maintain dry macula in 50% of the eyes. Cases wherein thinning of the choroidal thickness is observed after rescue PDT should be monitored for macular atrophy.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 661-667,2021.