Purpose: Pachychoroid neovasculopathy (PNV) with dilated choroidal vessels below macular neovascularization has recently attracted attention among patients with neovascular age-related macular degeneration. Some studies have reported that photodynamic therapy (PDT), considered an effective treatment for central serous chorioretinopathy, may be effective for PNV because the two diseases have similar conditions. Most of these studies evaluated the efficacy of PDT in combination with anti-vascular endothelial growth factor (VEGF) drugs, whereas few studies have reported the results of PDT alone or compared the results of PDT with those of anti-VEGF drugs. This study aimed to compare the 1-year results of PDT monotherapy for PNV with those of anti-VEGF drug therapy.
Methods: This retrospective observational study included patients diagnosed with PNV at the Department of Ophthalmology, Kagoshima University Hospital and treated with PDT monotherapy or anti-VEGF drug therapy as initial treatment. Changes in visual acuity, foveal thickness, and subfoveal choroidal thickness were evaluated using the Friedman test for 1 year after treatment. The number of anti-VEGF drug injections during 1 year in both groups was compared using the Mann-Whitney U test.
Results: There were 23 patients with 25 eyes in the PDT group (mean 63.4±11.7 years) and 14 patients with 14 eyes in the anti-VEGF group (69.1±9.2 years). The mean logarithmic minimum angle of resolution (logMAR) visual acuity in the PDT group improved 1 year after treatment but was not statistically significant. The mean foveal thickness (p<0.05) and mean subfoveal choroidal thickness (p<0.01) decreased significantly 1 year after treatment in the PDT group. The mean logMAR visual acuity (p<0.05) and mean foveal thickness (p<0.01) improved significantly at 1 year post-treatment in the anti-VEGF group, but there was no significant change in the mean subfoveal choroidal thickness. The number of anti-VEGF drug injections per year was significantly higher in the anti-VEGF group than in the PDT group (4.86±2.1 vs. 0.32±1.2; p<0.01).
Conclusion: PDT monotherapy for PNV can reduce the number of anti-VEGF drug injections after treatment compared with anti-VEGF drug therapy, suggesting that it may be an option for PNV treatment.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 1119-1126, 2023.