Combined Photodynamic Therapy and Anti-Vascular Endothelial Growth Factor Treatment for Idiopathic Polypoidal Choroidal Vasculopathy: One-Year Follow-up

Purpose: To evaluate the efficacy of a combination of photodynamic verteporfin therapy (PDT) and an intravitreal injection of an anti-vascular endothelial growth factor (VEGF) in the treatment of patients with polypoidal choroidal vasculopathy (PCV).Methods: Medical records from 21 eyes of 19 patients who received a combination therapy for PCV were retrospectively reviewed. The patients received intravitreal injections of an anti-VEGF agent (0.5 mg ranibizumab) within 7 days after receiving PDT. Eyes were then retreated with PDT and anti- VEGF injections or with anti-VEGF injections alone, when indicated. The bestcorrected visual acuities (BCVAs), recurrent bleeding episodes and complications of the treatments were evaluated.Results: The mean follow-up period was 14.3 months (ranged from 12 to 21 months). The BCVAs were 0.95, 0.82, 0.86, 0.64, and 0.75 logMAR at baseline, 3, 6, 9 and 12 months after treatment, respectively. The only significant change in the mean BCVA comparing to the mean baseline occurred at 9 months after treatment (p = 0.024, Wilcoxon signed-rank tests). Comparing to the baseline central foveal thickness (CFT) (312.1um), the mean CFT improved significantly at 3 (214.0μm, p ＜ 0.0001), 6 (221.8μm, p = 0.03), 9 (230.2μm, p = 0.003), and 12 months (243.8μm, p = 0.013) respectively (Wilcoxon signedrank tests). Retreatment was performed in 16 of the eyes (76%). The cessation of vascular leakage in 19 eyes (90.5%) at 12 months after treatment was revealed using ICG.Conclusions: The combination of PDT and anti-VEGF treatment appeared to be useful for both stabilizing visual acuity and for regressing polypoidal lesions. Improvements in both BCVA and CFT are most closely related to their respective baseline values (p= 0.021 and p＜0.001, respectively). When encountering recurrent or persistent active polypoidal lesions, additional treatment applications of PDT or anti-VEGF treatment showed equal outcomes, but only additional anti-VEGF injections were related to a significant decrease in CFT(p = 0.041).