Retreatment of polypoidal choroidal vasculopathy after photodynamic therapy combined with intravitreal ranibizumab

Purpose

To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60 months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12 months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present.

Results

During the follow-up period (mean 44 ± 13 months, median 48 months), 46 eyes (75.4 %) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59 % at the 12-month visit, 41 % at the 24 month, 31 % at the 36 month, and 20 % at the 60-month visit. The median retreatment-free period was 15.0 [95 % confidence interval (CI) 7.4–22.7] months, and the mean period was 24.9 (95 % CI 19.3–30.6) months. Cox regression analysis revealed that older age (P = 0.010, hazard ratio 1.06, CI 1.02–1.11) and male gender (P = 0.043, hazard ratio 2.41, CI 1.03–5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits.

Conclusions

About 80 % of eyes with PCV require retreatment within 5 years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.

     

Macular hole after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

A 67‐year‐old man visited the clinic presenting with the complaint of decreased vision in his left eye. Visual acuity of the left eye was 6/6. On fundus examination, an orange polypoidal lesion and retinal pigment epithelial (RPE) detachment were seen. Fluorescein angiography and indocyanine green angiography were performed. There was hyperfluorescence of a clustered polyp‐like lesion. The patient was diagnosed with polypoidal choroidal vasculopathy and we recommended that he be seen again in three months. At this visit, visual acuity of the left eye had decreased to 6/9 and the RPE detachment was aggravated. Intravitreal injection of ranibizumab was performed. One month after the injection, visual acuity of his left eye was 6/96. A macular hole was seen in his left eye and vitrectomy of the left eye was performed. Optical coherence tomography was checked and it showed that the macular hole was closed. Two more intravitreal ranibizumab injections were done on the left eye. Visual acuity of his left eye subsequently improved to 6/18.8.     

Hemorrhagic complications after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

ObjectiveTo evaluate clinical features and risk factors for hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after intravitreal ranibizumab injection.DesignRetrospective case series.ParticipantsThe charts of 54 patients with PCV who had received intravitreal ranibizumab 0.5 mg.MethodsThe study was conducted as a retrospective chart review of 54 patients with PCV who had received intravitreal ranibizumab 0.5 mg. Analysis of 2 groups was based on mean PCV lesion size: < 15mm² (n = 24); or ≥ 15mm² (n = 32). The occurrence of fresh postoperative subretinal hemorrhage, best corrected visual acuity, systemic disease, and medication history were documented and analyzed.ResultsThe mean injection number was 3.3 ± 0.7 (range, 1 to 6), with a mean follow-up of 7.4 ± 2.8 months (range, 4 to 14 months). During the follow-up period, postoperative subretinal hemorrhage was observed in 5 (8.9%) of 56 eyes. Occurrence of postoperative hemorrhage was significantly increased in the group with large PCV size (p = 0.01). Pars plana vitrectomy was performed for postoperative bleeding that resulted in vitreous hemorrhage in 1 eye (1.8%). Various systemic diseases and medication with an anticoagulant had no correlation with occurrence of hemorrhagic complications.ConclusionsSubretinal hemorrhage after ranibizumab injection can occur in patients with PCV. When considering ranibizumab injection for treatment of a large PCV lesion, the risk for hemorrhagic complications should be considered.     

光动力疗法联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变疗效观察

目的 观察光动力疗法（PDT）联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变（PCV）的安全性和有效性。方法 回顾性系列病例研究。临床确诊为PCV的患者24例24只眼纳入研究。所有患者均行视力、眼底彩色照相、荧光素眼底血管造影（FFA）、吲哚青绿血管造影(ICGA)和光相干断层扫描（OCT）检查。视力检查采用糖尿病视网膜病变早期治疗研究组视力表进行。患者治疗前平均视力为（33.41±19.43）个字母,平均黄斑视网膜厚度（CRT）为（343.63±88.60） μm。所有患者先行常规PDT治疗,72 h后玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml（含雷珠单抗0.5 mg）。根据检查情况确定是否需要重复行单独玻璃体腔注射雷珠单抗或PDT联合玻璃体腔注射雷珠单抗治疗。治疗后平均随访时间为13.1个月。观察统计每只眼的平均治疗次数、患者并发症及全身不良反应的发生情况。对比分析治疗前后患者视力和CRT的变化,以及黄斑区出血及渗出、PCV病灶的渗漏情况。结果 每只眼平均重复玻璃体腔注射雷珠单抗治疗次数为(2.8±1.6)次,平均重复联合治疗次数为(0.4±0.5)次。所有患眼均未出现与治疗相关的并发症和全身不良反应。末次随访时,患眼视力为（44.21±17.24）个字母,较治疗前平均提高10.8个字母。治疗前后视力比较,差异有统计学意义（t=-4.77,P＜0.01）。24只眼中,视力提高11只眼,占45.8%;视力稳定13只眼,占54.2%。眼底检查发现,黄斑区出血、渗出完全吸收7只眼,占29.2%;黄斑区出血、渗出明显减轻17只眼,占70.8%。FFA及ICGA检查发现,荧光渗漏停止17只眼,占70.8%;仍有轻微荧光渗漏7只眼,占29.2%。OCT检查发现,视网膜下积液消退19只眼,占79.2%;视网膜下积液减轻5只眼,占20.8%。患者平均CRT为（171.33±38.06） μm,较治疗前平均降低172.30 μm。治疗前后平均CRT比较,差异有统计学意义（t=11.96,P＜0.05）。结论 PDT联合玻璃体腔注射雷珠单抗治疗PCV安全有效,可提高患者视力,减轻视网膜水肿,停止或减少PCV病灶渗漏。     

Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy

Background

To clarify the efficacy of combined therapy with intravitreal ranibizumab injections and photodynamic therapy (PDT) in patients with symptomatic polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively reviewed 57 treatment-naïve eyes of 57 patients. Thirty-two patients were treated with standard fluence PDT (PDT group), and 25 patients were treated with three consecutive monthly intravitreal injections of ranibizumab and standard fluence PDT (ranibizumab plus PDT group). All patients were followed for at least 24 months.

Results

In the ranibizumab plus PDT group, the mean best-corrected visual acuity (BCVA) levels of decimal (logMAR equivalent) significantly improved from 0.30 (0.52) at baseline to 0.55 (0.26) at 24 months (P?<?0.001). In the PDT group, the BCVA levels stabilized from 0.26 (0.58) at baseline to 0.25 (0.60) at 24 months. The mean changes in the BCVA in the ranibizumab plus PDT group and the PDT group were improvement of 2.63 lines and decline of 0.16 lines respectively (P?=?0.010). The mean number of PDTs at 24 months in the ranibizumab plus PDT group and the PDT group were 1.4 and 2.6 respectively. Increased subretinal hemorrhages were seen in eight (18.0 %) eyes, all of which were belonging to the PDT group.

Conclusions

Combined intravitreal ranibizumab and PDT was significantly more effective in maintaining and improving VA for PCV patients compared with PDT monotherapy over 24 months.     

Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy

Purpose

To report the 2-year results of reduced-fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).

Methods

Twenty-four previously untreated eyes of 23 AMD patients with decimal best-corrected visual acuity (BCVA) of less than 0.7 received the combined therapy, followed by retreatments as needed over the subsequent 2 years. When the BCVA was better than or equal to 0.7, only 3 monthly IVR injections were performed during the retreatment.

Results

The BCVAs were maintained in 7 of 10 typical AMD eyes and in 13 of 14 PCV eyes at month 24. The mean BCVA improved in the PCV group (P < 0.05) but not in the typical AMD group. The central foveal thickness decreased in both groups (P < 0.01, P < 0.001). The mean numbers of the total PDT and IVR injections were 1.8 and 7.2 in the typical AMD group and 1.8 and 6.4 in the PCV group.

Conclusion

After RF-PDT combined therapy with administration of retreatments as needed that consisted of either 3 IVR injections alone or combined therapy, the BCVA was maintained in typical AMD and improved in PCV during a 2-year follow-up period.     

Choroidal thickness outside the laser irradiation area after photodynamic therapy in polypoidal choroidal vasculopathy

Purpose

To evaluate changes in choroidal thickness adjacent to the area of laser application after photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV) using enhanced depth imaging spectral-domain optical coherence tomography.

Methods

Masked observers measured the choroidal thickness at the subfovea and superior, inferior and temporal areas adjacent to the area of laser application before, 2 days, 1 week and 1 and 3 months after treatment.

Results

Thirty-seven patients with PCV treated with PDT with verteporfin were included. The mean subfoveal choroidal thickness decreased significantly (P < 0.001) from 256 ± 115 μm at baseline to 207 ± 111 μm at 3 months; the mean outside choroidal thickness including the superior, inferior and temporal areas decreased significantly (P < 0.001) from 240 ± 92 μm at baseline to 209 ± 86 μm at 3 months.

Conclusion

PDT affected not only the subfoveal choroid, but also the choroid outside the area of laser application in PCV.     

Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal choroidal vasculopathy

Purpose  

To investigate the subfoveal choroidal thickness in eyes with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using enhanced depth imaging optical coherence tomography.     

Short-term effectiveness of intravitreal bevacizumab vs. ranibizumab injections for patients with polypoidal choroidal vasculopathy

Purpose

To compare the effectiveness of intravitreal injections of bevacizumab and ranibizumab in patients with treatment-naive polypoidal choroidal vasculopathy (PCV).

Methods

Records from 106 consecutive patients who received intraviteral bevacizumab (n = 58, 1.25 mg) or ranibizumab (n = 52, 0.5 mg) for treatment of PCV were retrospectively reviewed. After three initial monthly loading injections, injection was performed as needed. The main outcome measures included best-corrected visual acuity (BCVA), foveal central thickness (FCT) as assessed by spectral domain optical coherence tomography, and the changes in polypoidal lesions based on an indocyanine green angiography.

Results

The average number of injections was 3.31 ± 1.25 in the bevacizumab group and 3.44 ± 0.92 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline to 6 months after injection improved by 0.17 in the bevacizumab group (p = 0.03) and by 0.19 in the ranibizumab group (p = 0.01). Average FCT decreased from 322 ± 62.48 µm to 274 ± 40.77 µm in the bevacizumab group (p = 0.02) and from 338 ± 50.79 µm to 286 ± 36.93 µm in the ranibizumab group (p = 0.02). Polyp regression rate was 20.7% (12 of 58 eyes) in the bevacizumab group and 21.2% (11 of 52 eyes) in the ranibizumab group. There was no statistically significant difference between groups in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups.

Conclusions

Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilizing of visual acuity, macular edema, and regression of polypoidal complex in PCV eyes over the short term.