Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy:a systematic review and Meta-analysis

AIM: To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV).METHODS: A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis.RESULTS: Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study.CONCLUSION: IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.     

Exudative idiopathic polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin

PURPOSE: To report two cases of exudative idiopathic polypoidal choroidal vasculopathy treated by photodynamic therapy with verteporfin. DESIGN: Interventional case reports. METHODS: Two patients, a man aged 58 years and a woman aged 57 years, with recent visual impairment in the right eye (OD) (both eyes best-corrected visual acuity: 10/50 and Pelli-Robson contrast sensitivity 1.35 and 1.20) and angiographically proved subfoveal idiopathic polypoidal choroidal vasculopathy were treated with photodynamic therapy using verteporfin (Visudyne; Novartis SA, Rueil Malmaison, France). Functional and angiographic outcomes were assessed 6 weeks and 3, 6, and 12 months after treatment. RESULTS: In Patient 1, 3 months after treatment, best-corrected visual acuity and contrast sensitivity improved (10/16 and 1.50) and then remained stable throughout the 12 months after treatment. In Patient 2, 6 weeks after treatment, vision and contrast sensitivity were 10/20 and 1.35; and at 3 months, were improved and stabilized at 10/12.5 and 1.50. Angiographically, photodynamic therapy with verteporfin was associated with nonperfusion and occlusion of the exudative polypoidal dilations. No acute recurrence was noted during the follow-up period. CONCLUSION: In subfoveal exudative idiopathic polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin may be associated with beneficial functional results.     

Polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin

Background We evaluated, in a nonrandomised, institutional, prospective study, the efficacy of photodynamic therapy (PDT) with verteporfin in age-related macular degeneration (AMD) eyes with polypoidal choroidal vasculopathy (PCV) and subfoveal exudation. Methods A prospective clinical and angiographic study was done in 40 consecutive eyes with PCV treated with PDT using masked best-corrected visual acuity (VA) and fluorescein and indocyanine green angiographic features at baseline and over 2 years. Results Twenty-one eyes completed 1-year follow-up and showed, after a mean 2.9 PDT sessions, VA improvement in 12 eyes, no change in five eyes, and VA decrease in four eyes. Leakage was absent at the retinal and choroidal level in 14 eyes at 1 year. Recurrence occurred in one eye during the first year. Six eyes completed 2 years of follow-up and showed, after a mean 4 PDT sessions, VA improvement in five eyes and VA decrease in one eye. Leakage was absent at the retinal and choroidal level in five eyes. Recurrence occurred in four of these six eyes during the second year of follow-up. No serious adverse events were observed during the 2 years of follow-up. Conclusions PDT with verteporfin was shown to be safe and effective for treating AMD eyes with PCV with subfoveal involvement. VA improvement and absence of leakage were achieved, respectively, in 57.1% and 66.6% of the eyes at 1 year. Recurrences were more frequent during the second year of follow-up.     

维替泊芬光动力疗法治疗息肉状脉络膜血管病变的随访观察

目的 观察维替泊芬光动力疗法(photodynamic therapy,PDT)对息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)的1年治疗效果.方法 9例(10只眼)经眼底彩照、荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)确诊的PCV患者,进行常规的PDT治疗,治疗后随访第2周、1月、3月、6月、1年,观察治疗前后的视力、眼底彩照、FFA和(或)ICGA.结果 PDT治疗后1年视力提高3只眼,视力稳定6只眼,1只眼PDT治疗后出血吸收第2月复发黄斑区出血视力下降;1只眼治疗后第2周出现严重视网膜下出血,随访后渐吸收,其余患眼底出血、渗出均吸收消失.第3个月造影检查渗漏停止7只眼,3只眼轻微渗漏,末次随访3只眼仍轻微渗漏.PDT治疗过程无一例出现严重全身并发症.结论 PDT是一种安全有效的PCV治疗方法,可以短期内减轻或封闭异常血管的渗漏,促进出血、渗出吸收,稳定或提高患者视力,个别患者治疗后出现严重网膜下出血能自行吸收.

Abstract：

Objective To observe prospectively one-year's effect of photodynamic therapy (PDT)with verteporfin in polypoidal choroidal vasculopathy (PCV). Methods Nine patients (10 eyes) diagnosed as PCV according to fundus color, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed PDT. Visual acuity, Fundus appearance, FFA and/or ICGA were compared before PDT, and then at 2 weeks, 1 month, 3 months, 6 months and 12 months afier PDT.Results One year after the PDT, visual acuity was improved in 3 eyes and stabilized in 6 eyes. Visual acuity in one eye decreased again because of recurred macular bleeding. Massive subretinal hemorthage in one eye appeared two weeks after PDT and absorbed during the period of follow-up. The bleeding and exudates in the last 8 eyes were absorbed during the follow-up. At the 3 months, FFA and/or ICGA showed no Ieakage in 7 eyes, slight leakage in 3 eyes and still leakage at the final follow-up. No systemic adverse effect was found during and after PDT. Conclusions PDT offers an effective and safe way of treating PCV. PDT may relieve or stop vascular leakage, promote the elimination of the retinal hemorrhage and exudates, improve or stable the visual acuity. Massive retinal hemorrhage after PDT appears and absorbs in individual patients.     

Indocyanine green videoangiography in macular variant of idiopathic polypoidal choroidal vasculopathy

BACKGROUND: Fifty patients diagnosed with choroidal neovascularization in age-related macular degeneration were examined by indocyanine green videoangiography. Results were correlated with fundus photographs and fluorescein angiograms. Two patients were diagnosed with the macular variant of idiopathic polypoidal choroidal vasculopathy. CASES: Two middle-aged hypertensive women were diagnosed with macular idiopathic polypoidal choroidal vasculopathy. Throughout the follow-up period, both cases showed improved signs and symptoms without worsening of visual acuity, and despite the absence of definitive therapy. OBSERVATIONS: Indocyanine green videoangiography demonstrated the characteristic polypoidal lesions in idiopathic polypoidal choroidal vasculopathy better than fluorescein angiography, particularly when blood, exudates, or pigment epithelial detachments blocked visualization of the lesions. CONCLUSIONS: Incidence of idiopathic polypoidal choroidal vasculopathy may not be as low as reported, as its presentation mimics choroidal neovascularization in age-related macular degeneration. Differentiation can be made only through indocyanine green videoangiography. Conservative management may be beneficial, as visual prognosis is good.     

Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results

PURPOSE: To assess the efficacy and adverse-events profile of combined treatment with ranibizumab and verteporfin photodynamic therapy (PDT) in patients with predominantly classic choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration. DESIGN: Two-year, multicenter, randomized, single-masked, controlled study. METHODS: Patients received monthly intravitreal injections of ranibizumab 0.5 mg (n = 106) or sham injections (n = 56). All patients received PDT on day zero, then quarterly as needed. Efficacy assessment included changes in visual acuity (VA) and lesion characteristics and PDT frequency. Adverse events were summarized by incidence and severity. RESULTS: At month 24, 88% of ranibizumab + PDT patients had lost <15 letters from baseline VA (vs 75% for PDT alone), 25% had gained >or=15 letters (vs 7% for PDT alone), and the two treatment arms differed by 12.4 letters in mean VA change (P < .05 for all between-group differences). The VA benefit of adding ranibizumab to PDT in year one persisted through year two. On average, ranibizumab + PDT patients exhibited less lesion growth and greater reduction of CNV leakage and subretinal fluid accumulation, and required fewer PDT retreatments, than PDT-alone patients (mean = 0.4 vs 3.0 PDT retreatments). Endophthalmitis and serious intraocular inflammation occurred, respectively, in 2.9% and 12.4% of ranibizumab + PDT patients and 0% of PDT-alone patients. Incidences of serious nonocular adverse events were similar in the two treatment groups. CONCLUSIONS: Through two years, ranibizumab + PDT was more effective than PDT alone and had a low rate of associated adverse events.     

Verteporfin PDT for non-standard indications—a review of current literature

Background  

Verteporfin photodynamic therapy (PDT) is approved for the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), as well as for subfoveal CNV due to pathologic myopia and ocular histoplasmosis syndrome. Verteporfin PDT addresses the underlying pathology of ocular vascular disorders through its angio-occlusive mechanism of action, which reduces both visual acuity loss and the underlying leakage associated with lesions. Verteporfin PDT has also been associated with encouraging treatment outcomes in case studies involving patients with choroidal vascular disorders such as polypoidal choroidal vasculopathy, central serous chorioretinopathy, choroidal haemangioma, angioid streaks, and inflammatory CNV, i.e. conditions currently considered as non-standard indications of verteporfin PDT. In many studies, outcomes were better than expected based on the natural courses of each of these conditions. Although the anti-vascular endothelial growth factor (VEGF) therapies, ranibizumab and pegaptanib, have been approved for CNV due to AMD, their role in these other choroidal vascular disorders remains to be established. We summarize current literature that has documented the use of verteporfin PDT in these conditions.     

Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series

OBJECTIVE: To determine the efficacy of photodynamic therapy (PDT) with verteporfin as a treatment for symptomatic polypoidal choroidal vasculopathy (PCV). DESIGN: Prospective consecutive, 2-centered, noncomparative interventional case series. PARTICIPANTS: Twenty-one Asian patients with 22 eyes presenting with serosanguinous maculopathy due to PCV and an initial best-corrected visual acuity (BCVA) of 20/40 or worse were recruited prospectively. All patients had angiographic leakage seen on fluorescein angiograms (FAs) and features of PCV seen with indocyanine green (ICG) angiography. METHODS: Intravenous infusion of verteporfin at a dose of 6 mg/m(2) of body surface area over 10 minutes was administered. Five minutes after the completion of infusion, a 689-nm laser was applied for 83 seconds, with a light dose of 50 J/cm(2). The laser spot size was chosen to cover the polyps and the surrounding abnormally dilated choroidal vessels shown on ICG angiography plus an extra 1000-microm margin. Photodynamic therapy retreatment was performed if leakage from the polyps was found on both repeat FAs and ICG angiography at regular 3-month follow-up intervals. MAIN OUTCOME MEASURES: The proportion of eyes with stable or improved vision at a 1-year follow-up. Secondary outcome measures included change in mean BCVA and the changes in clinical and angiographic features in FAs and ICG angiography. The total number of PDT sessions and any complications were also recorded. RESULTS: Stable or improved vision was achieved in 21 (95%) of the 22 eyes at the 1-year follow-up. Ten (45%) eyes had a moderate gain in vision (improved by > or =3 lines), whereas 1 (5%) eye suffered a moderate visual loss (decrease by > or =3 lines). The mean BCVA improved from a logarithm of the minimum angle of resolution(logMAR) of 0.73 to 0.60, an equivalent of 1.3 lines of improvement. The change in logMAR BCVA at 12 months was statistically significant (Wilcoxon signed-ranks test, P = 0.009). Complete absence of leakage in FAs and total regression of the polyps in ICG angiography were observed in 20 (91%) and 21 (95%) eyes, respectively. Severe loss of vision due to massive subretinal hemorrhage occurred in 1 eye; otherwise, there were no other serious treatment-related adverse events. CONCLUSIONS: The 1-year results of PDT in treating PCV of the macular type with serosanguinous presentations are encouraging. Further studies with longer follow-up and randomized controlled trials are warranted to assess the long-term safety and efficacy of PDT relative to observation or other treatment modalities.     

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.     

Laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathy

PURPOSE: To evaluate the efficacy of laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathic lesions. DESIGN: Interventional case series. METHODS: Fifteen eyes of 14 consecutive patients with idiopathic polypoidal choroidal vasculopathy lesions treated by laser photocoagulation of indocyanine green angiographically identified feeder vessels were investigated. RESULTS: In 10 of the 15 eyes, serous retinal detachment of sensory retina in the macula disappeared after photocoagulation of the feeder vessels. The best-corrected visual acuity improved by 2 or more lines in eight of the 15 eyes and worsened in two eyes during the mean follow-up period of 13.6 months. CONCLUSIONS: Laser photocoagulation targeted exclusively to the feeder vessels supplying the idiopathic polypoidal choroidal vasculopathy lesions is a safe and effective method and can improve vision in eyes in which a serous retinal detachment is present in the macula. Indocyanine green angiography-guided laser photocoagulation should be considered as an optional treatment for idiopathic polypoidal choroidal vasculopathy.     

Extensive submacular haemorrhage in polypoidal choroidal vasculopathy managed by sequential gas displacement and photodynamic therapy: a pilot study of one-year follow up

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) with peculiar vascular lesions presents frequently as recurrent submacular haemorrhage. The best treatment is still not certain. It is the authors' objective to evaluate the 1-year safety and efficacy of photodynamic therapy (PDT) using verteporfin for persistent macular PCV after pneumatic displacement of the massive submacular haemorrhage with intravitreal perfluoropropane (C(3)F(8)). METHODS: A prospective, non-comparative, interventional case series on patients with extensive and thick submacular haemorrhage secondary to PCV, which was displaced pneumatically with intravitreal pure 0.4 ml C(3)F(8). Fluorescein angiography and indocyanine green angiography were repeated 1-2 weeks later to delineate any persistent active leaking polypoidal lesions, which were then treated with PDT. Retreatment might be considered in each follow up at every 3 months. RESULTS: Six eyes of six patients with the mean age of 53.6 years had been recruited and completed 1-year follow up. The mean baseline Snellen equivalent best-corrected visual acuity (BCVA) was 6/92 and the mean final BCVA at 1 year was 6/17. The mean improvement in logMAR BCVA after the sequential treatments was seven lines (range +3 to +19 lines) (Wilcoxon signed-ranks test, P = 0.03). All patients had at least moderate visual gains. No patient suffered serious complications from PDT. CONCLUSIONS: This first report on combined treatment with intravitreal gas injection and sequential PDT on PCV seems to be a well-tolerated option. Further comparative studies with larger sample size and longer follow up are warranted.     

Photodynamic therapy alone versus combined with intravitreal bevacizumab for neovascular age-related macular degeneration without polypoidal choroidal vasculopathy in Japanese patients

Background  

To compare 12-month results of two single initial treatments—photodynamic therapy with verteporfin alone (PDT group), and this therapy combined with intravitreal bevacizumab (IVB) (COMB group)—for neovascular age-related macular degeneration (AMD), not including patients with polypoidal choroidal vasculopathy (PCV) who were presumed to have AMD.     

Polypoidal choroidal vasculopathy

Polypoidal choroidal vasculopathy (PCV) is characterized by a branching vascular network with polypoidal lesions under the retinal pigment epithelium (RPE). In Japan, it is classified as a specific form of exudative age-related macular degeneration. However, several issues which we investigated regarding the pathogenesis and treatment of PCV remain unresolved. We investigated the pathogenesis, clinical findings and treatment of PCV. 1. Indocyanine green angiographic findings. There were two different patterns on indocyanine green angiograms. In the first pattern, both feeder and draining vessels were visible and network vessels showed characteristic findings of choroidal neovascularization (CNV). Points of focal dilatation on marginal vessels were comprised of polypoidal lesions. In the second pattern, neither feeder nor draining vessels were visible and there were few network vessels. The points of deformation of network vessels appeared to be polypoidal lesions. The former represents a deformation of CNV, i.e. polypoidal CNV; the latter is thought to result from abnormalities of the choroidal vessels, i.e. PCV in the strict sense. 2. Pathological findings of PCV in the strict sense. The histopathological characteristics of PCV in the strict sense, which had been eliminated by vitrectomy, were dilatation and hyalinization of vessels, massive exudative changes in blood plasma, basement membrane-like deposits and scant granulomatous tissue. These vessels were located beneath Bruch's membrane. The findings indicate that PCV in the strict sense arises from hyalinized arteriolosclerosis of choroidal vessels. 3. Optical coherence tomographic findings. A break was found in the high reflective line which revealed Bruch's membrane. Low reflective tissue was observed at the break corresponding to a feeder vessel. The high reflective line which corresponded to the retinal pigment epithelium was uneven, and highly elevated portions of the RPE corresponded to thick network vessels and polypoidal lesions. Feeder vessels are thought to invade via Bruch's membrane to form network vessels and polypoidal lesions at the termini of the network vessels, both of which push the RPE upward. Therefore, polypoidal CNV is thought to represent a deformation of the CNV under the RPE. In PCV in the strict sense, an irregular thickened line with highly reflective substances adhering to the lower portion of it, curved downward corresponding to the site at which the network vessel filling began. A dimple in the RPE was observed which paralleled the curve of the line. The RPE was pushed upward, corresponding to the network vessels. Judging from the results of histopathological studies, abnormal vessels may be pushed up the RPE secondary to an increase in intravascular pressure due to the presence of several dilated vessels and by massive exudation from these vessels within the choroid at network vessels. The dimple in the RPE might be attributable to intra-choroidal pressure being decreased at the point at which network vessel filling began. 4. Genetic findings. There were significant differences in all distributions of ARMS 2 (A69S) between the polypoidal CNV and control groups. In contrast, the distribution of ARMS 2 (A69S) did not differ between the PCV in the strict sense group and the control group. The ARMS 2 (A69S) gene is closely related to age-related macular degeneration. Polypoidal CNV was thought to be associated with age-related macular degeneration. 5. Treatment of subfoveal PCV. Mean visual acuity improved 1 year after photodynamic therapy (PDT). Good visual acuity, small lesion size of the network of vessels with polypoidal lesions, and the absence of subfoveal polypoidal lesions were pre-PDT predictors that corresponded to the improvement in vision. However, mean visual acuity had decreased to a level similar to that prior to PDT at 2 and 3 years after treatment. In PCV in the strict sense, the branching vascular network persisted after PDT, and polypoidal lesions frequently recurred at the termini. The branching vascular network sometimes expanded and was accompanied by polypoidal CNV or classic CNV. These results indicate that repeated PDT, as monotherapy, has limitations as a long-term treatment for PCV in the strict sense. Intravitreal injection of ranibizumab for eyes with a visual acuity of 0.6 or more, which is not a good indication for PDT, achieved improvement in mean visual acuity 1 year after the treatment, though the frequency of polypoidal lesion regression was low. This procedure seems to be useful for eyes with good visual acuity for a period of at least one year. 6. Conclusion. Using indocyanine green angiography, optical coherence tomography and genetic testing, PCV was classified into 2 groups, polypoidal CNV and PCV in the strict sense. PCV in the strict sense was characterized by arteriolsclerosis histopathologically. Polypoidal CNV is thought to represent deformation of CNV under the RPE in age-related macular degeneration, while PCV in the strict sense is thought to be due to choroidal vessel abnormalities. The long-term efficacy of repeated PDT as monotherapy, for subfoveal PCV was limited. Further evaluation is necessary to establish a treatment algorithm for PCV.     

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

Purpose To determine the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV). Methods PDT was performed in 35 patients (35 eyes) with PCV. We evaluated the number of treatments and compared visual acuity (VA), ophthalmological findings, and changes in polypoidal lesions and branching vascular networks by measuring lesion diameters using Heidelberg retina angiography before PDT, and then every 3 months for 1 year after PDT. Results The mean annual number of treatment sessions was 2.2. VA was improved or maintained in 80% of the patients. Retinal pigment epithelium detachment, retinal detachment, hemorrhage, and/or exudates disappeared in 69%, and leakage resolved in 74% of the patients. Polypoidal lesions disappeared completely on indocyanine green angiography in 83% of the patients. All branching vascular networks persisted. Polypoidal lesions had recurred at the termini of the remaining branching vascular networks at 9 months after the first PDT in two eyes and at 12 months in one eye. Conclusions PDT with verteporfin for PCV appears to improve or maintain VA for the first posttreatment year. Approximately 70% of PCV cases showed improved ophthalmoscopic findings. However, as polypoidal lesions recur after PDT in some cases, further study is needed to confirm the long-term efficacy of PDT for PCV. Jpn J Ophthalmol 2007;51:270–277 @ Japanese Ophthalmological Society 2007     

Photodynamic therapy with verteporfin for polypoidal choroidal vasculopathy of the macula

PURPOSE: Indications for photodynamic therapy (PDT) have increased from age-related macular degeneration with choroidal neovascularization (CNV), containing more than 50% of the classic component, to occult CNV, myopic CNV and CNV due to ocular histoplasmosis syndrome. In the present study, the effect of PDT with verteporfin was examined in polypoidal choroidal vasculopathy (PCV) of the macula. METHODS: PDT was performed in 9 eyes with PCV of the macula. Fundus examination, fluorescein angiography, and indocyanine green angiography were performed before PDT and 3 months after PDT in all eyes. Optical coherence tomography was performed in 6 eyes. RESULTS: After the initial PDT, visual acuity was stabilized or improved in 8 eyes (89%), polypoid elements were obliterated in 7 eyes (78%), and vascular nets were reduced in 8 eyes (89%). Of 6 eyes that received optical coherence tomography, pigment epithelium detachment was reduced or disappeared in all eyes except 1, which developed a disciform scar. An additional PDT was performed in 4 eyes to decrease vascular leakage. During the follow-up period of 3-18 months, no reactivation of PCV was observed. CONCLUSION: PDT offers an effective way of treating PCV of the macula, by obliterating polypoid elements of the PCV. However, long-term follow-up is needed.     

Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia

AIM: To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. METHODS: Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. RESULTS: The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy (P<0.001) while PCV was associated with more likely to have received PDT (P<0.001) and PDT combined with ranibizumab therapy (P<0.001). CONCLUSION: The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.     

Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy: the TORPEDO trial at 2 years

Background  

The combination of verteporfin photodynamic therapy (PDT) and anti-angiogenics has been shown to be safe and efficacious in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The purpose of this study is to demonstrate long-term prevention of vision loss and improvement in best-corrected visual acuity (BCVA) after treatment with one-time reduced-fluence-rate PDT followed by administration of ranibizumab on a variable dosing regimen over 24 months in patients with neovascular AMD. Secondary outcome measures included the change in central macular thickness (CMT), reinjection frequency, and safety.     

【In Press】Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia

AIM: To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. METHODS: Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. RESULTS: The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy (P<0.001) while PCV was associated with more likely to have received PDT (P<0.001) and PDT combined with ranibizumab therapy (P<0.001). CONCLUSION: Based on our findings, The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.     

Macular polypoidal choroidal vasculopathy with a remote lesion

Purpose: To report cases of the macular type of polypoidal choroidal vasculopathy with a remote lesion. Methods: We report six patients (seven eyes) with polypoidal choroidal vasculopathy who had macular and remote lesions. These eyes were examined with angiography and tomography. Results: All seven eyes showed an exudative macular lesion beneath the fovea. In addition, all eyes showed remote polypoidal lesions that were not connected to the macular lesions; the remote lesion was detected outside of the vascular arcade in five eyes, superotemporally beside the optic disc in one eye and on the nasal side of the optic disc in one eye. Indocyanine green angiography, fluorescein angiography and optical coherence tomography failed to reveal any sign of a branching vascular network or choroidal neovascularization that connected the macular lesion with the more remote lesion. At the initial visit, visual acuity in the seven eyes ranged from 6/150 to 6/9 (median, 6/15). Four eyes underwent photodynamic therapy to the exudative macular lesion. During 27.6 ± 14.3 months of follow up, no worsening was detected in any of the remote lesions. Median visual acuity was 6/60 at the final visit. Conclusions: Some patients with macular polypoidal choroidal vasculopathy also have a remote lesion, although the remote lesion seems to have only a minor effect on visual outcome.     

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。