Sravani Chava, Manoj S*, Mradula Gangwar, Supreme Goel and Unnikrishnan Nair

Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, India

*Corresponding Author: Manoj S, Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, India.

Received: March 06, 2025; Published: March 20, 2025

Abstract

Purpose: To evaluate the 6 month and 1 year efficacy of a modified combination therapy protocol for Polypoidal Choroidal Vasculopathy (PCV).

Methods: We retrospectively reviewed 25 eyes of 24 patients who were diagnosed as PCV on ICG angiography and received a modified combination treatment strategy; intravitreal Anti VEGF injections initially followed by standard PDT. Mean changes in the best-corrected visual acuity, central retinal thickness between baseline, month 6 and month 12 and number of additional treatments were analysed and compared with known data on early PDT combination therapy and other relevant studies.

Results: Mean baseline vision improved from 0.40 ± 0.32 to 0.17 ± 0.21 logMAR units and 0.12 ± 0.19 logMAR units respectively at 6 months and 12 months post PDT. Mean visual acuity gain was 0.24 ± 0.27 logMAR units and 0.28 ± o.28 logMAR units at 6 months and 12 months respectively. The Mean CFT improved from 346.64 ± 130.67μ to 196.68 ± 52.98μ and 191.52 ± 41.47μ at 6 months and 12 months post PDT respectively. Mean CFT gain was 149.96 ± 140.01μ and 155.12 ± 133.43μ at 6 months and 12 months respectively. Mean number of injections required to dry the fovea before PDT were 2.05. Mean number of additional injections required was 0.6 and 0.71 at 6 months and 1 year respectively. Out of 25 eyes 40% required additional antiVEGF treatment with ranibizumab injection at 6 months and 48% at the end of one year. Number of patients requiring additional PDT was 0% at 6 months and 4% at 1 year.

Conclusion: Deferred PDT combined with antiVEGF therapy in PCV eyes show good visual and anatomical improvements at 6 months and 12 months. Delayed PDT combination leads to significantly fewer additional treatments and less complications.

Keywords: Idiopathic Polypoidal Choroidal Vasculopathy (IPCV); Branching Vascular Network (BVN)

References

1. Yannuzzi LA., et al. “Idiopathic polypoidal choroidal vasculopathy (IPCV)”. Retina1 (1990): 1-8.
2. Koh AH., et al. “Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment”. Retina4 (2013): 686-716.
3. Nowak-Sliwinska P., et al. “Photodynamic therapy for polypoidal choroidal vasculopathy”. Progress in Retin Eye Research 37 (2013): 182-199.
4. Cheung CMG., et al. “Polypoidal Choroidal Vasculopathy: Definition, Pathogenesis, Diagnosis, and Management”. Ophthalmology 5 (2018): 708-724.
5. Fenner BJ., et al. “Evolving treatment paradigms for PCV”. Eye (Lond)2 (2022): 257-265.
6. Sen P., et al. “Polypoidal Choroidal Vasculopathy: An Update on Diagnosis and Treatment”. Clinical Ophthalmology 17 (2023): 53-70.
7. Kumar A., et al. “Polypoidal choroidal vasculopathy: a comprehensive clinical update”. Therapeutic Advances in Ophthalmology 11 (2019): 2515841419831152.
8. Gregori NZ., et al. “Novel method for analyzing snellen visual acuity measurements”. Retina 7 (2010): 1046-1050.
9. Lai TY., et al. “Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy”. British Journal of Ophthalmology5 (2008): 661-666.
10. Gomi F and Tano Y. “Polypoidal choroidal vasculopathy and treatments”. Current Opinion on Ophthalmology 3 (2008): 208-212.
11. Mori R., et al. “Treatment results at 1 year of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good visual acuity”. Japanese Journal of Ophthalmology4 (2015): 365-371.
12. Kang HM and Koh HJ. “Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy”. American Journal of Ophthalmology4 (2013): 652-660.
13. Sakai T., et al. “Three-year visual outcomes of intravitreal ranibizumab with or without photodynamic therapy for polypoidal choroidal vasculopathy”. Acta Ophthalmology8 (2016): e765-e771.
14. Koh A., et al. “EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy”. Retina 8 (2012): 1453-1464.
15. Gomi F., et al. “INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY: The Fujisan Study”. Retina 8 (2015): 1569-1576.

Citation

Citation: Manoj S., et al. “Modified Combination Therapy Strategy for Polypoidal Choroidal Vasculopathy".Acta Scientific Ophthalmology 8.4 (2025): 06-12.

Copyright

Copyright: © 2025 Manoj S., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.