Presence of polypoidal choroidal vasculopathy lesions increases risk of late failure after PDT

Retina. 2009;29(7):960-965.

The risk of recurrence of active lesions is greater in patients with polypoidal choroidal vasculopathy lesions and age-related macular degeneration who are treated with photodynamic therapy than patients with AMD alone, according to a study.

Visual acuity was more often maintained out to 2 years in 38 eyes of 38 patients treated with PDT for AMD alone. In 25 eyes with AMD with polypoidal choroidal vasculopathy lesions, vision was stable out to 12 months but decreased by 0.09 logMAR every 3 months thereafter. The risk of recurrence in patients with polypoidal choroidal vasculopathy lesions increased 82% every 3 months after 12 months.

In the group of patients with polypoidal choroidal vasculopathy lesions, best corrected visual acuity changed –0.03 logMAR every 3 months during the first year, whereas there was no less change in BCVA during the entire 24 months in the AMD only group. Higher baseline BCVA was associated with an improvement in BCVA; the polypoidal choroidal vasculopathy lesions group had a higher baseline BCVA.

The study noted risk factors for late lesion recurrence among patients with polypoidal choroidal vasculopathy lesions, including subretinal hemorrhage and the presence of grape-like clusters of polypoidal lesions, which may explain late vision loss.

"We recommend that patients with AMD plus [polypoidal choroidal vasculopathy lesions], especially those with the grape-like clusters of polypoidal lesions, be followed more carefully and informed of the risk of recurrences, even 1 year after the initial PDT," the study authors said.