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PDT with anti-VEGF temporarily better than PDT alone for polypoidal choroidal vasculopathy
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Photodynamic therapy combined with intravitreal bevacizumab temporarily treated polypoidal choroidal vasculopathy more effectively than PDT alone, according to a study.
The retrospective study included 36 eyes of 36 patients with a mean age of 67.8 years who underwent combined PDT with adjuvant Avastin (bevacizumab, Genentech); 33 eyes of 33 patients with a mean age of 65.6 years were treated with PDT alone.
Investigators assessed best corrected visual acuity, tonometry and fundus photos before treatment and at all follow-up points. Optical coherence tomography, fluorescein angiography and indocyanine green angiography were performed before treatment and at subsequent 3-month intervals.
At 3 months, mean logMAR BCVA had improved from 0.73 to 0.53 in the combined treatment group and from 0.79 to 0.72 in the monotherapy group. The between-group difference in treatment efficacy was statistically significant (P < .001) at 3 months.
Improvements in BCVA were insignificant after 21 months in the combined treatment group and 15 months in the monotherapy group. The between-group difference in efficacy was insignificant after 6 months, the authors said.
Perspective
Back to TopAndrew M. Hendrick, MD
The authors of this paper retrospectively compare two practice patterns in managing polypoidal choroidal vasculopathy (PCV) in Taiwan. Briefly, they report on 2-year outcomes between full fluence photodynamic therapy (PDT) monotherapy every 3 months as-needed for persistent leakage vs. combining PDT with monthly as-needed intravitreal bevacizumab. Their main results demonstrate an initial visual and anatomic benefit to the use of bevacizumab that fades during follow-up. A secondary finding was that final visual outcomes were predicted by initial visual acuity, lesion size and lesion location.
PCV is likely under-diagnosed in the United States as most practitioners do not routinely obtain indocyanine green angiography on patients with exudative macular disease. This report highlights the importance of early recognition and proper management of PCV. It additionally underscores the utility of PDT for PCV without clear long-term benefit of bevacizumab. Further studies will be needed to clarify best practice patterns.
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