Combined photodynamic therapy and ranibizumab for polypoidal choroidal vasculopathy:a 2-year result and systematic review

摘要

AIM:To report a cohort of patients with polypoidal choroidal vasculopathy(PCV)treated with photodynamic therapy(PDT)followed by intravitreal ranibizumab injection 24-48 h later,and to compare the results between eyes with PCV treated by PDT followed by intravitreal anti-vascular endothelial growth factor(VEGF)injection and intravitreal anti-VEGF injection followed by PDT by Meta-analysis.METHODS:Retrospective study and systematic literature review. Medical records of patients with PCV who were initially treated using PDT followed by intravitreal ranibizumab injection 24-48 h after PDT and had completed at least 2y follow-up were reviewed and analyzed. Clinical data,including age,sex,best-corrected visual acuity(BCVA),fundus photograph,fluorescein angiography,indocyanine green angiography and optical coherence tomography were investigated. A systematic literature review was also conducted,and a visual outcome of studies over 1y was compared using Meta-analysis. RESULTS:A total of 52 patients were included in the study. Mean BCVA at baseline and follow-up at 1 or 2y were 0.71± 0.61,0.51±0.36 and 0.68±0.51 log MAR,respectively. The cumulative hazard rate for recurrence at 1 and 2y followup was 15.4% and 30.3% respectively. The percentage of eyes with polyps regression at 3,12 and 24 mo follow-up was 88.5%,84.6% and 67.3% respectively. A Meta-analysis based on 22 independent studies showed the overall vision improvements at 1,2 and 3y follow-up were 0.13±0.04(P<0.001),0.12±0.03(P<0.001),0.16±0.06(P<0.001),respectively. The proportion of polyps regression at 1y follow-up was 64.6%(95%CI:51.5%,77.7%,P<0.001)in 434 eyes treated by intravitreal anti-VEGF agents beforePDT and 76.0%(95%CI:64.8%,87.3%,P=0.001)in 199 eyes treated by intravitreal anti-VEGF agents after PDT. CONCLUSION:Intravitreal ranibizumab injection 24-48 h following PDT effectively stabilizes visual acuity in the eye with PCV. PDT followed by intravitreal anti-VEGF agents may contribute to a relatively higher proportion of polyps’ regression as compared to that of intravitreal anti-VEGF before PDT.