Skip to main content
Top
Published in: Japanese Journal of Ophthalmology 1/2019

01-01-2019 | Clinical Investigation

The 24-month outcomes of intravitreal aflibercept combined with photodynamic therapy for polypoidal choroidal vasculopathy

Authors: Shunichiro Nakai, Wataru Matsumiya, Otsuka Keiko, Akiko Miki, Makoto Nakamura, Shigeru Honda

Published in: Japanese Journal of Ophthalmology | Issue 1/2019

Login to get access

Abstract

Purpose

This study was prospectively carried out to clarify the effectiveness of visual and anatomical outcomes under combination therapy of intravitreal aflibercept (IVA) and verteporfin photodynamic therapy (vPDT) in over 24 months.

Study design

A single-arm prospective exploratory study.

Methods

Twenty-six eyes of 26 treatment naïve PCV patients were enrolled in this study. The primary outcome measures were the changes in best corrected visual acuity (BCVA) and the complete polyp regression rate. The secondary outcome measures included central retinal thickness assessed by optical coherence tomography.

Results

The patients showed significant improvement in BCVA by 0.14 logMAR units at 12 months and 0.11 logMAR units at 24 months from baseline (both p < 0.01). The mean central retinal thickness also significantly decreased at 12 months (p < 0.001) and at 24 months (p = 0.001). Complete regression of polypoidal lesions was achieved by 15 out of 20 eyes (75%) at 12 months and 11 out of 20 eyes (55%) at 24 months. The mean treatment number was 2.9 courses of IVA and 1.5 courses of vPDT and the mean retreatment free interval after initial therapy was 12.8 months during follow up of 24 months. The complete data from all predetermined examinations were observed in 17 out of 26 enrolled patients (65%) in this study.

Conclusion

In this study, combination therapy of IVA and vPDT yielded visual and anatomical improvements in treatment-naïve PCV patients over a 24-month follow-up period.
Literature
1.
go back to reference Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10:1–8.CrossRefPubMed Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10:1–8.CrossRefPubMed
2.
go back to reference Uyama M, Matsubara T, Fukushima I, Matsunaga H, Iwashita K, Nagai Y, et al. Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol. 1999;117:1035–42.CrossRefPubMed Uyama M, Matsubara T, Fukushima I, Matsunaga H, Iwashita K, Nagai Y, et al. Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol. 1999;117:1035–42.CrossRefPubMed
3.
go back to reference Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA. The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol. 1997;115:478–85.CrossRefPubMed Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA. The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol. 1997;115:478–85.CrossRefPubMed
4.
go back to reference Spaide RF, Yannuzzi LA, Slakter JS, Sorenson J, Orlach DA. Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina. 1995;15:100–10.CrossRefPubMed Spaide RF, Yannuzzi LA, Slakter JS, Sorenson J, Orlach DA. Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina. 1995;15:100–10.CrossRefPubMed
5.
go back to reference Ciardella AP, Donsoff IM, Huang SJ, Costa DL, Yannuzzi LA. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004;49:25–37.CrossRefPubMed Ciardella AP, Donsoff IM, Huang SJ, Costa DL, Yannuzzi LA. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004;49:25–37.CrossRefPubMed
6.
go back to reference Maruko I, Iida T, Saito M, Nagayama D, Saito K. Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol. 2007;144:15–22.CrossRefPubMed Maruko I, Iida T, Saito M, Nagayama D, Saito K. Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol. 2007;144:15–22.CrossRefPubMed
7.
go back to reference Yamamoto A, Okada AA, Kano M, Koizumi H, Saito M, Maruko I, et al. One-year results of intravitreal aflibercept for polypoidal choroidal vasculopathy. Ophthalmology. 2015;122:1866–72.CrossRefPubMed Yamamoto A, Okada AA, Kano M, Koizumi H, Saito M, Maruko I, et al. One-year results of intravitreal aflibercept for polypoidal choroidal vasculopathy. Ophthalmology. 2015;122:1866–72.CrossRefPubMed
8.
go back to reference Koh AH, Chen LJ, Chen SJ, Chen Y, Giridhar A, Iida T, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina. 2013;33:686–716.CrossRefPubMed Koh AH, Chen LJ, Chen SJ, Chen Y, Giridhar A, Iida T, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina. 2013;33:686–716.CrossRefPubMed
9.
go back to reference Koh AH, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, et al. Efficacy and safety of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: a randomized clinical trial. JAMA Ophthalmol. 2017;135:1206–13.CrossRefPubMedPubMedCentral Koh AH, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, et al. Efficacy and safety of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: a randomized clinical trial. JAMA Ophthalmol. 2017;135:1206–13.CrossRefPubMedPubMedCentral
10.
go back to reference Saito M, Iida T, Kano M, Itagaki K. Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2013;251:2099–110.CrossRefPubMed Saito M, Iida T, Kano M, Itagaki K. Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2013;251:2099–110.CrossRefPubMed
11.
go back to reference Yoshida Y, Kohno T, Yamamoto M, Yoneda T, Iwami H, Shiraki K. Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2013;57:283–93.CrossRefPubMed Yoshida Y, Kohno T, Yamamoto M, Yoneda T, Iwami H, Shiraki K. Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2013;57:283–93.CrossRefPubMed
12.
go back to reference Kim M, Kim K, Kim DG, Yu S-Y, Kwak H-W. Two-year results of photodynamic therapy combined with intravitreal antivascular endothelial growth factor for polypoidal choroidal vasculopathy. Ophthalmologica. 2011;226:205–13.CrossRefPubMed Kim M, Kim K, Kim DG, Yu S-Y, Kwak H-W. Two-year results of photodynamic therapy combined with intravitreal antivascular endothelial growth factor for polypoidal choroidal vasculopathy. Ophthalmologica. 2011;226:205–13.CrossRefPubMed
13.
go back to reference Lee YA, Yang CH, Yang CM, Ho TC, Lin CP, Huang JS, et al. Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up. Am J Ophthalmol. 2012;154:872–80.CrossRefPubMed Lee YA, Yang CH, Yang CM, Ho TC, Lin CP, Huang JS, et al. Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up. Am J Ophthalmol. 2012;154:872–80.CrossRefPubMed
14.
go back to reference Hata M, Tsujikawa A, Miyake M, Yamashiro K, Ooto S, Oishi A, et al. Two-year visual outcome of polypoidal choroidal vasculopathy treated with photodynamic therapy combined with intravitreal injections of ranibizumab. Graefes Arch Clin Exp Ophthalmol. 2015;253:189–97.CrossRefPubMed Hata M, Tsujikawa A, Miyake M, Yamashiro K, Ooto S, Oishi A, et al. Two-year visual outcome of polypoidal choroidal vasculopathy treated with photodynamic therapy combined with intravitreal injections of ranibizumab. Graefes Arch Clin Exp Ophthalmol. 2015;253:189–97.CrossRefPubMed
15.
go back to reference Matsumiya W, Honda S, Otsuka K, Miki A, Nagai T, Imai H, et al. One-year outcome of combination therapy with intravitreal aflibercept and verteporfin photodynamic therapy for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2017;255:541–8.CrossRefPubMed Matsumiya W, Honda S, Otsuka K, Miki A, Nagai T, Imai H, et al. One-year outcome of combination therapy with intravitreal aflibercept and verteporfin photodynamic therapy for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2017;255:541–8.CrossRefPubMed
16.
go back to reference Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, 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. 2012;32:1453–64.CrossRefPubMed Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, 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. 2012;32:1453–64.CrossRefPubMed
18.
go back to reference Tang K, Si JK, Guo DD, Cui Y, Du YX, Pan XM, et al. Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis. Int J Ophthalmol. 2015;18:1056–66. Tang K, Si JK, Guo DD, Cui Y, Du YX, Pan XM, et al. Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis. Int J Ophthalmol. 2015;18:1056–66.
19.
go back to reference Oishi A, Tsujikawa A, Yamashiro K, Ooto S, Tamura H, Nakanishi H, et al. One-year result of aflibercept treatment on age-related macular degeneration and predictive factors for visual outcome. Am J Ophthalmol. 2015;159:853–60.CrossRefPubMed Oishi A, Tsujikawa A, Yamashiro K, Ooto S, Tamura H, Nakanishi H, et al. One-year result of aflibercept treatment on age-related macular degeneration and predictive factors for visual outcome. Am J Ophthalmol. 2015;159:853–60.CrossRefPubMed
20.
go back to reference Papadopoulos N, Martin J, Ruan Q, Rafique A, Rosconi MP, Shi E, et al. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab. Angiogenesis. 2012;15:171–85.CrossRefPubMedPubMedCentral Papadopoulos N, Martin J, Ruan Q, Rafique A, Rosconi MP, Shi E, et al. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab. Angiogenesis. 2012;15:171–85.CrossRefPubMedPubMedCentral
21.
go back to reference Stewart MW, Rosenfeld PJ. Predicted biological activity of intravitreal VEGF Trap. Br J Ophthalmol. 2008;92:667–8.CrossRefPubMed Stewart MW, Rosenfeld PJ. Predicted biological activity of intravitreal VEGF Trap. Br J Ophthalmol. 2008;92:667–8.CrossRefPubMed
22.
go back to reference Kawashima Y, Oishi A, Tsujikawa A, Yamashiro K, Miyake M, Ueda-Arakawa N, et al. Effects of aflibercept for ranibizumab-resistant neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2015;253:1471–7.CrossRefPubMed Kawashima Y, Oishi A, Tsujikawa A, Yamashiro K, Miyake M, Ueda-Arakawa N, et al. Effects of aflibercept for ranibizumab-resistant neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2015;253:1471–7.CrossRefPubMed
23.
go back to reference Lee MY, Lee WK, Baek J, Kwon OW, Lee JH. Photodynamic therapy versus combination therapy in polypoidal choroidal vasculopathy: changes of aqueous vascular endothelial growth factor. Am J Ophthalmol. 2013;156:343–8.CrossRefPubMed Lee MY, Lee WK, Baek J, Kwon OW, Lee JH. Photodynamic therapy versus combination therapy in polypoidal choroidal vasculopathy: changes of aqueous vascular endothelial growth factor. Am J Ophthalmol. 2013;156:343–8.CrossRefPubMed
24.
go back to reference Kikushima W, Sakurada Y, Sugiyama A, Tanabe N, Kume A, Iijima H. Comparison of initial treatment between 3-monthly intravitreal aflibercept monotherapy and combined photodynamic therapy with single intravitreal aflibercept for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2017;255:311–6.CrossRefPubMed Kikushima W, Sakurada Y, Sugiyama A, Tanabe N, Kume A, Iijima H. Comparison of initial treatment between 3-monthly intravitreal aflibercept monotherapy and combined photodynamic therapy with single intravitreal aflibercept for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2017;255:311–6.CrossRefPubMed
26.
go back to reference Gomi F, Oshima Y, Mori R, Kano M, Saito M, Yamashita A, et al. Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy: the Fujisan Study. Retina. 2015;35:1569–76.CrossRefPubMed Gomi F, Oshima Y, Mori R, Kano M, Saito M, Yamashita A, et al. Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy: the Fujisan Study. Retina. 2015;35:1569–76.CrossRefPubMed
27.
go back to reference Lee WK, Iida T, Ogura Y, Chen SJ, Wong TH, Mitchell P, et al. Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy in the PLANET study. A randomized clinical trial. JAMA Ophthalmol. 2018;136(7):786–93.CrossRefPubMedPubMedCentral Lee WK, Iida T, Ogura Y, Chen SJ, Wong TH, Mitchell P, et al. Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy in the PLANET study. A randomized clinical trial. JAMA Ophthalmol. 2018;136(7):786–93.CrossRefPubMedPubMedCentral
28.
go back to reference Chan WM, Lam DS, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004;111:1576–84.CrossRefPubMed Chan WM, Lam DS, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004;111:1576–84.CrossRefPubMed
29.
go back to reference Oh IK, Huh K, Oh J. Risk factors for retinal hemorrhage after photodynamic therapy in age-related macular degeneration. Ophthalmologica. 2009;223:78–84.CrossRefPubMed Oh IK, Huh K, Oh J. Risk factors for retinal hemorrhage after photodynamic therapy in age-related macular degeneration. Ophthalmologica. 2009;223:78–84.CrossRefPubMed
30.
go back to reference Lee MY, Lee WK, Baek J, Kwon OW, Lee JH. Photodynamic therapy versus combination therapy in polypoidal choroidal vasculopathy: changes of aqueous vascular endothelial growth factor. Am J Ophthalmol. 2013;156:343–8.CrossRefPubMed Lee MY, Lee WK, Baek J, Kwon OW, Lee JH. Photodynamic therapy versus combination therapy in polypoidal choroidal vasculopathy: changes of aqueous vascular endothelial growth factor. Am J Ophthalmol. 2013;156:343–8.CrossRefPubMed
Metadata
Title
The 24-month outcomes of intravitreal aflibercept combined with photodynamic therapy for polypoidal choroidal vasculopathy
Authors
Shunichiro Nakai
Wataru Matsumiya
Otsuka Keiko
Akiko Miki
Makoto Nakamura
Shigeru Honda
Publication date
01-01-2019
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology / Issue 1/2019
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-018-0636-z

Other articles of this Issue 1/2019

Japanese Journal of Ophthalmology 1/2019 Go to the issue