Author: Jong Beom Park
Co-authors: Kiyoung Kim, Seung-Young Yu, Eung Suk Kim, Jun Woo Lee
Abstract
Purpose: To evaluate the long-term visual outcomes and causes of vision loss in polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) according to early polypoidal lesion regression.Methods: A retrospective review of clinical and multimodal imaging data of 36 naïve PCV eyes treated with anti-VEGF and combined verteporfin PDT and followed for 7 years or longer. Collected data included demographic profile, best corrected visual acuity (BCVA), central subfield retinal thickness (CSRT), any fluid on OCT, causes of vision loss and treatments. Analysis was done according to OCT- and ICGA-defined polypoidal lesion regression at one year after the first combined treatment: group R (polypoidal lesion regression) and group P (polypoidal lesion persistent).
Results: In the group R (23 eyes), the mean BCVAs at baseline, 1-, 2-, 3-, 5-, and 7-year were 0.52, 0.25, 0.30, 0.33, 0.48, and 0.50 logMAR, respectively. In the group P (13 eyes), the mean BCVAs, logMAR at baseline, 1-, 2-, 3-, 5-, and 7-year were 0.64, 0.44, 0.59, 0.55, 0.65, and 0.65 logMAR, respectively. The mean BCVA was significantly improved until 3-year in group R (P = 0.010) and 1-year in group P (P = 0.018). The mean BCVA of group R was significantly better than the mean BCVA of group P at 1-, 2- and 3-year follow up (all P 0.04). At the 7-year visit, 10 eyes (43.5%) in group R and 4 eyes (30.8%) in group P maintained BCVA of 20/40 or better and 3 eyes (13.0%) in group R and 3 eyes (23.1%) in group P were legally blind with BCVA of 20/200 or worse. The mean CSRT were not significantly different between group R and group P and 4 eyes (17.4%) in group R had recurrence of polypoidal lesion during 7-year follow up. For 7 years, in group R and P, total number of PDT was 1.59 ± 1.37 and 1.80 ± 1.23 (P = 0.325), respectively and total number of anti-VEGF treatment was 11.36 ± 14.45 and 10.60 ± 6.08 (P = 0.411). A large greatest linear dimension and subretinal hemorrhage were associated with poorer vision at the final visit.
Conclusion: Polypoidal lesion regression at 1 year after the initial combination treatment was associated with long-term BCVA changes and may be predictors of long-term visual outcomes.
