ObjectiveTo compare the efficacy of photodynamic therapy (PDT) alone or in combined with ranibizumab versus ranibizumab monotherapy (intravitreal injection, IVR) in patients with polypoidal choroidal vasculopathy (PCV). Methods80 eyes of 72 patients with PCV were enrolled into this retrospective and comparative study according to their therapeutic plan. 30 eyes of 28 patients, 28 eyes of 30 patients and 22 eyes of 21 patients were divided into PDT group, ranibizumab 0.5 mg group (IVR group) or the combination group, respectively. The patients with PCV were diagnosed according to clinical symptoms, optical coherence tomography (OCT) and fluorescent indocyanine green angiography (ICGA). The baseline best-corrected visual acuity (BCVA) before treatment was more than 0.05, and there was no retinal fibrosis and scar for all patients. There was no statistical difference of age (F=0.187), gender (χ2=0.423), average BCVA (F=1.120) and central retinal thickness (CRT) (F=0.431) among three groups (P > 0.05). They had not received any treatment before. Patients received verteporfin PDT in PDT group, 3 consecutive monthly IVRs starting day 1 in IVR group, and 3 IVRs after 3 days, 1 month, 2 months of PDT starting day 1 in combination group. Re-treatment was considered 3 months later if the follow up shown no changes in fundus photography, OCT and ICGA. The average follow-up time was 19 months. BCVA at baseline and follow-up visit at 1, 3, 6, 12 months was measured, and the proportion of patients with ICGA-assessed complete regression of polyps at month 6 was recorded as primary outcome. The CRT was measured at baseline and 6 months as secondary outcome. ResultsThere were significant difference of BCVA at 1, 3, 6 and 12 months among three groups(F=5.480, 5.249, 3.222, 4.711; P < 0.05). The average BCVA was significantly better at 1, 3, 6, 12 month than that at baseline(t=-6.632, -4.127, -3.904, -4.494; P < 0.05) in combination group, and was significantly better at 3, 6, 12 months than that at baseline (t=-5.636, -3.039, -3.833; P < 0.05) in IVR group. However there was no significant difference of the average BCVA in PDT group between follow-up at 1, 3, 6, l 2 months and baseline (t=1.973, 0.102, -0.100, -0.761; P > 0.05). The proportion of patients with complete regression of polyps at 6 months was higher in PDT (76.7%) or combination group (68.2%) than IVR group (35.7%) (χ2=0.003, 0.025; P < 0.05). There was no significant difference of CRT among 3 groups at baseline (P=0.651). The mean CRT decreased in all 3 treatment groups over 6 months (t=5.120, 3.635, 5.253; P < 0.05), but there was no significant difference of CRT among 3 groups (F=1.293, P > 0.05). ConclusionsThree therapies could effectively decrease CRT. IVR or IVR combined with PDT are both more effective than PDT therapy to improve vision of PCV patients. PDT or PDT combined with IVR was superior to IVR pnly in achieving complete regression of polyps in 6 months in PCV patients.
Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD). Methods In this retrospective study, 34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT), 23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF). After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days. Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT (quot;dry macularquot;), or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension (GLD), type of CNV, SRF or IRF and posttreatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved (9.4plusmn;10.2) letters and reach 44.9plusmn;21.3 letters (t=5.438，P＜0.01) and CRT decreased (184.6plusmn;214.6) mu;m (t=4.810，P＜0.01) at 6 month visit. The average of injection number was 1.9plusmn;0.9 (including initial injection of combination therapy). With multiple lineal regression analysis, only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802.P＜0.01). The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA (r=0.053, -0.183, 0.139 and 0.053, respectively.P＞0.05). BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207，P=0.035). The change of BCVA after treatment (t=-0.076), change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05). The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05). The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P＞0.05). No severe complications were noticed during follow-up.Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short-term.
ObjectiveTo observe the clinical efficacy of half-dose photodynamic therapy (PDT) in the treatment of acute central serous chorioretinopathy (CSC) by enhanced deep imaging-OCT (EDI-OCT).MethodsA retrospective case study. From September 2015 to November 2018, 100 patients with acute CSC who received half-dose PDT in Hangzhou Branch of the Eye Optometry Hospital of Wenzhou Medical University were included in the study. Among 100 patients, 69 patients were males and 31 patients were females; the average age was 49.63±7.97 years; the average duration of disease was 2.19±0.71 months. All patients underwent BCVA, EDI-OCT, FFA, ICGA and other examinations. BCVA was used on the international standard visual acuity chart and converted to logMAR visual acuity records. Before treatment, the average logMAR BCVA was 0.29±0.19, the average macular foveal retinal thickness (CMT) was 370.59±134.98 μm, and the average macular subfoveal choroidal thickness (SFCT) was 366.93±86.95 μm. All patients were treated with half-dose PDT. We compared the changes of BCVA, CMT, SFCT, and subretinal fluid (SRF) of the eye before treatment and 2 weeks after treatment and 1, 3, and 6 months. Pearson correlation analysis method was used to analyze the correlation between BCVA and baseline BCVA, CMT, SFCT after 6 months of treatment.ResultsSix months after treatment, SRF was completely absorbed in 98 eyes, with an effective rate of 98.0%. Compared with before treatment, 2 weeks and 1, 3, and 6 months after treatment, the BCVA of the eye significantly increased (F=66.493, P＜0.001), and CMT and SFCT significantly decreased (F=134.625, 30.394; P＜0.001,＜0.001). The results of Pearson correlation analysis showed that BCVA was positively correlated with baseline BCVA 6 months after treatment (r=0.529, P＜0.001), and there was no significant correlation with CMT and SFCT. There were no serious complications related to treatment during the follow-up period.ConclusionsHalf-dose PDT can effectively increase BCVA in a short period of time for acute CSC. EDI-OCT can observe that CMT, SFCT and SRF absorption are significantly reduced after treatment.
ObjectiveTo assess the efficacy and safety of intravitreal aflibercept injection (IAI) compared with photodynamic therapy (PDT) in the treatment of Chinese patients with predominantly classic subfoveal choroidal neovascularization (CNV) lesions secondary to neovascular age-related macular degeneration (nAMD).MethodsA randomized, double-blind, multi-center phase-3 clinical trial lasting for 52 weeks (from December 2011 to August 2014). Subjects were randomized in a 3:1 ratio to either IAI group or PDT-to-IAI group. Subjects in the IAI group received 2 mg IAI at baseline and at week 4, 8, 16, 24, 32, 40, 48, with sham injection at week 28, 36. Subjects in the PDT-to-IAI group were forced to receive PDT once at baseline and more time at week 12, 24 if PDT retreatment conditions were met. Sham injections were given in PDT-to-IAI group at baseline and at week 4, 8, 16 and 24, followed by 2 mg IAI at week 28, 32, 36, 40, 48. The primary outcome of efficacy were the change in mean Best Corrected Visual Acuity (BCVA) from baseline to week 28, and that of week 52. Safety evaluation included the percentage of subjects who suffered treatment emergent adverse events (TEAEs).ResultsAmong the 304 subjects enrolled, there were 228 and 76 cases in IAI group and PDT-to-IAI group respectively. At week 28, the changes of mean BCVA in IAI group, PDT-to-IAI group compared to baseline were +14.0, +3.9 letters, respectively. At week 52, the changes of mean BCVA in two groups were +15.2, +8.9 letters respectively with the difference of +6.2 letters (95%CI 2.6−9.9, P=0.000 9). At week 52, the mean foveal retinal thickness in the two groups decreased by −189.6, −170.0 μm, respectively. Subjects with the most BCVA increase in IAI group were those aged ＜65, and those with active CNV lesion area ＜50% of total lesion area. The most common TEAEs in IAI group and PDT-to-IAI group are macular fibrosis [11.8% (27/228), 6.6% (5/76)] and BCVA decline [6.6% (15/228), 21.1% (16/76)]. There were 3 cases of arterial thromboembolic events defined in the antiplatelet experimental collaboration group, but all were considered unrelated to interventions.ConclusionsThe efficacy of aflibercept is superior to that of PDT in nAMD patients in China. The therapeutic effect of aflibercept persisted to week 52 in all subjects. The rate of adverse events was consistent with the safety data of aflibercept known before.
ObjectiveTo further compare the effect of intravitreal injection of bevacizumab (IVB) and photodynamic therapy (PDT) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia by meta-analysis. MethodsPertinent publications were identified through systemic searches of PubMed, EMBASE and the Cochrance Controlled Trials Register. All clinical comparative studies of IVB or PDT as initial treatment for CNV secondary to pathologic myopia were included. Meta analysis of these clinical trials was performed to analyze the effect of IVB and PDT for CNV secondary to pathologic myopia. Measurements included best corrected visual acuity (BCVA) and central foveal thickness (CFT). ResultsA total of 6 comparative studies involving 351 eyes were included. There were 196 eyes in IVB group and 215 eyes in PDT group. Funnel plots, Egger linear regression and Begg method did not show publication bias. Compared with PDT group, at 3, 6 and 12 months after IVB treatment, BCVA significantly increased . However, change of CFT at 3, 6 and 12 months did not vary significantly between IVB group and PDT group (3 months: WMD=-22.49, 95% CI=-93.49 to 48.52, P=0.53; 6 months: WMD=-17.34, 95% CI=-56.00 to 21.31, P=0.38; 12 months: WMD=-5.32, 95% CI=-56.37 to 45.74, P=0.84). ConclusionPatients with CNV secondary to pathologic myopia experienced a significant benefit of visual improvement after IVB, but reduction in CFT after the IVB or PDT did not vary significantly.
Objective To observe the efficacy of monotherapy and combination treatments of photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (VEGF) drugs for advanced exudative age-related macular degeneration (EAMD). Methods Thirty-two eyes from 28 patients with EAMD were enrolled in this study. Fifteen eyes were treated with PDT or intravitreal anti-VEGF drugs (monotherapy group), while 17 eyes were treated with combination treatments of PDT and intravitreal anti-VEGF drugs (combination group). The follow-up was ranged from 5 to 28 months with a mean of 21 months. Vision and intraocular pressure were measured and optical coherence tomography (OCT) was performed every month after treatment. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed every 3 months during follow-up period. The changes of visual acuity, leakage in macula lutea and central retinal thickness (CRT) before and after treatment, and adverse events during follow-up period were observed. The mean treatment times of monotherapy and combination group were compared and analyzed. Results Among 32 eyes, visual acuity improved in 20 eyes (62.5%), stabilized in 9 eyes (28.1%) and decreased in 3 eyes (9.4%). The leakage in macula lutea disappeared in 17 eyes (53.1%), decreased in 12 eyes (37.5%) and increased in 3 eyes (9.4%). CRT was reduced in 23 eyes (71.8%), increased in 9 eyes (28.2%). The mean treatment times of the combination group (2.3plusmn;0.2) was significantly less than that of monotherapy group (3.4plusmn;0.5)(P＜0.05). No adverse events such as secondary retinal hemorrhage, vitreous hemorrhage or endoophthalmitis were found during the follow-up duration. Conclusions Both monotherapy and combination treatments of PDT and intravitreal anti-VEGF drugs for EAMD may improve visual acuity, exudation and macular edema. Combination of PDT and anti-VEGF therapy decreases the frequency of retreatment.
Objective To evaluate safty and effects of a single photodynamic therapy(PDT) for circumscribed choroid hemangiomas. Methods We performed a retrospective analysis of 11 eyes of 10 patients who were reated with single standard PDT. Of 10 patients, 6 males, 4 females；mean 40 .2 years old；of 11 eyes, 6 left eyes, 5 right eyes; 1 patient who both eyes wer e involved. Follow-up time varied from 1month to 14months, mean 6.2 month. Results After treatment, all tumors show various degrees of regression and subretinal fluid were absorbed completely or partly. The visual acuity of 8 eyes improved; that of 3 eyes unchanged. Conclusions PDT is effective modality for circumscribed choroid hemangiomas. (Chin J Ocul Fundus Dis,2008,24:111-113)
Objective To observe the therapeutic effects of photodynamic therapy（PDT）on choroidal neovascularization（CNV）with or without cystoid macular edema（CME）in patients with wet agerelated macular degeneration（AMD）. Methods The clinical data of 54 patients (54 eyes) with wet AMD who had undergone the standard PDT，including 16 patients（21 eyes）with CME and 28 patients（33 eyes）without CME were retrospectively analyzed. The visual acuity and BFT of patients were examined by early treatment diabetic retinopathy study (ETDRS) and optical coherence tomography（OCT）before and per three months after PDT. The follow up was 3-18 months with the mean of 8.3 months.Results At the last time of follow up, in CME group，ETDRS letter score was（29.429plusmn;17.907）and the BFT was （316.429plusmn;77.161）mu;m，compared with that before the treatment, the difference were statistically significant (t=-0.389，2.246；P＝0.701，0.019). In nonCME group, ETDRS letter score was (48.121plusmn;17.911) and the BFT was (244.667plusmn;37.619) mu;m, compared with that before the treatment, the difference were statistically significant (t=-3.424，6.880；P＝0.002，0.000). There were statistical significance for the change of ETDRS letter score and BFT between the two groups (t=-2.194，2.212；P＝0.033，0.031）). Conclusions Therapeutic effect of PDT on CNV with CME was better than without CME in patients with wet AMD.