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Tanaka N, Azuma K, Aoki S, Kitamoto K, Ueda K, Fujino R, Inoue T, Obata R. Intravitreal anti-vascular endothelial growth factor and combined photodynamic therapy for pachychoroid neovasculopathy: long-term treatment outcomes. Graefes Arch Clin Exp Ophthalmol 2024; 262:1811-1818. [PMID: 38294513 PMCID: PMC11106190 DOI: 10.1007/s00417-024-06387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/23/2023] [Accepted: 01/20/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE To examine the long-term visual outcomes after initial treatment with combined photodynamic therapy (PDT) or aflibercept treat-and-extend (TAE) monotherapy in patients with pachychoroid neovasculopathy (PNV). METHODS Patients diagnosed with PNV, initially treated with PDT combined with anti-vascular endothelial growth factor (VEGF) or intravitreal aflibercept (IVA) monotherapy in the TAE protocol and followed up for at least 6 months, were included in the study. Medical records were retrospectively reviewed. Survival analysis was performed, in which deterioration in logMAR visual acuity by 0.1 or 0.3 is defined as "death." The annual number of treatments was also analyzed. Sub-analysis was performed on 33 patients diagnosed with PNV without polypoidal lesions. RESULTS This study included 46 patients (23 in the initial combined PDT group and 23 in the IVA TAE group). Mean age, sex, mean baseline logMAR visual acuity, or duration of observation (3.6 ± 3.2 years vs. 3.1 ± 1.9 years) in both groups were comparable. As for visual outcome, no significant differences were found in survival analysis based on worsening of 0.1 or 0.3 logMAR (3-year survival; 26% vs. 26%, 91% vs. 90%, respectively). Meanwhile, the additional number of anti-VEGF injections per year was significantly lower in the initial combined PDT group than in the IVA TAE group (1.0 ± 1.3 vs. 4.1 ± 1.5, p < 0.0001). No significant differences were found in the number of additional PDTs per year (0.07 ± 0.20 vs. 0.02 ± 0.09, p = 0.27). Similar results were found in a sub-analysis of 33 patients without polyps. CONCLUSION In the treatment of PNV, regardless of the presence of polyps, the long-term visual outcomes were similar between the initial combined PDT and IVA TAE monotherapy. However, the annual number of anti-VEGF injections was lower in the initial combined PDT group than in the aflibercept TAE group, whereas that of PDT was comparable.
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Affiliation(s)
- Nobuya Tanaka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
- Department of Ophthalmology, Shinseikai Toyama Hospital, Toyama, Japan
| | - Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Kohdai Kitamoto
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Kohei Ueda
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
- Department of Ophthalmology, Teishin Hospital, Tokyo, Japan
| | - Ryosuke Fujino
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan.
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Sayanagi K, Fujimoto S, Hara C, Fukushima Y, Maruyama K, Kawasaki R, Sato S, Nishida K. Effect of polyp regression and reduction on treatment efficacy in polypoidal choroidal vasculopathy treated with aflibercept. Sci Rep 2024; 14:1833. [PMID: 38246960 PMCID: PMC10800340 DOI: 10.1038/s41598-024-52448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Intravitreal injection of aflibercept (IVA) has successfully treated polypoidal choroidal vasculopathy (PCV), and polyp morphology is an important indicator of treatment efficacy. However, many studies have not reported the presence or absence of polyp regression and treatment outcomes, and few studies have reported polyp reduction and treatment outcomes in cases with residual polyps. We retrospectively measured the polyp area on indocyanine green angiography images before and after the IVA loading phase and investigated the regression and reduction of polyps and treatment outcomes of 81 eyes with PCV treated with IVA. We investigated the relationship between the presence or absence of complete regression of polyps and the percentage change in the polyp area and treatment outcomes. Eyes with complete polyp regression had significantly better visual acuity improvements compared with baseline at 12 months (P = 0.0108), fewer treatments (P = 0.0024), fewer recurrences during 12-months follow-up (P = 0.0010), and more "dry maculas" at 3 months (P = 0.0048) than eyes in which polyp regression did not occur. A significant correlation was seen only between the percentage of polyp regression and visual acuity at 3 months (P = 0.0395). Regarding IVA therapy for PCV, the presence or absence of complete polyp regression at the end of the loading phase affected the treatment outcome, whereas the degree of polyp reduction in cases of residual polyps had no effect.
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Affiliation(s)
- Kaori Sayanagi
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
| | - Satoko Fujimoto
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Chikako Hara
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yoko Fukushima
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shigeru Sato
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Kohji Nishida
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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Dong S, Fan P, Yu H, Jiang B, Sun D. A study of the relationship between cytokine levels and the response to anti-VEGF therapy in polypoid choroidal vasculopathy with different choroidal thicknesses. Front Endocrinol (Lausanne) 2024; 14:1307337. [PMID: 38260125 PMCID: PMC10802117 DOI: 10.3389/fendo.2023.1307337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is an irreversible retinal choroidal disease. Individuals with PCV exhibit diverse baseline characteristics, including systemic characteristics, ocular traits, metabolic factor levels, and different responses to intravitreal anti-VEGF therapy. This study aims to investigate the pathogenesis of PCV by analyzing the systemic characteristics, ocular traits, and cytokine levels at baseline within a cohort of patients who exhibit different responses to anti-VEGF treatment. Methods We conducted a retrospective analysis involving 80 eyes diagnosed with PCV. Patients were categorized into two groups based on responses to suboptimal intravitreal ranibizumab injection therapy: those with suboptimal responses and optimal responses. Aqueous humor samples were collected from the experimental eyes, and cytokine expression levels were assessed using cytometric bead array analysis. All subjects were further stratified into two groups according to the median choroidal thickness. Subsequently, logistic regression analysis and the ROC curve were employed to examine the relationship between cytokine expression levels, choroidal thickness, and anti-VEGF response. Results The results revealed that compared to the group of optimal anti-VEGF response, the choroid in the suboptimal response group exhibited a significantly greater thickness. Additionally, compared to the suboptimal anti-VEGF response group, the expression levels of VEGF and VCAM-1 were markedly lower observed in the optimal anti-VEGF response group, while TNF-α showed the opposite trend. Logistic regression analysis indicated that VEGF, VCAM-1, and TNF-α in the aqueous humor were independent risk factors for a suboptimal anti-VEGF response. After adjusting other risk factors, the risk of suboptimal anti-VEGF response decreased to 0.998-fold, 0.997-fold, and 1.294-fold. The AUC values for VEGF, VCAM-1, and TNF-α were determined to be 0.805, 0.846, and 0.897, respectively. Furthermore, the risk of VEGF, VCAM-1, and TNF-α were significantly associated with an increased risk of suboptimal anti-VEGF response after correction for risk factors in the thick choroid group. Conclusions Our study demonstrated that PCV exhibits systemic and ocular characteristics variations based on different anti-VEGF responses. The levels of cytokines in aqueous humor were found to have a significant correlation with the anti-VEGF response in PCV. VEGF, VCAM-1, and TNF-α are potential targets for assessing treatment response in thick choroidal PCV.
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Affiliation(s)
| | | | | | - Bo Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dawei Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Kawai K, Miyata M, Ooto S, Tamura H, Ueda-Arakawa N, Takahashi A, Uji A, Muraoka Y, Miyake M, Yamashiro K, Tsujikawa A. Macular atrophy at 5 years after photodynamic therapy for polypoidal choroidal vasculopathy. Eye (Lond) 2023; 37:1067-1072. [PMID: 35422494 PMCID: PMC10102034 DOI: 10.1038/s41433-022-02067-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate predictors for macular atrophy (MA) involving the fovea after photodynamic therapy (PDT) followed by pro re nata (PRN) treatment for polypoidal choroidal vasculopathy (PCV). METHODS This prospective observational study analysed treatment-naïve eyes with symptomatic PCV without MA at baseline which were followed up for 5 years. All eyes were initially treated with PDT, followed by a PRN regimen of anti-vascular endothelial growth factor (VEGF) therapy and/or PDT. We assigned eyes with and eyes without development of MA involving the fovea 5 years after the initial treatment into MA and non-MA groups, respectively. Baseline parameters and the number of treatments were compared between the two groups. RESULTS Seventy-two eyes of 69 consecutive patients were included, and 29 eyes of 29 patients were analysed. Twelve (41%) and 17 (59%) eyes were assigned into the MA and non-MA groups, respectively. There were significant differences in subfoveal choroidal thickness (226.2 ± 47.8 μm vs. 278.8 ± 68.1 μm, P = 0.03) and number of anti-VEGF injections (13.7 ± 9.6 vs. 5.4 ± 5.6, P = 0.007) between the MA and non-MA groups, but not in the number of PDT sessions (P = 0.71). Best-corrected visual acuity at 5 years in the MA group was lower than in the non-MA group (P = 0.048). CONCLUSION Our long-term observation suggests that a thin subfoveal choroid at baseline and many followed anti-VEGF injections in a PRN regimen increase the risk for development of MA involving the fovea 5 years after PDT.
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Affiliation(s)
- Kentaro Kawai
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Otsu Red Cross Hospital, Otsu, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Seven-year outcome after 1-year fixed regimen of intravitreal aflibercept injections followed by pro re nata treatment for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05982-w. [PMID: 36735070 DOI: 10.1007/s00417-023-05982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The study aims to investigate the 7-year best-corrected visual acuity (BCVA) course after 1-year fixed regimen of intravitreal aflibercept injection (IVA) for neovascular age-related macular degeneration (nAMD) and to identify factors affecting this BCVA. METHODS This longitudinal, observational study included 63 treatment-naïve eyes (61 patients) with nAMD, treated with 1-year fixed regimen of IVA-3 monthly injections and 4 subsequent bimonthly injections-essentially followed by PRN regimen of IVA but sometimes followed by agent switching, photodynamic therapy (PDT), or vitrectomy, as needed. We assessed BCVA changes over a 7-year period. Morphologically, we assessed central retinal thickness (CRT), central choroidal thickness (CCT), subfoveal pigment epithelial detachment (PED) height, vitreomacular traction/adhesion (VMT/VMA), epiretinal membrane (ERM), and macular atrophy involving the fovea. RESULTS Logarithm of the minimum angle of resolution (logMAR) BCVA changed from 0.20 ± 0.24 to 0.29 ± 0.45 over 7 years. BCVA improved significantly after years 1 and 2 (P = 0.002 and 0.001, respectively) and then slowly decreased. BCVA after years 3-7 did not significantly differ from baseline. CRT and CCT decreased significantly during follow-up, while PED height did not. VMT/VMA decreased significantly, whereas ERM and macular atrophy increased significantly. Seven-year and baseline BCVA positively correlated (P = 0.007, β = 0.35). CONCLUSIONS BCVA was maintained for 7 years in nAMD eyes after 1-year fixed regimen of IVA, essentially followed by PRN regimen, but sometimes followed by agent switching, PDT, or vitrectomy, without severe drug-induced complications. Thus, early diagnosis and treatment of nAMD are essential for maintaining good long-term BCVA, even in eyes with relatively poor baseline vision.
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Bo Q, Zhang M, Chen J, Jia H, Shen M, Sun M, Xu M, Feng J, Yan Q, Yu Y, Huang P, Li T, Wang F, Rosenfeld PJ, Sun X. Progression of Polypoidal Lesions Associated with Exudative Recurrence in Polypoidal Choroidal Vasculopathy. Ophthalmology 2023; 130:167-178. [PMID: 36152843 DOI: 10.1016/j.ophtha.2022.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the characteristics of the branching vascular network (BVN) and polypoidal lesions in polypoidal choroidal vasculopathy (PCV) to determine near-term indicators that may predict exudative recurrence. DESIGN Retrospective cohort study. PARTICIPANTS Patients with PCV receiving anti-vascular endothelial growth factor (VEGF) monotherapy or anti-VEGF plus photodynamic therapy were followed for at least 1 year using swept-source OCT angiography (SS-OCTA) imaging. METHODS Patients were divided into 2 groups based on whether exudative recurrence occurred during follow-up. Multiple parameters were collected and compared between the 2 groups, such as age, gender, visual acuity, number of polypoidal lesions, lesion area at the first SS-OCTA visit, and total lesion area change from the first SS-OCTA visit to the last SS-OCTA visit. To evaluate the association between SS-OCTA imaging-based risk factors and the exudative recurrences, imaging features associated with PCV such as BVN growth and polypoidal lesion progression (enlargement, new appearance, and reappearance) at each follow-up visit were analyzed. The time intervals from the nonexudative visit with lesion progression to the corresponding exudative recurrence visit were documented to explore their association with exudative recurrences. Cox regression and logistic regression analyses were used. MAIN OUTCOME MEASURES Association between BVN growth and polypoidal lesion progression with exudative recurrence. RESULTS Thirty-one eyes of 31 patients (61% men) were included. Sixteen eyes had no recurrence of exudation, and 15 eyes had recurrence during follow-up. The average follow-up duration was 20.55 ± 6.86 months (range, 12-36 months). Overall, the recurrence group had worse best-corrected visual acuity (P = 0.019) and a greater increase in lesion area (P = 0.010). Logistical regression analysis showed that polypoidal lesion progression, including new appearance, enlargement, and reappearance of polypoidal lesions, was associated with exudative recurrences within 3 months (odds ratio, 26.67, 95% confidence interval, 3.77-188.54, P = 0.001). CONCLUSIONS Growth of nonexudative BVN and progression of polypoidal lesions were found to be lesion characteristics associated with exudative recurrences, and progression of polypoidal lesions might serve as a stand-alone indicator for the near-term onset of exudation. In PCV, more frequent follow-up visits are recommended when polypoidal lesions show progression.
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Affiliation(s)
- Qiyu Bo
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Min Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
| | - Huixun Jia
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mengsha Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Mengqiao Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jingyang Feng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Quan Yan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Yang Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Peirong Huang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Tong Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
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Ando R, Hirooka K, Saito M, Kase S, Noda K, Ishida S. Two-year clinical outcomes of triple therapy with photodynamic therapy, anti-vascular endothelial growth factor agent, and triamcinolone acetonide for neovascular age-related macular degeneration. Jpn J Ophthalmol 2023; 67:50-58. [PMID: 36346553 DOI: 10.1007/s10384-022-00955-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To analyze the 2-year treatment outcomes of triple therapy with standard-fluence photodynamic therapy (PDT), intravitreal injection of ranibizumab (IVR)/aflibercept (IVA), and sub-tenon injection of triamcinolone acetonide (STTA) for neovascular age-related macular degeneration (nAMD) in Japanese patients. STUDY DESIGN A retrospective, clinical case-series study. METHODS Forty-four eyes of 44 patients with treatment-naïve nAMD followed for more than 24 months were evaluated. Initial treatment was given with triple therapy and retreatment with IVR/IVA as a pro re nata regimen. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), the number of treatments, and intraocular pressure elevation were analyzed. RESULTS The mean age was 73.3 ± 10.0 years. The mean BCVA significantly improved from 0.61 ± 0.30 at baseline to 0.50 ± 0.46 at 24 months (p = 0.034). CRT significantly improved from 373 ± 162 μm at baseline to 200 ± 107 μm at 24 months (p < 0.001). The number of treatments given during the 2-year treatment period was 2.7 ± 1.8. No retreatments were necessary in 18 of 44 eyes (40.9%), with no significant difference between IVR (46.4%) or IVA (31.3%) used during the 2-year follow-up of triple therapy (p = 0.51). Four eyes (9.1%) temporarily required glaucoma eye drop treatments. CONCLUSION In nAMD patients, induction treatment with triple therapy resulted in approximately 40% of the patients requiring no retreatment for 2 years. The type of anti-VEGF agents used made no difference in the results.
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Affiliation(s)
- Ryo Ando
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kousuke Noda
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
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Chay J, Fenner BJ, Finkelstein EA, Teo KYC, Cheung CMG. Real-world cost-effectiveness of anti-VEGF monotherapy and combination therapy for the treatment of polypoidal choroidal vasculopathy. Eye (Lond) 2022; 36:2265-2270. [PMID: 34811522 PMCID: PMC9674616 DOI: 10.1038/s41433-021-01856-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES For patients with polypoidal choroidal vasculopathy (PCV), intravitreal anti-vascular endothelial growth factor (anti-VEGF) combination therapy has been shown to be cost-saving relative to monotherapy in a clinical trial setting. However, whether this also applies to real-world settings is unclear. We aim to compare the real-world functional outcomes and cost-effectiveness of intravitreal anti-VEGF combination therapy relative to monotherapy, to investigate whether combination therapy is truly cost-saving. METHODS We used a Markov model to simulate a hypothetical cohort of PCV patients treated at Singapore National Eye Centre. Model parameters were informed by coarsened exact matched estimates of a two-year retrospective study of patients who initiated treatment in 2015. Treatment options included intravitreal aflibercept, bevacizumab, or ranibizumab, as monotherapy or in combination with full-fluence verteporfin photodynamic therapy. RESULTS The two-year logMAR letters gains were significant for combination therapy ( + 10.6, P = 0.006) but not monotherapy (-2.2, P = 0.459). Over 20 years, a PCV patient would cost the health system SGD 48,790 under monotherapy and SGD 61,020 under combination therapy. Quality-adjusted life-years (QALYs) were estimated to be 7.41 for monotherapy and 7.80 for combination therapy. The incremental cost-effectiveness ratio of combination therapy was SGD 31,460/QALY, which is less than the common willingness-to-pay threshold of per capita gross domestic product of Singapore (SGD 88,990/QALY). Sensitivity analysis showed that combination therapy remained incrementally cost-effective, but not cost-saving. CONCLUSIONS Our study shows that combination therapy is good value for money but is likely to increase costs when applied in real-world settings.
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Affiliation(s)
| | - Beau J Fenner
- Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Kelvin Y C Teo
- Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
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Shimizu Y, Miyata M, Ooto S, Miyake M, Mori Y, Tamura H, Ueda‐Arakawa N, Uji A, Muraoka Y, Takahashi A, Wakazono T, Yamashiro K, Hata M, Tsujikawa A. Pachychoroid-phenotype effects on 5-year visual outcomes of anti-VEGF monotherapy in polypoidal choroidal vasculopathy. Acta Ophthalmol 2022; 100:e943-e949. [PMID: 34533280 DOI: 10.1111/aos.15015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate whether the efficacy of anti-vascular endothelial growth factor (VEGF) monotherapy for polypoidal choroidal vasculopathy (PCV) differs between pachychoroid and non-pachychoroid phenotypes in the long term. METHODS This retrospective longitudinal study included 115 treatment-naïve eyes in 115 consecutive patients with symptomatic PCV who were treated with anti-VEGF monotherapy and were followed up for 5 years. Eligible eyes were assigned to either a pachy-PCV group, with a pachychoroid phenotype, or a non-pachy-PCV group, without a pachychoroid phenotype. Best-corrected visual acuity (BCVA) and other parameters over a 5-year period were compared between the groups. RESULTS Forty-eight eyes and 67 eyes were classified into the pachy-PCV and non-pachy-PCV groups respectively. Baseline and 5-year BCVA (logarithm of the minimum angle of resolution) were 0.19 ± 0.20 and 0.16 ± 0.28 in the pachy-PCV group, respectively, and 0.25 ± 0.26 and 0.26 ± 0.36 in the non-pachy-PCV group respectively. BCVA did not change significantly in either group (p = 0.18 and 0.08 respectively). BCVA did not differ between the groups at any observation time-point. Subfoveal choroidal thickness (SFCT) at baseline and at 5 years was significantly higher in the pachy-PCV group than in the non-pachy-PCV group (both p < 0.001); however, the mean rate of decrease in SFCT did not differ in either group over the 5-year period (22% vs. 23%, p = 0.81). CONCLUSION Our findings suggest that anti-VEGF monotherapy was similarly effective for pachychoroid- and non-pachychoroid-phenotype eyes with PCV, for at least 5 years, although further studies are required.
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Affiliation(s)
- Yuichiro Shimizu
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Yuki Mori
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Naoko Ueda‐Arakawa
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Tomotaka Wakazono
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
- Department of Ophthalmology Red Cross Otsu Hospital Otsu City Japan
| | - Masayuki Hata
- Biochemistry and Molecular Medicine Maisonneuve‐Rosemont Hospital Research Centre University of Montreal Montreal QC Canada
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
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10
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Park JY, Park YJ, Park SJ, Park KH, Yeo JH, Kim J, Yoon YH, Lee JY, Woo SJ. Comparison of visual outcomes of polypoidal choroidal vasculopathy and typical neovascular age-related macular degeneration-up to 10 years of follow-up. Acta Ophthalmol 2022; 100:e1579-e1588. [PMID: 35363434 DOI: 10.1111/aos.15149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate long-term visual outcomes of patients with polypoidal choroidal vasculopathy (PCV) and typical neovascular age-related macular degeneration (nAMD) in the real-world setting. METHODS Retrospective, multicenter, noninterventional consecutive cohort study. Two hundred eighty-five eyes of 261 patients with PCV and 902 eyes of 877 patients with typical nAMD, who could be followed up 1 year or longer from 2005 to 2018, were included. Mean changes in best-corrected visual acuity (BCVA) from baseline in the PCV and the typical nAMD groups were compared. RESULTS Mean follow-up period of total patients was 4.3 ± 2.8 (1-10) years. Baseline BCVA was better in the PCV group than that in the typical nAMD group (0.59 ± 0.52 versus 0.79 ± 0.63 logMAR, p < 0.001). The mean changes in BCVA from baseline in the PCV and nAMD group were +2.1 and -0.1 letters at 1 year, -0.2 and -3.7 letters at 3 years, -3.9 and -10.5 letters at 5 years and - 8.7 and - 12.1 letters at 7 years, respectively. Before 2006, the initial BCVA was sustained for approximately 1 year in eyes with PCV and for less than half year in eyes with typical nAMD. However, after 2007, when anti-VEGF agents were available, the initial BCVA was sustained for 4 years in eyes with PCV, while it was sustained for 1 year in eyes with typical nAMD. CONCLUSION In the real-world, long-term BCVA deteriorated in both PCV and typical nAMD groups, but the PCV group showed better visual outcomes than the typical nAMD group.
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Affiliation(s)
- Jun Young Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
- Department of Ophthalmology Uijeongbu Eulji Medical Center, Eulji University School of Medicine Uijeongbu South Korea
| | - Young Joo Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
- Department of Ophthalmology Kangwon National University Hospital, Kangwon National University Graduate School of Medicine Chuncheon South Korea
| | - Sang Jun Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
| | - Joon Hyung Yeo
- Department of Ophthalmology Chung‐Ang University Gwangmyeong Hospital, Chung‐Ang University College of Medicine Gwangmyeong South Korea
| | - June‐Gone Kim
- Department of Ophthalmology, Asan Medical Center University of Ulsan, College of Medicine Seoul South Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center University of Ulsan, College of Medicine Seoul South Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center University of Ulsan, College of Medicine Seoul South Korea
| | - Se Joon Woo
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
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11
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Miyata M, Ooto S, Yamashiro K, Tamura H, Uji A, Miyake M, Muraoka Y, Takahashi A, Tsujikawa A. Influence of vitreomacular interface score on treatment outcomes of anti-VEGF therapy for neovascular age-related macular degeneration. Int J Retina Vitreous 2021; 7:77. [PMID: 34930502 PMCID: PMC8690868 DOI: 10.1186/s40942-021-00342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To quantitatively evaluate the vitreomacular interface of eyes with neovascular age-related macular degeneration (AMD) and to investigate its association with the 1-year treatment outcome following intravitreal injections of aflibercept (IVA). METHODS This prospective observational case series included 59 eyes of 59 consecutive patients with treatment-naïve neovascular AMD who were treated with three monthly IVA and subsequent four bi-monthly IVA and were followed up for 1 year. We estimated posterior vitreous detachment at 1, 9, and 25 macular points within an area of 6 × 6 mm2 at the center of the fovea using the built-in enhanced vitreous visualization mode of swept-source optical coherence tomography. One year after the initial IVA, we classified the eyes into either wet or dry groups. RESULTS The wet and dry groups included 12 and 47 eyes, respectively. The resistance rate against IVA was 20.3%. The 25-point interface score was higher in the wet group than in the dry group (23.0 ± 4.3 vs. 18.6 ± 9.8, P = 0.03), whereas there were no significant between-group differences in the 9-point and 1-point scores (P = 0.21, and 0.47, respectively) or in the other studied parameters. Multivariable analysis revealed that the 25-point vitreomacular interface score was strongly correlated with subfoveal choroidal thickness (P = 0.02, β = - 0.31). CONCLUSIONS Our findings suggest that wide-ranged separation of the posterior vitreous membrane from the retina induces poor response to IVA.
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Affiliation(s)
- Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan.,Department of Ophthalmology, Red Cross Otsu Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8501, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara Cho 54, Sakyo Ku, Kyoto, Kyoto, 606-8507, Japan
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12
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Real world experience of the treatment outcome between photodynamic therapy combined with ranibizumab and aflibercept monotherapy in polypoidal choroidal vasculopathy. Sci Rep 2021; 11:20115. [PMID: 34635762 PMCID: PMC8505609 DOI: 10.1038/s41598-021-99634-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 11/09/2022] Open
Abstract
To provide real-world experiences of treating polypoidal choroidal vasculopathy (PCV) patients with photodynamic therapy (PDT) plus intravitreal injection of ranibizumab or intravitreal injection of aflibercept alone. Retrospective chart review of patients with PCV in a single tertiary referral center in Taiwan. Chart review of PCV patients treated with PDT and injection of ranibizumab or injection of aflibercept. A total of 101 eyes of 101 patients (38 females and 63 males) were reviewed. Of those, 48 and 53 eyes received primary/adjunctive PDT along with injections of ranibizumab or intravitreal injections of aflibercept only, respectively. Initial visual acuity (VA) and central subfield choroidal thickness were similar between the two groups (p > 0.05). In addition, changes in VA at 3, 6, and 12 months post treatment were similar. The central retinal thickness decreased with either treatment (p < 0.01); however, this change did not translate into VA performance (p > 0.05). In the subgroup analysis of pachychoroid and non-pachychoroid patients, better initial VA and post-treatment VA at 3 months and 6 months was noted in the latter group of patients treated with anti-vascular endothelial growth factor monotherapy (p < 0.05). Aflibercept monotherapy is comparable with PDT plus ranibizumab in PCV patients with PCV (pachychoroid and non-pachychoroid patients). In addition, better prognosis regarding VA was observed in non-pachychoroid patients treated with aflibercept monotherapy.
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13
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Doi A, Miyata M, Ooto S, Tamura H, Ueda-Arakawa N, Uji A, Muraoka Y, Miyake M, Takahashi A, Wakazono T, Yamashiro K, Tsujikawa A. Long-Term Visual Outcome in Inferior Posterior Staphyloma and Efficacy of Treatment for Complicated Choroidal Neovascularization. Am J Ophthalmol 2021; 229:152-159. [PMID: 33838120 DOI: 10.1016/j.ajo.2021.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate long-term visual outcome in inferior posterior staphyloma (IPS) in each group classified based on macular complications and to examine the treatment effect for eyes with IPS with choroidal neovascularization (CNV). DESIGN Prospective clinical cohort study. PARTICIPANTS We analyzed 56 eyes of 43 consecutive patients with IPS who were followed for 4 years. METHODS We classified eligible eyes into 3 groups based on baseline findings: eyes without CNV or retinal exudate (no-exudate group), eyes without CNV and with retinal exudate (exudate group), and eyes with CNV (CNV group). We investigated the best-corrected visual acuity (BCVA) and associated parameters for 4 years. RESULTS BCVA declined during 4 years only in the exudate group (P = .002), whereas it was maintained for 4 years in the no-exudate and CNV groups (P = .53 and .20, respectively). Baseline BCVA was lower in the CNV group than in the exudate group (P = .004); however, the 4-year BCVA was not (P = .84). The 4-year BCVA was associated with baseline BCVA in all groups. Eyes in the CNV group required 9.0 ± 8.7 anti-vascular endothelial growth factor therapy in 4 years. CONCLUSIONS Better baseline BCVA in eyes with exudative IPS without CNV spontaneously declined in 4 years, whereas worse baseline BCVA in eyes with IPS with CNV did not, probably because of treatment for retinal exudate from CNV. Anti-vascular endothelial growth factor therapy would be effective for long-term maintenance of BCVA in eyes with IPS with CNV, similar to other diseases with CNV.
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Affiliation(s)
- Ayaka Doi
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Manabu Miyata
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City.
| | - Sotaro Ooto
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Hiroshi Tamura
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Naoko Ueda-Arakawa
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Akihito Uji
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Yuki Muraoka
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Masahiro Miyake
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Ayako Takahashi
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Tomotaka Wakazono
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Kenji Yamashiro
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City; Department of Ophthalmology, Red Cross Otsu Hospital, Nagara, Otsu City, Shiga Prefecture, Japan
| | - Akitaka Tsujikawa
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
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14
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Roh HC, Kim SJ, Kang SW, Eun JS, Choi KJ. Long-term outcomes of polypoidal choroidal vasculopathy in comparison with typical exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 260:83-92. [PMID: 34350467 DOI: 10.1007/s00417-021-05190-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare long-term outcomes between typical exudative age-related macular degeneration (TexAMD) and polypoidal choroidal vasculopathy (PCV), and to investigate factors related to the outcomes. METHODS This retrospective study included 319 eyes (164 with TexAMD and 155 with PCV) treated with anti-vascular endothelial growth factor and followed more than 5 years. The primary outcome was visual acuity (VA) change from baseline to final visit. Linear regression analyses were used to determine factors associated with final VA. RESULTS Baseline logMAR VA was 0.7 ± 0.5 in the TexAMD group and 0.5 ± 0.4 in the PCV group (p < 0.001). After a mean follow-up of 9 years, final VA was also significantly worse in the TexAMD group than in the PCV group (0.9 ± 0.6 vs. 0.6 ± 0.5; p < 0.001). The PCV group showed longer maintenance of improved vision and later onset of significant visual decline than the TexAMD group. In multivariate analysis, loss to follow-up, worse baseline VA, macular atrophy, and subretinal fibrosis were significantly associated with poor final VA in both groups. CONCLUSION PCV eyes showed relatively favorable long-term visual outcome than TexAMD eyes. The results of this study emphasized the importance of compliance with treatment, along with other well-known prognostic factors.
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Affiliation(s)
- Hyeon Cheol Roh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jun Soo Eun
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Jun Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Tanaka K, Mori R, Wakatsuki Y, Onoe H, Kawamura A, Nakashizuka H. Two-Thirds Dose Photodynamic Therapy for Pachychoroid Neovasculopathy. J Clin Med 2021; 10:jcm10102168. [PMID: 34067863 PMCID: PMC8155862 DOI: 10.3390/jcm10102168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Pachychoroid neovasculopathy (PNV) is treated with antivascular endothelial growth factor (VEGF) injection and photodynamic therapy (PDT), but no curative treatment has yet been established. We aimed to clarify the treatment results of a reduced dose of PDT for PNV. The subjects were 27 eyes of 27 patients (male:female = 20:7, mean age 58.9 years). PDT, at 2/3 of the conventional dose (2/3PDT), was administered once. The patients were then observed for one year. Eyes with polypoidal choroidal vasculopathy (PCV) were excluded. We investigated the associations among the central retinal thickness, choroidal thickness, and visual acuity changes before treatment and one, three, six and 12 months after PDT. When serous retinal detachment was increased or unchanged or new hemorrhages were observed, as compared with pretreatment findings, intravitreal injection of an anti-VEGF agent was performed. Visual acuity was significantly improved, as compared to before treatment, at three, six, and 12 months after 2/3PDT. Foveal retinal thickness was significantly decreased after versus before treatment in the 2/3PDT group (p < 0.001). Foveal choroidal thickness was also significantly reduced in the 2/3PDT group (p = 0.001). Additional intravitreal anti-VEGF agent injections were administered to three patients (11%), while 24 (89%) required no additional treatment during the one-year follow-up period. For PNV without polyps, 2/3PDT appears to be effective.
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Affiliation(s)
- Koji Tanaka
- Correspondence: ; Tel.: +81-3-3293-1711 or +81-3-3292-2880
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16
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Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy. Sci Rep 2021; 11:2735. [PMID: 33531615 PMCID: PMC7854625 DOI: 10.1038/s41598-021-82316-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/19/2021] [Indexed: 12/02/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a vision-threatening disease common in Asian populations. However, the optimal treatment for PCV remains under debate. We searched the databases with optimal searching strategy. The study included randomized clinical trials and prospective studies that recruited patients with active PCV who had received interventions, including PDT, anti-VEGF, or a combination of PDT and anti-VEGF. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used for rating the quality of evidence. Our study included 11 studies involving 1277 patients. The network meta-analysis of RCTs revealed the anti-VEGF group, early combination group, and late combination group had significant BCVA changes compared with the PDT group. Early combination therapy led to a significant decrease in CRT compared with PDT, anti-VEGF, and late combination therapy. Additionally, the early combination group had a significantly higher complete polyp regression rate than the anti-VEGF group. No significant differences were detected in the analysis of the number of anti-VEGF injections and safety profile. This network meta-analysis revealed that early combination therapy exhibited better efficacy related to anatomical outcomes than other therapies. Nonetheless, no significant differences related to BCVA change could be detected between anti-VEGF and late combination therapy.
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17
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Azuma K, Okubo A, Nomura Y, Zhou H, Terao R, Hashimoto Y, Asano KS, Azuma K, Inoue T, Obata R. Association between pachychoroid and long-term treatment outcomes of photodynamic therapy with intravitreal ranibizumab for polypoidal choroidal vasculopathy. Sci Rep 2020; 10:8337. [PMID: 32433551 PMCID: PMC7239911 DOI: 10.1038/s41598-020-65346-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/30/2020] [Indexed: 11/30/2022] Open
Abstract
We investigated long-term treatment responses in patients with treatment-naïve polypoidal choroidal vasculopathy (PCV) undergoing photodynamic therapy (PDT) with intravitreal ranibizumab (IVR). The medical charts of 14 patients with treatment-naïve PCV who underwent PDT with IVR were retrospectively reviewed. Patients were followed up and treated with additional IVR for ≥3 years. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), greatest linear dimension (GLD) on angiography, polyp regression and central choroidal thickness (CCT) were assessed. Associations between these functional or anatomic outcomes with age, baseline CCT, baseline GLD or choroidal vascular hyperpermeability (CVH) were investigated using univariate and multivariate analysis. Mean logMAR BCVA improved significantly at 3 years (0.34 ± 0.24 to 0.12 ± 0.29, p = 0.003). Greater BCVA improvement and longer time to first recurrence was significantly associated with CVH. Fewer number of IVR retreatment within 3 years was associated with thicker baseline CCT. Mean CCT significantly decreased at 3 years (217 ± 33 µm to 197 ± 48 µm, p = 0.003). Greater decrease of CCT was significantly associated both with greater number of IVR retreatment within 3 years and absence of CVH. These results showed that pachychoroid characteristics at baseline was associated long-term functional and anatomic outcomes in patients with treatment-naïve PCV who had undergone combination PDT and IVR.
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Affiliation(s)
- Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Atsushi Okubo
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Yoko Nomura
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Hanpeng Zhou
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Kimiko Shimizu Asano
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Kunihiro Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
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18
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Komuku Y, Iwahashi C, Gomi F. Effectiveness of polypoidal lesion-selective photodynamic therapy with intravitreal antivascular endothelial growth factor for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2020; 64:265-270. [PMID: 32206935 DOI: 10.1007/s10384-020-00734-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the 24-month effectiveness of polypoidal lesion-selective photodynamic therapy (PDT) combined with antivascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with branching vascular networks (BVNs) involving the fovea with 1 or more polyps. STUDY DESIGN A retrospective case series. PATIENTS AND METHODS Twenty-six eyes from 25 PCV patients treated with polypoidal lesion-selective PDT combined with aflibercept were included in the study. The main outcome measure was change in best-corrected visual acuity (BCVA), and the secondary outcome measures were changes in central retinal thickness and subfoveal choroidal thickness on optical coherence tomography (OCT), status of exudation at 24 months, and number of additional treatments. RESULTS Fourteen eyes of 14 patients showed treatment-naïve PCV, and 12 eyes of 11 patients were switched from anti-VEGF monotherapy. The baseline mean logMAR BCVA was 0.43, and this had increased significantly, by 0.31, at 24 months (P = .034). The mean central retinal thickness (CRT) and central choroidal thickness (CCT) were significantly lower at all time points than those at baseline. The mean number of additional injections of aflibercept was 3.1 (range, 0-9), and that of additional PDT treatments was 0.5 (range, 0-2). CONCLUSION Polypoidal lesion-selective PDT with aflibercept was effective for relatively large, fovea-involved PCV, with significant visual improvement at 24 months.
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Affiliation(s)
- Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | | | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
- Department of Ophthalmology, Sumitomo Hospital, Osaka, Japan.
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Wataru K, Sugiyama A, Yoneyama S, Matsubara M, Fukuda Y, Parikh R, Sakurada Y. Five-year outcomes of photodynamic therapy combined with intravitreal injection of ranibizumab or aflibercept for polypoidal choroidal vasculopathy. PLoS One 2020; 15:e0229231. [PMID: 32092094 PMCID: PMC7039440 DOI: 10.1371/journal.pone.0229231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/31/2020] [Indexed: 11/19/2022] Open
Abstract
We report 5-year visual and anatomical outcomes after combination therapy of photodynamic therapy (PDT) and intravitreal injection of ranibizumab or aflibercept for polypoidal choroidal vasculopathy (PCV) and predictive factors for visual outcomes at 5-year and time to recurrence. Medical charts were retrospectively reviewed for 43 consecutive eyes with PCV treated with combination therapy of PDT and intravitreal injection of ranibizumab(n = 13) or aflibercept(n = 30) and completed 5-year follow-up. The variants of ARMS2 A69S and CFH I62V were genotyped using TaqMan assay. Best corrected visual acuity (BCVA) significantly improved at 5-year (P = 0.01) with 20% reduction of subfoveal choroidal thickness irrespective of presence or absence of recurrence. Visual improvement was associated with baseline shorter greatest linear dimension (GLD) (P = 1.0×10-4). Mean time to recurrence was 28.6±23.1 months (95% CI: 21.5-35.7, Median:18.0) and time to recurrence was associated with G allele (protective allele) of ARMS2 A69S and GLD (P = 4.0×10-4 and 1.0×10-2, respectively). Multiple regression analysis revealed that time to recurrence extended by 15.5 months when the G allele of ARMS2 A69S increased by one allele (TT: 15.7±17.0, TG: 30.8±23.5, GG: 41.1±22.6 months). The combination therapy resulted in a favorable visual outcome for PCV during 5-year follow-up.
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Affiliation(s)
- Kikushima Wataru
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Kofu, Japan
| | - Atsushi Sugiyama
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Kofu, Japan
| | - Seigo Yoneyama
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Kofu, Japan
| | - Mio Matsubara
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Kofu, Japan
| | - Yoshiko Fukuda
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Kofu, Japan
| | - Ravi Parikh
- New York University School of Medicine, New York, New York, United States of America
- Manhattan Retina and Eye Consultants, New York, New York, United States of America
| | - Yoichi Sakurada
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Kofu, Japan
- * E-mail:
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Chen LJ, Cheng CK, Yeung L, Yang CH, Chen SJ, Chen JT, Chen LJ, Chen SN, Chen WL, Cheng CK, Hsu SM, Hwang DK, Lai CC, Lai CH, Lee FL, Yang CH, Yang CM, Yeung L, Wu TT, Chen SJ. Management of polypoidal choroidal vasculopathy: Experts consensus in Taiwan. J Formos Med Assoc 2020; 119:569-576. [DOI: 10.1016/j.jfma.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
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Cho HJ, Kim K, Lim SH, Kang DH, Kim JW. Retinal pigment epithelial atrophy after anti-vascular endothelial growth factor therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol 2020; 104:1443-1447. [PMID: 31896542 DOI: 10.1136/bjophthalmol-2019-315496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND/AIMS To describe the risk factors for the development of retinal pigment epithelial (RPE) atrophy following intravitreal anti-vascular endothelial growth factor (VEGF) injection treatment for polypoidal choroidal vasculopathy (PCV). METHODS We retrospectively included 162 eyes of 162 treatment-naïve patients with PCV in this study. All patients were treated with an initial series of three monthly loading doses of anti-VEGF injections, followed by further injections as required. Baseline ocular characteristics and lesion features were assessed using fluorescein angiography, indocyanine green angiography and spectral domain optical coherence tomography, to determine and evaluate the potential risk factors for RPE atrophy through 2 years of follow-up. RESULTS RPE atrophy had developed in 17 of 162 eyes (10.5%) after 2 years of anti-VEGF treatment. Nine cases (53.0%) of RPE atrophy occurred at branching vascular networks, and eight (47.0%) developed at locations with polyp or polyp-associated pigment epithelial detachment. Among the baseline characteristics, the mean subfoveal choroidal thickness was significantly thinner (192±98 vs 288±152; p=0.009) and presence of subretinal drusenoid deposits was significantly more frequent in eyes with RPE atrophy (11.8% vs 2.1%; p=0.028). Using multiple logistic regression analysis, the mean subfoveal choroidal thickness (OR 0.975; 95% CI 0.929 to 1.324; p=0.002) was identified as a significant risk factor for the development of RPE atrophy. CONCLUSIONS Approximately one-tenth of the patients with PCV developed RPE atrophy during the 24 months after intravitreal anti-VEGF injections. Subfoveal choroidal thinning at baseline is associated with increased risk of post-treatment RPE atrophy.
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Affiliation(s)
- Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Kunhae Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Soo Hyun Lim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Dong Hyun Kang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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