ObjectiveTo systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV), and to investigate the primary treatment tentatively.
MethodsA systematic search of Pubmed, Embase, the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone, intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy. Outcomes of interest included the regression and recurrence rate of polypoidal lesions, best corrected visual acuity (BCVA), central retinal thickness (CRT), therapeutic times, and the occurrence rate of adverse events. 2 randomized controlled trials (RCT) and 19 non-RTCs were identified. According to treatment methods, the data extracted was classified to 3 groups, analyzed with odds ratio (OR), weighted mean difference (WMD) and 95%confidence interval (95%CI).
ResultsMeta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34, 0.07; 95%CI=0.13-0.88, 0.02-0.36) and BCVA (WMD=0.25, 0.11; 95%CI=0.14-0.36, 0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P < 0.05). The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35, 95%CI=0.16-0.74, P=0.006). BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36, 95%CI=6.04-603.50, P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group.
ConclusionsCombined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone. Combined treatment takes priority over all others in the primary treatment of PCV.
ObjectiveTo quantitatively analyze the changes of choroidal capillaries in chronic central serous chorioretinopathy (CCSC) before and after half-dose photodynamic therapy (PDT).MethodsA retrospective cohort study. Nineteen patients (21 eyes) with CCSC were enrolled in this study from November 2017 to September 2018 in People’s Hospital of Wuhan University. Among them, there were 14 males (15 eyes) and 5 females (6 eyes), with diseases course over than 6 months. All patients underwent half-dose PDT. Twenty normal subjects (40 eyes) matched with age and sex in CCSC group were taken as controls. The subfoveal choroidal thickness (SFCT) was measured by Heidelberg depth enhanced imaging-OCT before and after PDT treatment in CCSC patients and in normal subjects. Spectral-domain OCT (Retina map) and Angio-OCT angiography (3 mm×3 mm) were arranged for all subjects at the same time. Macular fovea retinal thickness (CMT) was recorded under OCT-Retina map mode, and Angio-OCT 3 mm×3 mm choroidal capillary images were binarized using Image J software, and calculating the area ratio of low pixel area as flow signal void (FSV). BCVA, spectral-domain OCT and Angio-OCT were performed 1 week and 1, 3 months after PDT with the same equipment and methods before PDT. The changes of CMT, SFCT, FSV and BCVA in CCSC patients before and after PDT treatment were compared. Pearson correlation analysis was used to analyze the correlation between FSV and SFCT, age.ResultsThe average CMT, SFCT and FSV in CCSC patients increased significantly compared with the controls (P＜0.05). The average SFCT and FSV in CCSC patients 3 months after treatment were higher and the average CMT decreased compared with the controls (P=0.000, 0.000, 0.000). Comparison before and after PDT in CCSC patients: there were significant differences in average CMT, SFCT and FSV before and after PDT (P=0.000, 0.000, 0.000). Post Hoc multiple comparisons showed that the average CMT (P=0.000, 0.000, 0.000, 0.000, 0.000) and FSV (P=0.010, 0.000, 0.000, 0.001, 0.000) decreased significantly in all time points except for 1 month and 3 months after treatment, so as the average FSV (P=0.788, 0.702). The average SFCT decreased 1 month and 3 months after treatment compared with the baseline (P=0.024, 0.008), and there was no significant difference between before treatment and 1 week after treatment (P=0.162), and between 1 month and 3 months after treatment (P=0.687). The correlation analysis showed that there was no correlation between FSV and age in CCSC patients (r=0.052, P=0.822), but there was a correlation between FSV and age in controls (r=0.716, P=0.000).ConclusionQuantitative analysis of OCTA showes the degree of choriocapillary ischemia in the form of FSV in CCSC patients decreased after PDT treatment, however, which is still higher than normal controls.
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.
ObjectiveTo observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV).
MethodsEighty-six eyes of 79 patients with PCV were enrolled in this study. There were 60 males (65 eyes) and 19 females (21 eyes). The average age was (64.48±13.15) years old. Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured. The average BCVA was 0.19±0..20. There were three groups in this study including photodynamic therapy (PDT) group (group A, 45 eyes), PDT and intravitreal ranibizumab injection group (group B, 31 eyes), and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C, 10 eyes). Follow up begun at 1 month after the treatment. 40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months. 9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months. Patients with recurrent or worsen lesions were followed by FFA or ICGA. Pre- and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed.
ResultsAll eyes (100.0%) in group A, 20 eyes (64.52%) in group B and 9 eyes (90.00%) in group C received treatment only once. The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061, 3.262, 3.258; P<0.05), but no significant difference was found between the 3 groups (t=1.345, 0.683, 0.168; P>0.05). Compared to pre-treatment measures, the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239, 4.334; P<0.05), but not changed in group C (t=2.286, P>0.05) at 1 month after treatment. Thirteen eyes in group A were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED), 4 eyes with partial closed PCV, 3 eyes with stable PCV and 3 eyes with worsen PCV. Ten eyes in group B were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV, 3 eyes with partial closed PCV, 4 eyes with recurrence PCV. Five eyes in group C were followed by FFA and (or) ICGA, which showed that there were 4 eyes with complete closed PCV, 1 eyes with recurrence PCV.
ConclusionAll 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.
Objective To evaluate the efficacy and safety of intravitreal anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) vs. photodynamic therapy for polypoidal choroidal vasculopathy (PCV).Methods A computerized search was conducted in Pubmed, OVID, Chinese Biological Medicine Database（CBM）,China National Knowledge Infrastructure （CNKI） by using key words ldquo;polypoidal choroidal vasculopathy, photodynamic therapy, intravitreal anti-VEGFrdquo; in Chinese and/or English combined with manually searching of bibliographies of pertinent articles, journals and literature reference proceedings. Randomized controlled trials (RCT) and non-RCT were collected. The search time was ranged from establishment of each database to September, 2011. The search was no 1imitation in language. The best corrected visual acuity (BCVA),resolution and recurring of lesions, decrease or complete resolution of pigment epithelial detachment （PED）,visual extinction or blindness rate,the rate of subretinal hemorrhage were analyzed by RevMan 5.0 software. Results In total, one RCT and four non-RCTs (273 patients) were included in the meta-analysis involving 148 patients in single treatment group and 125 patients in combined treatment group. The results of metaanalyses showed that there was no significant difference between two groups in the mean logarithm of minimal angle of resolution BCVA at six months ［standard mean difference=0.01, 95% confidence interval (CI): -0.12- 0.14,P=0.84］and 12 months ［standard mean difference = 0.04, 95%CI: -0.16-0.25,P=0.69 after treatment. There was no significant difference between two groups in the resolution of lesions ［odds ratio (OR)=1.38,95%CI:0.74-2.55,P=0.31］ at the months after treatment and decrease or complete resolution of PED (OR=0.67,95%CI:0.12-3.69,P=0.65) at 12 months after treatment. There was no significant difference between two groups in the recurring of lesions (OR=1.14, 95% CI:0.58-2.24,P=0.71) and lost of ge; three lines vision or blindness rate (OR=1.20, 95%CI:0.34-4.18,P=0.78) at 12 months after treatment. The rate of subretinal hemorrhage in combine treatment group was significant lower than single treatment group (OR=0.41, 95%CI:0.18 -0.94,P=0.04). Conclusions The incidence of subretinal hemorrhage occurred in patients with PCV after intravitreal anti-VEGF combined with PDT is much lower than that after single PDT.But the visual improvement, resolution of lesions and recurring of lesions of combined treatment need further studied to see if it is better than single PDT.
ObjectiveTo observe the clinical effect of prolonged photodynamic therapy (PDT) irradiation time combined with intravitreal injection of ranibizumab in the treatment of circumscribed choroidal hemangioma (CCH).MethodsA retrospective clinical study. From March 2012 to March 2018, 51 eyes of 51 patients diagnosed in Shenzhen Eye Hospital were included in the study. Among the patients, the tumor of 36 eyes were located in macular area, of 15 eyes were located outside macular area (near center or around optic disc). All patients underwent BCVA, color fundus photography, FFA, ocular B-scan ultrasonography and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. OCT showed 48 eyes with macular serous retinal detachment. of 36 eyes with tumor located in macular area, the logMAR BCVA was 0.05±0.05, the tumor thickness was 4.5±2.2 mm, the diameter of tumor was 9.7±3.6 mm. Of 15 eyes with tumor located outside macular area, the logMAR BCVA was 0.32±0.15, the tumor thickness was 3.8±1.4 mm, the diameter of tumor was 7.7±1.9 mm. PDT was performed for all eyes with the irradiation time of 123 s. After 48 h, all patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml). At 1, 3 and 6 months after treatment, the same equipment and methods before treatment were used for related examination. BCVA, subretinal effusion (SRF), tumor leakage and size changes were observed. BCVA, tumor thickness and diameter before and after treatment were compared by t test.ResultsAt 6 months after treatment, the tumor was becoming smaller without scar formation. FFA showed that the blood vessels in the tumor were sparse compared with those before treatment, and the fluorescence leakage domain was reduced. OCT showed 43 eyes of macular serous detachment were treated after the combined treatment. The logMAR BCVA were 0.16±0.15 and 0.55±0.21 of the eyes with tumor located in or outside macular area, respectively. The difference of logMAR BCVA between before and after treatment was significant (t=－2.511, －2.676; P=0.036, 0.040). Both the tumor thickness (t=3.416, 3.055; P=0.011, 0.028) and diameter (t=4.385, 4.171; P=0.002, 0.009) of CCH patients were significantly reduced compared with that before treatment.ConclusionThe tumor of CCH can be reduced by prolonged PDT irradiation time combined with intravitreal injection of ranibizumab.
ObjectiveTo compare the visual outcomes of treatment with intravitreal ranibizumab alone or in combination with photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).
MethodsIn this retrospective and comparative study, 36 eyes of 36 patients with PCV were enrolled. Eighteen eyes received 0.5 mg (0.05 ml) ranibizumab injection only (simple injection group) and the other 18 eyes underwent combination therapy of ranibizumab injection and PDT (combination treatment group). Intravitreal ranibizumab was given at the third day after PDT. Re-treatment was considered in clinic examination. The minimum re-treatment interval was 3 months for combination therapy and 1 month for ranibizumab. Best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) at baseline and each follow-up visit at 1, 3, 6, 12 month was measured as a primary outcome, and complications also observed in every follow-up.
ResultsNo complications occurred in these 36 patients during the treatment or follow-up, such as retinal detachment, sustained high intraocular pressure, retinal holes, intraocular inflammation, and systemic adverse reactions. The average times of ranibizumab injections of simple injection group and combined treatment group were (3.00±0.84) and (1.89±0.68) times respective, and the difference was significant (t=4.370, P=0.000). The logMAR BCVA of the first and third month after initial treatment between two groups were significant different (t=0.668, 0.940; P>0.05). However, there was no significant difference between them at the 6th and 12th month (t=2.188, 2.547; P<0.05). In the last follow-up, the logMAR BCVA were improved in simple injection group and combination treatment group compared to the pre-treatment values (t=3.351, 9.408; P=0.012, 0.000). In simple injection group, visual acuity was improved in 3 eyes (16.7%), stable in 13 eyes (72.2%) and decreased in 2 eyes (11.1%). In combination treatment group, visual acuity was improved in 4 eyes (22.2%), stable in 13 eyes (72.2%) and decreased in 1 eyes (5.6%).
ConclusionsIntravitreal ranibizumab injection and combined with PDT are both effective to improve vision in patients with PCV. Visual acuity was the same between the two treatments in 3 months after initial treatment; however 6 to 12 months after first treatment, patients received PDT combined with intravitreal ranibizumab injection had better visual acuity than those received the intravitreal ranibizumab injection only.
Objective
To evaluate short-term effects of a single photodynamic therapy (PDT) treatment with visudyne (CIBA Vision Corp.) for choroidal neovascularization (CNV) in age-ralated macular degeneration (AMD).
Methods
Thirty cases (35 eyes) diagnosed as AMD patients with classic CNV were treated with PDT. The data of visual acuity testing, fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography （OCT) were used to evaluate the effects of a single treatment of PDT before and 1 week, 1 ,3 month after treatment.
Results
The visual acuity of 34 eyes were stable or improved in 3 months follow-up；and the visual acuity of 1 eye was decreased. Decrease or dispearance of fluorescein leakage from CNV was noted in 19 eyes. No serious complication occurred.
Conclusion
Single treatment of PDT for CNV in AMD can achieve short-term decrease or cessation of fluorescein leakage from CNV without loss of visual acuity.
(Chin J Ocul Fundus Dis, 2002, 18: 171-174)
