J Korean Ophthalmol Soc.  2010 May;51(5):684-692.

Intravitreal Bevacizumab With or Without Photodynamic Therapy for the Treatment of Polypoidal Choroidal Vasculopathy

• Lee JK
• Lee JW
• Lee JE
• Oum BS

Abstract

PURPOSE
To compare the efficacy of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab and bevacizumab monotherapy in polypoidal choroidal vasculopathy (PCV).
METHODS
Twenty-six eyes, diagnosed with PCV were reviewed retrospectively. They were divided into two groups: combined treatment (COMB) and bevacizumab monotherapy (BEV). Visual acuity, fluorescein angiography (FA) and indocyanine green angiography (ICG) results were reviewed to compare changes in the polypoidal vessels and the branching vascular networks.
RESULTS
Among 26 eyes of 26 patients, there were 12 eyes in the COMB group and 14 eyes in the BEV group. Follow-up periods were about 42 weeks and 48 weeks for the respective groups. In the COMB group, visual acuity improved from log MAR 0.92 to 0.56, whereas visual acuity in the BEV group changed only minimally from log MAR 0.98 to 0.97. In the COMB group, the polypoidal vessel resolved in six eyes. In the BEV group, the polypoidal vessel resolved in one eye. In the COMB group, the vascular network resolved in one eye, improved in ten eyes, and did not change in one eye. In the BEV group, the vascular network did not change in any of the 14 eyes.
CONCLUSIONS
Combined treatment with PDT and intravitreal bevacizumab resulted in a more prolonged effect, induced the resolution of polypoidal vessels more effectively than did bevacizumab monotherapy, and is expected to reduce recurrence and retreatment.

Keyword

Bevacizumab; Photodynamic therapy; Polypoidal choroidal vasculopathy

MeSH Terms

Angiography
Antibodies, Monoclonal, Humanized
Choroid
Eye
Fluorescein Angiography
Follow-Up Studies
Glycosaminoglycans
Humans
Indocyanine Green
Photochemotherapy
Porphyrins
Recurrence
Retreatment
Retrospective Studies
Triazenes
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized
Glycosaminoglycans
Indocyanine Green
Porphyrins
Triazenes

Figure

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  Figure 1. Changes of best corrected visual acuity in LogMAR (logarithm of the minimum angle of resolution) after the combination treatment (COMB) and the bevacizumab monotheray (BEV) for polypoidal choroidal vasculopathy (*; P <0.05).

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  Figure 2. Changes of central foveal thickness after the combination treatment (COMB) and the bevacizumab monotheray (BEV) for polypoidal choroidal vasculopathy.

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  Figure 3. Changes of polypoidal vessels and branching vascular network in indocyanine green angiography after the combination treatment group (COMB) and the bevacizumab monotherapy group (BEV, p<0.05)

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  Figure 4. Fundus photograph, indocyanine green angiograms (ICG) and optical coherence tomography (OCT) scans of left eye of COMB group patient, 65 years old man with polypoidal choroidal vasculopathy before intravitreal bevacizumab. (A) Pretreatment fundus photograph showing pigment epithelial detachment (PED) involving the fovea. The patient's best-corrected visual acuity was 0.1. (B), (C) Early and late phases ICG at baseline showed polypoidal lesions. (D) OCT at baseline showed PED with intraretinal cystic fluid. (E) After 3 months of combination therapy with PDT and bevacizumab and after 5 weeks of second bevacizumab injection, the fundus photo showed reduced exudation and fibrosis of macula and the patient's visual acuity improved to 0.32. (F), (G) ICG showed complete regression of the polypoidal lesions. (H) OCT showed absence of subretinal fluid with reduction of PED.

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  Figure 5. Fundus photograph, indocyanine green angiograms (ICG) and optical coherence tomography (OCT) scans of the right eye of BEV group patient, 74-year-old man with polypoidal choroidal vasculopathy before intravitreal bevacizumab. (A) Pretreatment fundus photograph showing serous elevation involving the fovea. The patient's best-corrected visual acuity was 0.32. (B), (C) Early and late phases ICG at baseline showed polypoidal lesions. (D) OCT at baseline showed intraretinal cystic fluid. (E) At 1 months, after two injections of intravitreal bevacizumab, OCT showed a reduction in the subretinal fluid. (F) After another one more injection of intravitreal bevacizumab, the fundus photograph showed a reduction in subretinal elevation, but the patient's vision did not improve. (G), (H) ICG still showed persistent polypoidal lesions with reduced leakage. (I) OCT showed absence of the subretinal fluid.

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  Figure 6. Fundus photograph, indocyanine green angiograms (ICG) and optical coherence tomography (OCT) scans of the right eye of COMB group patient, 81-year-old man with polypoidal choroidal vasculopathy before intravitreal bevacizumab. (A) Pretreatment fundus photograph showing diffuse subretinal exudation and serous detachment involving the fovea. The patient's best corrected visual acuity was 0.02. (B), (C) Early and late phases ICG at baseline showed polypoidal lesions and diffuse branching vascular network. (D) OCT at baseline showed serous detachment with intraretinal cystic fluid. (E) After 5 months of combination therapy with PDT and bevacizumab and another two times of bevacizumab injection was done, the fundus photograph showed reduced exudation and fibrosis of the macula and the patient's visual acuity improved to 0.32. (F), (G) ICG showed regression of the polypoidal lesions and branching vascular network. (H) OCT showed decrease in subretinal fluid.

Reference

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