Department of Ophthalmology, Osaka University Medical School, Japan.
Am J Ophthalmol. 2010 Jul;150(1):48-54.e1. doi: 10.1016/j.ajo.2010.02.008.
To compare the efficacy of photodynamic therapy (PDT) with or without intravitreal bevacizumab injection for polypoidal choroidal vasculopathy.
Retrospective, comparative, interventional case series.
We included 146 eyes of 146 patients with treatment-naïve polypoidal choroidal vasculopathy including the subfoveal region treated with PDT monotherapy or combined with intravitreal bevacizumab injection. Treatments were chosen according to the time period. For eyes that received combination therapy, bevacizumab (1.25 mg) was administrated 1 day before PDT. All eyes were followed up for at least 12 months. Ophthalmic evaluations, including measurement of the best-corrected visual acuity and optical coherence tomography, were performed at every visit. Indocyanine green angiography and fluorescein angiography were performed every 3 months.
Sixty-one eyes were treated with PDT combined with bevacizumab and 85 eyes were treated with PDT monotherapy. The mean best-corrected visual acuity was significantly better in the combined treatment group than in the monotherapy group at 3 months (P = .0016), 6 months (P = .028), 9 months (P = .038), and 12 months (P = .048). However, lesions resolved in 78.7% of eyes in the combined group and in 75.3% in the monotherapy group; the recurrence rates were 43.8% and 40.6%, respectively, and did not differ significantly. The rate of development of subretinal hemorrhage within 1 month from the initial treatment was significantly lower in the combined group than in the PDT monotherapy group (4.5% vs 17.7%; P = .023).
Photodynamic therapy combined with bevacizumab injection offers significantly better early visual outcomes than PDT alone. Combined treatment did not affect the resolution and recurrence of lesions; however, it decreased the rate of development of PDT-related hemorrhages.
比较光动力疗法（PDT）联合与不联合玻璃体内贝伐单抗注射治疗息肉状脉络膜血管病变的疗效。
回顾性、对照、干预性病例系列研究。
我们纳入了 146 例 146 只治疗初发息肉状脉络膜血管病变的患眼，病变累及中心凹下区域，这些患眼接受 PDT 单药治疗或 PDT 联合玻璃体内贝伐单抗注射治疗。治疗方案的选择依据治疗时间而定。接受联合治疗的患眼，在 PDT 治疗前 1 天给予贝伐单抗（1.25mg）。所有患眼均至少随访 12 个月。每次就诊时均进行眼科评估，包括最佳矫正视力和光学相干断层扫描检查。每 3 个月行吲哚青绿血管造影和荧光素血管造影检查。
61 只眼接受 PDT 联合贝伐单抗治疗，85 只眼接受 PDT 单药治疗。治疗后 3 个月（P =.0016）、6 个月（P =.028）、9 个月（P =.038）和 12 个月（P =.048），联合治疗组的最佳矫正视力明显优于单药治疗组。联合治疗组病变完全消退率为 78.7%，单药治疗组为 75.3%，两组差异无统计学意义；联合治疗组的复发率为 43.8%，单药治疗组为 40.6%，两组差异无统计学意义。初始治疗后 1 个月内发生视网膜下出血的比例，联合治疗组明显低于 PDT 单药治疗组（4.5%比 17.7%；P =.023）。
与 PDT 单药治疗相比，PDT 联合玻璃体内贝伐单抗注射治疗能显著提高早期视力预后。联合治疗并未影响病变的消退和复发，但降低了 PDT 相关出血的发生率。
