Medical Retina, Singapore National Eye Centre, Singapore, Singapore Eye Research Institute.
Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, 11 Third Hospital Avenue, Singapore 168751, Singapore.
Retina. 2018 Aug;38(8):1509-1517. doi: 10.1097/IAE.0000000000001758.
To investigate the influence of choroidal vascular hyperpermeability (CVH) and choroidal thickness on treatment outcomes in eyes with polypoidal choroidal vasculopathy (PCV) undergoing anti-vascular endothelial growth factor monotherapy or combination therapy of photodynamic therapy and anti-vascular endothelial growth factor injections.
The authors performed a prospective, observational cohort study involving 72 eyes of 72 patients with polypoidal choroidal vasculopathy (mean age 68.6 years, 51% men) treated with either monotherapy (n = 41) or combination therapy (n = 31). Each eye was imaged with color fundus photography, fluorescent angiography, indocyanine green angiography, and spectral domain optical coherence tomography. Indocyanine green angiography images were used to evaluate CVH, and spectral domain optical coherence tomography was used to measure central choroidal thickness. Changes in visual acuity over 12 months, and number of anti-vascular endothelial growth factor injections were investigated.
Choroidal vascular hyperpermeability was present in 31 eyes (43.1%). Visual acuity change over 12 months was numerically better in the CVH group compared with the CVH (-) group (-0.099 and -0.366 logarithm of the minimal angle of resolution unit in the CVH (-) and CVH (+) groups, respectively, multivariate P = 0.063) and significantly better in a matched pair analysis (P = 0.033). Furthermore, in the combination therapy group, the number of injection was significantly lower in the CVH (+) group compared with the CVH (-) group (4.68 vs. 2.58 injections/year in the CVH (-) and CVH (+) groups; P = 0.0044). There was no significant relationship between treatment response and choroidal thickening.
The presence of CVH is associated with better visual outcome in eyes with polypoidal choroidal vasculopathy and lower injection number in combination therapy. Thus, CVH, but not choroidal thickness, should be further evaluated as a potential biomarker for selecting patients for combination therapy.
研究脉络膜血管通透性增加（CVH）和脉络膜厚度对接受抗血管内皮生长因子单药治疗或光动力疗法联合抗血管内皮生长因子注射联合治疗的息肉样脉络膜血管病变（PCV）患者治疗效果的影响。
作者进行了一项前瞻性、观察性队列研究，共纳入 72 例（72 只眼）息肉样脉络膜血管病变患者（平均年龄 68.6 岁，51%为男性），分别接受单药治疗（n=41）或联合治疗（n=31）。每只眼均进行彩色眼底照相、荧光血管造影、吲哚菁绿血管造影和谱域光相干断层扫描检查。吲哚菁绿血管造影图像用于评估 CVH，谱域光相干断层扫描用于测量中心脉络膜厚度。观察 12 个月时视力变化和抗血管内皮生长因子注射次数。
31 只眼（43.1%）存在 CVH。12 个月时，CVH 组的视力变化较 CVH（-）组更好（CVH（-）和 CVH（+）组分别为-0.099 和-0.366 对数最小分辨角单位，多变量 P=0.063），配对分析差异更显著（P=0.033）。此外，在联合治疗组中，CVH（+）组的注射次数明显少于 CVH（-）组（CVH（-）和 CVH（+）组分别为 4.68 和 2.58 次/年；P=0.0044）。治疗反应与脉络膜增厚之间无显著关系。
息肉样脉络膜血管病变患者存在 CVH 与视力预后较好和联合治疗时注射次数较少相关。因此，CVH 而非脉络膜厚度应作为潜在的生物标志物，进一步评估其在选择联合治疗患者中的作用。
