National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.
BMC Ophthalmol. 2020 Apr 15;20(1):150. doi: 10.1186/s12886-020-01419-8.
The EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV). The optimal PDT protocol remains controversial and it is postulated that less intensive PDT strategies may reduce complications. We aimed to compare the efficacy of reduced and standard-fluence PDT.
Case-control review of 38 consecutive PDT-naïve macular PCV patients who underwent verteporfin PDT using one of two PDT regimens at a tertiary referral centre in an Asian population. Comparison of outcomes between standard-fluence PDT (light dose, 50 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 83 s) and reduced-fluence PDT (light dose, 25 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 42 s). Primary outcome measure was best corrected LogMAR visual acuity (VA). Secondary outcome measures included OCT measurements such as central retinal thickness (CRT), height of subfoveal sub-retinal fluid (SRF), central choroid thickness (CCT), mean number of PDT treatments needed, mean number of anti-VEGF injections needed, polyp closure and recurrence rates.
Of these 38 eyes of 38 patients, an equal number of eyes (19 in each arm) were treated with standard-fluence and reduced-fluence PDT. Mean letter gain at 12 months for the standard-fluence group was 6.0 compared to 4.3 letters for the reduced-fluence group (p = 0.61). Similar results were observed at all time points. There was no statistically significant difference between the retinal and choroidal anatomical OCT outcomes, rates of polyp closure and recurrences between the two PDT regimens.
Reduced-fluence PDT was comparable to standard-fluence PDT in the treatment of PCV in terms of visual gains, clinical and anatomical OCT outcomes.
EVEREST II 研究报道，在治疗息肉状脉络膜血管病变（PCV）时，联合标准光动力疗法（PDT）与玻璃体内雷珠单抗治疗可显著提高息肉封闭率和视力预后。目前，对于最佳 PDT 方案仍存在争议，有观点认为强度较低的 PDT 策略可能会减少并发症。本研究旨在比较低强度和标准强度 PDT 的疗效。
对在亚洲人群中于一家三级转诊中心接受维替泊芬 PDT 的 38 例初治 PCV 患者进行病例对照回顾性研究，这些患者采用两种 PDT 方案之一进行治疗。比较标准强度 PDT（光剂量为 50 J/cm2；剂量率为 600 mW/cm2；波长为 689nm，将 PDT 应用于治疗眼 83s）和低强度 PDT（光剂量为 25 J/cm2；剂量率为 600 mW/cm2；波长为 689nm，将 PDT 应用于治疗眼 42s）的结果。主要观察指标为最佳矫正视力（BCVA）的 LogMAR 测量值。次要观察指标包括 OCT 测量结果，如中心视网膜厚度（CRT）、中心下视网膜下液（SRF）高度、中心脉络膜厚度（CCT）、所需 PDT 治疗次数、所需抗 VEGF 注射次数、息肉封闭率和复发率。
在这 38 例患者的 38 只眼中，各有 19 只眼接受了标准强度和低强度 PDT 治疗。标准强度组在 12 个月时的平均字母增益为 6.0，而低强度组为 4.3（p=0.61）。在所有时间点均观察到类似的结果。两种 PDT 方案之间在视网膜和脉络膜解剖学 OCT 结果、息肉封闭率和复发率方面无统计学差异。
在治疗 PCV 方面，低强度 PDT 在提高视力、临床和解剖学 OCT 结果方面与标准强度 PDT 相当。
