Miyakubo Tomoko, Mukai Ryo, Matsumoto Hidetaka, Morimoto Masahiro, Takahashi Maki, Nagai Kazuki, Nakamura Kosuke, Hoshino Junki, Akiyama Hideo
Department of Ophthalmology, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan.
Clin Ophthalmol. 2023 Feb 11;17:571-577. doi: 10.2147/OPTH.S386222. eCollection 2023.
To compare the efficacies of photodynamic therapy (PDT) combined with intravitreal aflibercept (IVA) injections and IVA monotherapy using a treat-and-extend regimen (TAE) for treatment-naïve polypoidal choroidal vasculopathy (PCV).
One hundred and nine eyes treated with PDT combined with IVA (PDT+IVA group: 51 eyes) or IVA monotherapy (IVA group: 58 eyes) were assessed for 2 years. The main outcome measures included best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), number of IVA injections, and macular atrophy (MA). Polypoidal lesions before and after the loading phase were assessed using indocyanine green angiography.
In both groups, BCVA significantly improved after the loading phase and was maintained for 2 years. CMT and CCT were significantly reduced in both groups, without significant differences after 2 years between the groups (P=0.2708). The mean number of IVA injections in the IVA and PDT+IVA groups during the 2 years were 13.2±3.3 and 12.7±1.8, respectively, without a significant difference (P=0.06). The frequencies of MA expansion in the IVA and PDT+IVA groups during the 2 years were 25.9% and 33.4%, respectively, with no significant difference in the incidence (odds ratio: 1.40, P=0.4253). The ratios of polyp regression after the loading phase in the IVA and PDT+IVA groups were 55.2% and 94.1%, respectively, with a significant difference (P<0.0001).
PDT combined with IVA injections using a TAE regimen is effective for anatomical and visual function improvement, without a significant difference as compared to IVA monotherapy. It can facilitate complete regression of polyps with higher odds.
比较光动力疗法（PDT）联合玻璃体内注射阿柏西普（IVA）与单纯IVA单药治疗并采用治疗-延长方案（TAE）治疗初治息肉样脉络膜血管病变（PCV）的疗效。
对109只接受PDT联合IVA治疗（PDT+IVA组：51只眼）或IVA单药治疗（IVA组：58只眼）的眼睛进行了2年的评估。主要观察指标包括最佳矫正视力（BCVA）、中心黄斑厚度（CMT）、中心脉络膜厚度（CCT）、IVA注射次数和黄斑萎缩（MA）。使用吲哚菁绿血管造影评估负荷期前后的息肉样病变。
两组在负荷期后BCVA均显著改善，并维持2年。两组的CMT和CCT均显著降低，2年后两组间无显著差异（P=0.2708）。IVA组和PDT+IVA组在2年期间的平均IVA注射次数分别为13.2±3.3次和12.7±1.8次，无显著差异（P=0.06）。IVA组和PDT+IVA组在2年期间MA扩展的频率分别为25.9%和33.4%，发生率无显著差异（优势比：1.40，P=0.4253）。IVA组和PDT+IVA组在负荷期后息肉消退的比例分别为55.2%和94.1%，有显著差异（P<0.0001）。
采用TAE方案的PDT联合IVA注射对改善解剖结构和视觉功能有效，与IVA单药治疗相比无显著差异。它可以促进息肉的完全消退，几率更高。
