Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo Hospital, Tokyo, 113-8655, Japan.
Department of Ophthalmology, Shinseikai Toyama Hospital, Toyama, Japan.
Graefes Arch Clin Exp Ophthalmol. 2024 Jun;262(6):1811-1818. doi: 10.1007/s00417-024-06387-z. Epub 2024 Jan 31.
To examine the long-term visual outcomes after initial treatment with combined photodynamic therapy (PDT) or aflibercept treat-and-extend (TAE) monotherapy in patients with pachychoroid neovasculopathy (PNV).
Patients diagnosed with PNV, initially treated with PDT combined with anti-vascular endothelial growth factor (VEGF) or intravitreal aflibercept (IVA) monotherapy in the TAE protocol and followed up for at least 6 months, were included in the study. Medical records were retrospectively reviewed. Survival analysis was performed, in which deterioration in logMAR visual acuity by 0.1 or 0.3 is defined as "death." The annual number of treatments was also analyzed. Sub-analysis was performed on 33 patients diagnosed with PNV without polypoidal lesions.
This study included 46 patients (23 in the initial combined PDT group and 23 in the IVA TAE group). Mean age, sex, mean baseline logMAR visual acuity, or duration of observation (3.6 ± 3.2 years vs. 3.1 ± 1.9 years) in both groups were comparable. As for visual outcome, no significant differences were found in survival analysis based on worsening of 0.1 or 0.3 logMAR (3-year survival; 26% vs. 26%, 91% vs. 90%, respectively). Meanwhile, the additional number of anti-VEGF injections per year was significantly lower in the initial combined PDT group than in the IVA TAE group (1.0 ± 1.3 vs. 4.1 ± 1.5, p < 0.0001). No significant differences were found in the number of additional PDTs per year (0.07 ± 0.20 vs. 0.02 ± 0.09, p = 0.27). Similar results were found in a sub-analysis of 33 patients without polyps.
In the treatment of PNV, regardless of the presence of polyps, the long-term visual outcomes were similar between the initial combined PDT and IVA TAE monotherapy. However, the annual number of anti-VEGF injections was lower in the initial combined PDT group than in the aflibercept TAE group, whereas that of PDT was comparable.
研究初始治疗时联合光动力疗法（PDT）或阿柏西普玻璃体腔内注射治疗及随访（TAE）单药治疗对肥厚性脉络膜新生血管病变（PNV）患者的长期视力结局。
纳入初始接受 PDT 联合抗血管内皮生长因子（VEGF）或玻璃体内注射阿柏西普（IVA）单药 TAE 方案治疗并至少随访 6 个月的 PNV 患者。回顾性分析病历资料。生存分析中，将 logMAR 视力恶化 0.1 或 0.3 定义为“死亡”。同时分析每年的治疗次数。对 33 例无息肉样病变的 PNV 患者进行亚组分析。
本研究纳入 46 例患者（初始联合 PDT 组 23 例，IVA TAE 组 23 例）。两组患者的平均年龄、性别、平均基线 logMAR 视力或观察时间（3.6±3.2 年比 3.1±1.9 年）均相似。在生存分析中，基于 logMAR 视力恶化 0.1 或 0.3 的结果无显著差异（3 年生存率分别为 26%和 26%，91%和 90%）。同时，初始联合 PDT 组每年抗 VEGF 注射次数明显少于 IVA TAE 组（1.0±1.3 次比 4.1±1.5 次，p<0.0001）。每年额外 PDT 次数无显著差异（0.07±0.20 次比 0.02±0.09 次，p=0.27）。在无息肉的 33 例患者的亚组分析中也得到了相似的结果。
在 PNV 的治疗中，无论是否存在息肉，初始联合 PDT 和 IVA TAE 单药治疗的长期视力结局相似。然而，初始联合 PDT 组每年的抗 VEGF 注射次数少于阿柏西普 TAE 组，而 PDT 注射次数则相似。
