Two-year outcomes of half-fluence photodynamic therapy combined with intravitreal aflibercept for treatment-naïve pachychoroid neovasculopathy

Summary

Tx-naive Pachy NV: PDT+Eylea maintained dry lesion at 2 years in 44% of eyes. Retrospective, 61 eyes.

Abstract

Purpose: We previously reported 1-year outcomes of half-fluence photodynamic therapy (HFPDT) combined with intravitreal aflibercept (IVA) in treatment-naïve pachychoroid neovasculopathy (PNV). In this study, we evaluated the 2-year outcomes of HFPDT combined with IVA in treatment-naïve PNV without polypoidal lesions.

Study design: Retrospective, interventional case series METHODS: We retrospectively studied 61 eyes with treatment-naïve PNV that received HFPDT combined with IVA and were followed for at least 2 years. Additional treatments were given if a dry macula was not achieved or if exudation recurred. We evaluated the best-corrected visual acuity (BCVA), foveal thickness (FT), central choroidal thickness (CCT), and macular neovascularization thickness (MNVT). Factors associated with additional treatment were also analyzed.

Results: BCVA was significantly improved at 1 year (P <.05), but not at 2 years (P = .07). FT, CCT, and MNVT significantly decreased throughout the study period (all P <.01). A dry macula without further treatment was maintained in 44% of the eyes. These eyes were significantly younger (P <.01), with lower MNVT (P <.01) and greater CCT (P <.05) at baseline. Logistic regression identified age and MNVT as significant factors for additional treatment. PDT-induced acute exudative maculopathy (PAEM) was observed in 26.5% of the eyes requiring additional treatment, but not in those without retreatment.

Conclusion: HFPDT combined with IVA for treatment-naïve PNV maintained a dry macula for 2 years with initial treatment alone in 44% of the cases. Age, MNVT, and PAEM were associated with the need for additional treatment.