Impact of photodynamic therapy combined with Anti-VEGF vs. Anti-VEGF monotherapy on choriocapillaris vessel density in polypoidal choroidal vasculopathy

Purpose: To compare the choriocapillaris vessel density between intravitreal ranibizumab (Lucentis) (IVR) plus photodynamic therapy (PDT) and intravitreal aflibercept (Eylea) (IVA) monotherapy in patients experiencing polypoidal choroidal vasculopathy (PCV). Design: An observational, retrospective cohort study. Subjects: Adults with treatment-naïve PCV. Intervention: IVR plus PDT or IVA monotherapy. Main outcome measures: After propensity-score (PS) matching, study outcomes were compared at 1 month after the final treatment. The primary outcome was a choriocapillaris vessel density, recognized by optical coherence tomography angiography (OCTA). The secondary outcomes included best corrected visual acuity (BCVA), presence of retinal hemorrhage, central macular thickness (CMT) and subfoveal choroidal thickness (SFCT), assessed by optical coherence tomography (OCT). Results: Initially, 23 patients receiving IVR plus PDT, and 75 patients receiving IVA monotherapy were included. After PS-matching, 19 eyes of 19 patients receiving IVR plus PDT and 38 eyes of 38 patients receiving IVA monotherapy were analyzed. A significantly lower choriocapillaris vessel density in the IVR plus PDT group than the IVA monotherapy group (41.9 % vs. 52.2 %, p = 0.009) was demonstrated. The similarity of the BCVA, occurrence and severity of retinal hemorrhage, CMT, and SFCT between two treatment groups was exhibited. Conclusions: The choriocapillaris vessel density was significantly reduced in PCV patients treated with IVR plus PDT compared to those receiving IVA monotherapy.