Outcome of polypoidal choroidal vasculopathy at 1 year by combined therapy of photodynamic therapy with ranibizumab and predictive factors governing the outcome.

AIM: To report the visual outcome of polypoidal choroidal vasculopathy receiving combined treatment with photodynamic therapy using Visudyne and intravitreal ranibizumab injections, and to analyze the predictive factors of visual outcome at 1 year post treatment.

METHODS: Seventy-four consecutive patients with newly diagnosed polypoidal choroidal vasculopathy were treated with photodynamic therapy using Visudyne and three loading doses of intravitreal ranibizumab. The final visual outcome and polyp eradication rate at 1 year were reported. A stepwise regression model was used to estimate the baseline clinical factors predictive of better visual outcome and polyp eradication.

RESULTS: Visual acuities at 12-months follow-up improved significantly compared with baseline from 0.828 logMAR to 0.728 logMAR (P=0.026). The mean foveal thickness decreased from 380±175 to 278±117 μm. In all 29.7% of eyes improved at least by 0.3 logMAR, and 55.4% remained stable in visual acuity with less than 0.3 logMAR change. Overall, 85% of eyes achieved at least stable vision, 20.2% (15/74) cases achieved polyp eradication on angiogram, and 60.8% (45/74) achieved polyp size reduction on angiogram at 1 year. Regarding predictive factors, the baseline visual acuity (P=0.003), no foveal involvement by abnormal choroidal vasculature (P<0.0001), absence of hard exudates (0.001) or subretinal fluid (<0.0001) are important clinical factors affecting the final visual outcome.

CONCLUSIONS: Combination therapy with photodynamic therapy using Visudyne and three loading doses of intravitreal ranibizumab injections resulted in 85% success rate on visual stabilization and 81% success rate in polypoidal lesion control.