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Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept

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Abstract

Introduction

To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV).

Methods

Patients with PPCV were treated with PDT combined with 3 IVA injections on a monthly basis, followed by pro re nata criteria. The 12-month follow-up consisted of multiple revaluations of visual acuity and SS-OCT parameters of clinical activity.

Results

Nineteen eyes were included in the study; mean age was 65.5 years. Visual acuity improved after 12 months (0.35 ± 0.25 to 0.2 ± 0.20 logMAR, p = 0.005). Percentage of eyes with intraretinal and subretinal fluid reduced from baseline to the 12-month follow-up (from 52.6 to 10.5%, p = 0.12, and from 89.5 to 5.3% p = 0.0009, respectively). Central retinal and mean macular thicknesses reduced (258 ± 39.6 to 204.8 ± 38.8 μm p = 0.04 and 293.8 ± 32.1 to 248.1 ± 29.6 μm p = 0.017, respectively). Central choroidal and mean choroidal thicknesses also displayed a reduction (328.6 ± 54.9 to 289.8 ± 44.6 μm p = 0.001 and 314.5 ± 55.3 to 287.9 ± 47.6 μm p = 0.015, respectively). The mean number of injections was 4.6/year.

Conclusion

The results support the use of a combined therapy with Aflibercept and PDT in PPCV. This treatment would act in synergy, with anti-VEGF controlling exudation and PDT closing the aneurysmal vessel and reducing choroidal congestion.

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Data Availability

The data are only available to the researchers. They are partially stored as electronic records and preserved according to Italian privacy laws.

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Funding

This study received no funding.

Author information

Author notes

  1. Maria Vadalà and Massimo Castellucci have contributed equally to this work.

Authors and Affiliations

  1. Biomedicine, Neuroscience and Advance Diagnostic Department, Ophthalmology Institute, University of Palermo, Villa Belmonte, Via Cardinale Rampolla 1, 90142, Palermo, Italy

    Maria Vadalà, Massimo Castellucci, Giulia Guarrasi, Giovanni Cillino, Vincenza Maria Elena Bonfiglio & Salvatore Cillino

  2. Department of Health Promotion, Internal Medicine and of Excellence, University of Palermo, Mother-Child Care, Palermo, Italy

    Alessandra Casuccio

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  1. Maria Vadalà
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Contributions

Maria Vadalà: conceptualization, methodology, analysis and interpretation of data, writing original draft; Massimo Castellucci: conceptualization, methodology, investigation, analysis and interpretation of data, writing original draft; Giulia Guarrasi: investigation, analysis and interpretation of data, writing review; Giovanni Cillino: analysis and interpretation of data, writing review; Vincenza Maria Elena Bonfiglio: analysis and interpretation of data, writing review; Alessandra Casuccio: formal and statistical analysis, validation of data, writing review; Salvatore Cillino: validation of data, writing review. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Maria Vadalà or Massimo Castellucci.

Ethics declarations

Conflicts of interest

Maria Vadalà is a consultant for Allergan Italia SpA, Bayer Italia Spa, Novartis Italia SpA. The other authors declare no conflict of interest. No author has a proprietary interest in this study.

Ethics approval

The research was conducted ethically in accordance with the declaration of Helsinki. As stated in the manuscript, informed consent documents were obtained from all individual participants included in the study, to the data collection for the study and the scientific use of them.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Data were partially presented as an oral poster presentation at EURETINA Congress, Paris 6th September 2019.

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Vadalà, M., Castellucci, M., Guarrasi, G. et al. Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept. Int Ophthalmol 42, 601–610 (2022). https://doi.org/10.1007/s10792-021-02032-4

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  • DOI: https://doi.org/10.1007/s10792-021-02032-4

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