Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy

Abstract

Aim: To evaluate the efficacy of intravitreal bevacizumab (Avastin) with or without verteporfin photodynamic therapy (PDT) in the treatment of polypoidal choroidal vasculopathy (PCV).

Methods: Fifteen eyes of 15 patients with symptomatic PCV who received three monthly intravitreal bevacizumab were retrospectively reviewed. Subsequent retreatments with intravitreal bevacizumab and/or PDT were performed in patients with recurrent or persistent polypoidal lesions on indocyanine green angiography (ICGA), and persistent or recurrent subretinal fluid.

Results: The mean follow-up duration was 12.8 months. At 3 months, the mean logMAR BCVA improved from 0.61 to 0.51 (p = 0.014), and the mean CFT reduced from 347 μm to 247 μm (p = 0.015). Despite the visual and anatomical improvements, persistent polyps were present in ICGA of all eyes at 3 months. At the last follow-up, mean BCVA remained at 0.51 after additional treatment with intravitreal bevacizumab and/or PDT (p = 0.022). Patients who had subsequent PDT were less likely to have persistent polypoidal lesions on ICGA at the last visit (p = 0.041).

Conclusions: Intravitreal bevacizumab appeared to result in stabilisation of vision and reduction of exudative retinal detachment in PCV patients. However, intravitreal bevacizumab monotherapy had limited effectiveness in causing regression of the polypoidal lesions in ICGA, and additional PDT appeared to be useful for treating these lesions.