Combined photodynamic therapy with intravitreal bevacizumab injections for polypoidal choroidal vasculopathy: long-term visual outcome – Accepted Manuscript

Abstract: Purpose: To evaluate the long-term visual outcome after combination therapy of photodynamic therapy (PDT) with intravitreal bevacizumab injections for polypoidal choroidal vasculopathy (PCV).Design: Retrospective, observational study.Methods: The medical records of 34 eyes (34 patients) with naive PCV who were treated with combination therapy were analyzed. All patients completed at least 3 years of follow-up. All clinical data, including age, best-corrected visual acuity (BCVA, logMAR; logarithm of the minimum angle resolution), imaging data of fluorescein angiography, indocyanine green angiography, and optical coherence tomography, were investigated.Results: During a mean follow-up period of 46.82 ± 5.22 months, a mean of 1.44 ± 0.71 times of PDT and 9.18 ± 6.61 intravitreal bevacizumab injections were performed. During follow-up, 21 eyes (61.8%) showed at least one recurrence. Mean BCVA was 0.59 ± 0.35 logMAR (20/77 Snellen equivalent) at baseline, and 0.39 ± 0.34 logMAR (20/49 Snellen equivalent) at 3 years (P=.004). At 3 years, 14 patients (41.2%) gained 0.3 logMAR or more BCVA, and 4 patients (11.8%) lost 0.3 logMAR or more BCVA than baseline. Baseline polyp size (B=.551; P=.005) and location of polyps (B= -.400; P=.033) were significantly correlated with long-term visual outcome after combination therapy for PCV.Conclusions: Combination therapy of PDT with intravitreal bevacizumab injections showed favorable visual outcomes, and significant visual improvement was maintained in PCV patients. A total of 88.2% of patients avoided visual loss at 3 years after treatments. Largest polyp size at baseline and location of polypoidal lesions were prognostic factors for long-term visual outcomes in these patients.