Comparison of the effects of photodynamic therapy, intravitreal ranibizumab and combination for polypoidal choroidal vasculopathy under 1 + PRN regimen

Abstract

Background: The optimal treatment for polypoidal choroidal vasculopathy (PCV) is still under debate. Little knowledge is known about the treatment effect of "1+pro re nata(PRN)" treatment regimen for PCV. The aim of this study was to compare the outcomes of photodynamic therapy (PDT), intravitreal ranibizumab injection (IVR) and combination therapy under the "1 + PRN" treatment regimen for PCV.

Methods: Fifty-seven eyes of 57 patients completed the 12 months' follow-up in this prospective study. The patients in the PDT arm(n = 23), ranibizumab arm(n = 18), or combination arm(n = 16) underwent a session of PDT, IVR or combination of both at baseline followed by additional IVR as needed. Mean change of logarithm of the minimal angle of resolution (logMAR) visual acuity (VA), central foveal thickness (CFT) and the regression rate of polyps were evaluated. Cost-benefit analysis was also performed.

Results: At Month 12, the mean logMAR VA improved from 0.90 ± 0.52 to 0.75 ± 0.57 in the PDT group (P < 0.05), from 0.96 ± 0.58 to 0.77 ± 0.41 in the IVR group (P < 0.05), and from 0.94 ± 0.55 to 0.72 ± 0.44 in the combination group (P < 0.05), respectively. The CFT decreased from 478.04 ± 156.70 μm, 527.5 ± 195.90 μm, and 522.63 ± 288.40 μm at the baseline to 366.43 ± 148.28 μm, 373.17 ± 134.88 μm and 328.44 ± 103.25 in the PDT group (P < 0.05), IVR group (P < 0.01), and the combination group (P < 0.05), respectively. However, no statistical difference was found between groups (P > 0.05). PDT treatment (60.87%) was superior to the IVR therapy (22.22%) in achieving complete regression of polyps (P < 0.05). Cost-benefit analysis showed that IVR treatment cost the least money for improving per 0.1logMAR units and the combination therapy demanded the least money for reducing per 100 μm of CFT.

Conclusions: PDT, IVR and the combination therapy have similar efficacy in the VA improvement as well as the reduction of CFT under the "1 + PRN" treatment regimen.

Trial registration: Current Controlled Trials NCT03459144 . Registered retrospectively on March 2, 2018.

Keywords: Combination therapy; Cost-benefit; Photodynamic therapy; Polypoidal choroidal vasculopathy; Ranibizumab.

Conflict of interest statement

Ethics approval and consent to participate

The study was conducted after obtaining the written informed consent from the patients and the ethical clearance from the Institutional Review Board of Sun Yat-sen University in accordance with the tenets of the Declaration of Helsinki. Ethical approval Reference Number: 2012KYNL058.

Consent for publication

Written informed consents were obtained from the patients for publication of any information contained within the manuscript itself. A copy of the written consent is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

The changes of the mean logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) during the 12-month follow-up. In the PDT group, there were significant differences for the logMAR VA at each time-point compared with the baseline except month 1 and month 2 (P > 0.05 for month 1 and month 2, P < 0.05 for all the other time-points). In both the IVR group and the combination group, significant differences were found at each time-point compared with the baseline except month 1(P > 0.05 for month 1, P < 0.05 for all the other time-points)

Fig. 2

Mean improvements of best corrected visual acuity (BCVA) in logMAR VA during the 12-month follow-up. Although no statistical difference was found for the improvements of the logMAR VA between any two groups at any follow-up time-point (P > 0.05), a trend that combination group might have greater improvements compared with PDT or IVR monotherapy group could be seen from the histogram. Data were expressed as mean ± SEM

Fig. 3

Time course of the central foveal thickness (CFT) during the 12-month follow-up. All the patients experienced a statistically significant decreasement of CFT at each time-point compared with the baseline in each group (P < 0.05 for all time-points in each group). However, no statistical difference was found between any two groups (P > 0.05)

Fig. 4

Mean reductions of central foveal thickness (CFT) from baseline during the 12-month follow-up. Although no statistical difference was found for the reductions of CFT between any two groups at any follow-up time-point (P > 0.05), a trend that combination group might have greater reduction when compared with PDT or IVR monotherapy group could be seen from the histogram. Data were expressed as mean ± SEM