Daniel Vilaplana, Vladimir Poposki, Isaac Alarcón, Saideh Khaouly, Miguel Castilla-Martí, Spain

Advantages:
The focal (selective) treatment with photodynamic therapy (PDT) to treat polypoidal choroidal vasculopathy (PCV) has the advantage of producing minimum changes in the choroid and pigment epithelium but it is not exempt from complications. The low-fluence (exposure time of 1/2) therapy associated with intravitreals aflibercept injections is useful for improving vision, reducing complications and decreasing the number of re-treatments.

Methods:
We performed a prospective study of 9 eyes of 9 patients with visual loss due to PCV. Diagnosis was confirmed with indocyanine green (ICG) angiography. Only the “hot spot” or the maximum hyperfluorescence focal areas were treated with PDT. All patients had a minimum follow-up of 18 months. The intravitreal injection was applied during the first 24 hours. Visual acuity (VA) using ETDRS optotype, funduscopic examination and OCT were performed in all the follow-up visits. We insisted in anti-VEGF injections if we observed OCT activity in the lesions. We re-treated with low-fluence PDT if we observed that the polypoidal lesions were not occluded in a superior period of 3 month from the anterior treatment.

Effectiveness/Safety:
Five women and four men were included in the study. Age ranged from 51 to 94 years old (x=79). The vision improved during the first 6 months. The mean initial and 6 months period visual acuity was 30 and 34 letters respectively (P=0.02). During the follow-up, VA changes didn’t modify significantly, but globally at 48 months it decreased, when the mean initial and 48 months VA was 37 and 22 letters respectively (P=0.115). OCT showed more thinness when more treatments were carried out (P=0.040), which probably was a consequence of the retinal atrophy generated. The age in relation to VA was an important factor of influence. To be under or over 80 years old determines an initial VA of a mean of 36 vs. 26 letters respectively.

Contact Details:
Daniel Vilaplana
Hospitals Universitaris Esperança – Mar
Barcelona
Spain
Cell Phone : +34 629666603
Work Phone : +34 93 725 4139
Email : oftalmovilaplana@gmail.com