title: INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY: The Fujisan Study.
abstract: OBJECTIVE
  To compare the 1-year results of initial or deferred photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) for eyes with polypoidal choroidal vasculopathy.
  
  
  METHODS
  Prospectively, 72 men with treatment-naive polypoidal choroidal vasculopathy were randomized to initial or later PDT combined with IVR. In both groups, 2 additional monthly IVR followed. From Month 3, PDT and IVR were administered according to the retreatment criteria. Mean changes in the best-corrected visual acuity between baseline and Month 12 and central retinal thickness, the rate of eyes showing regression of polypoidal lesions, and number of additional treatments were compared.
  
  
  RESULTS
  The best-corrected visual acuity increased by a mean of 8.1 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters in the initial PDT group and 8.8 ETDRS letters in the later PDT group, and there was a no significant difference (P = 0.59). The mean central retinal thickness decreased significantly in both groups but more so with combination therapy within the first 4 months; the difference was not significant at Month 12 (P = 0.30). The rate of eyes showing resolution of polypoidal lesions at 12 months was 62.1% in the initial PDT group and 54.8% in the later PDT group and again, there was no significant difference (P = 0.53). The mean number of additional IVR was 1.5 in initial PDT and 3.8 in later PDT; that of additional PDTs was 0.14 and 0.45, respectively, and they were significantly different (P < 0.001 and P = 0.013, respectively).
  
  
  CONCLUSIONS
  Both initial and deferred PDT combined with IVR to treat polypoidal choroidal vasculopathy show the similar visual and anatomical improvements at 12 months. Initial PDT combination leads to significantly fewer additional treatments.
authors.affiliation: *Department of Ophthalmology, Sumitomo Hospital, Osaka, Japan; †Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan; ‡Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; §Department of Ophthalmology, Surugadai Nihon University Hospital, Fukuoka, Japan; ¶Department of Ophthalmology, Fukushima Medical University, Fukuoka, Japan; **Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan; and ††Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Fumi
authors.initials: F
authors.lastname: Gomi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oshima
authors.forename: Ryusaburo
authors.initials: R
authors.lastname: Mori
authors.forename: Mariko
authors.initials: M
authors.lastname: Kano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Saito
authors.forename: Ayana
authors.initials: A
authors.lastname: Yamashita
authors.forename: Eiji
authors.initials: E
authors.lastname: Iwata
authors.forename: Ruka
authors.initials: R
authors.lastname: Maruko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004396:Coloring Agents / Q000737:chemistry; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D011127:Polyps / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D000069579:Ranibizumab / Q000009:adverse effects / Q000627:therapeutic use*; D019233:Retreatment; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D004396:Coloring Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007208:Indocyanine Green; D000069579:Ranibizumab