Retreatment of polypoidal choroidal vasculopathy after photodynamic therapy combined with intravitreal ranibizumab.
OBJECTIVE
To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60 months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV).


METHODS
We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12 months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present.


RESULTS
During the follow-up period (mean 44 ± 13 months, median 48 months), 46 eyes (75.4 %) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59 % at the 12-month visit, 41 % at the 24 month, 31 % at the 36 month, and 20 % at the 60-month visit. The median retreatment-free period was 15.0 [95 % confidence interval (CI) 7.4-22.7] months, and the mean period was 24.9 (95 % CI 19.3-30.6) months. Cox regression analysis revealed that older age (P = 0.010, hazard ratio 1.06, CI 1.02-1.11) and male gender (P = 0.043, hazard ratio 2.41, CI 1.03-5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits.


CONCLUSIONS
About 80 % of eyes with PCV require retreatment within 5 years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Wataru
W
Kikushima
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan. sakurada@yamanashi.ac.jp.
Yoichi
Y
Sakurada
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Atsushi
A
Sugiyama
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Naohiko
N
Tanabe
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Seigo
S
Yoneyama
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Hiroyuki
H
Iijima
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D002829:Choroid / Q000000981:diagnostic imaging*; D015862:Choroid Diseases / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D010778:Photochemotherapy / Q000379:methods*; D000069579:Ranibizumab / Q000008:administration & dosage*; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab
Photodynamic therapy; Polypoidal choroidal vasculopathy; Ranibizumab; Retreatment; Retreatment-free period
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