ObjectiveTo compare the efficacy of photodynamic therapy (PDT) alone or in combined with ranibizumab versus ranibizumab monotherapy (intravitreal injection, IVR) in patients with polypoidal choroidal vasculopathy (PCV). Methods80 eyes of 72 patients with PCV were enrolled into this retrospective and comparative study according to their therapeutic plan. 30 eyes of 28 patients, 28 eyes of 30 patients and 22 eyes of 21 patients were divided into PDT group, ranibizumab 0.5 mg group (IVR group) or the combination group, respectively. The patients with PCV were diagnosed according to clinical symptoms, optical coherence tomography (OCT) and fluorescent indocyanine green angiography (ICGA). The baseline best-corrected visual acuity (BCVA) before treatment was more than 0.05, and there was no retinal fibrosis and scar for all patients. There was no statistical difference of age (F=0.187), gender (χ2=0.423), average BCVA (F=1.120) and central retinal thickness (CRT) (F=0.431) among three groups (P > 0.05). They had not received any treatment before. Patients received verteporfin PDT in PDT group, 3 consecutive monthly IVRs starting day 1 in IVR group, and 3 IVRs after 3 days, 1 month, 2 months of PDT starting day 1 in combination group. Re-treatment was considered 3 months later if the follow up shown no changes in fundus photography, OCT and ICGA. The average follow-up time was 19 months. BCVA at baseline and follow-up visit at 1, 3, 6, 12 months was measured, and the proportion of patients with ICGA-assessed complete regression of polyps at month 6 was recorded as primary outcome. The CRT was measured at baseline and 6 months as secondary outcome. ResultsThere were significant difference of BCVA at 1, 3, 6 and 12 months among three groups(F=5.480, 5.249, 3.222, 4.711; P < 0.05). The average BCVA was significantly better at 1, 3, 6, 12 month than that at baseline(t=-6.632, -4.127, -3.904, -4.494; P < 0.05) in combination group, and was significantly better at 3, 6, 12 months than that at baseline (t=-5.636, -3.039, -3.833; P < 0.05) in IVR group. However there was no significant difference of the average BCVA in PDT group between follow-up at 1, 3, 6, l 2 months and baseline (t=1.973, 0.102, -0.100, -0.761; P > 0.05). The proportion of patients with complete regression of polyps at 6 months was higher in PDT (76.7%) or combination group (68.2%) than IVR group (35.7%) (χ2=0.003, 0.025; P < 0.05). There was no significant difference of CRT among 3 groups at baseline (P=0.651). The mean CRT decreased in all 3 treatment groups over 6 months (t=5.120, 3.635, 5.253; P < 0.05), but there was no significant difference of CRT among 3 groups (F=1.293, P > 0.05). ConclusionsThree therapies could effectively decrease CRT. IVR or IVR combined with PDT are both more effective than PDT therapy to improve vision of PCV patients. PDT or PDT combined with IVR was superior to IVR pnly in achieving complete regression of polyps in 6 months in PCV patients.
ObjectiveTo observe the characteristics of optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) patients with different symptom duration before and after photodynamic therapy (PDT), and investigate its relationship with vision prognosis. Methods93 CSC patients (103 eyes) who had undergone the treatment of PDT were enrolled in this study. The eyes were divided into 3 groups according to symptom duration including group A (< 4 months, 28 eyes), group B (4-6 months, 42 eyes), group C (> 6 months, 33 eyes). The best corrected visual acuity (BCVA) and OCT were performed before and after treatment. Before the treatment, the percentage of patients with regular retinal pigment epithelium (RPE), irregular bump or detachment of RPE and disordered RPE were 63.0%, 37.0%, 0.0% in group A; 41.9%, 53.5%, 4.7% in group B and 24.2%, 57.6%, 18.2% in group C, respectively. The difference of percentage of RPE structure was no significance among the three groups (χ2=19.88, P=0.001). The outer nuclear layer (ONL) thickness was (220.42±49.88), (145.81±19.65), (98.15±33.02) μm in group A, B, C respectively, the difference between three groups was significant (P=0.000). The BCVA differences in different RPE structure and the relationship between ONL thickness and vision prognosis were recorded and analyzed. ResultsThe difference of ONL thickness in eyes with regular RPE and irregular bump or detachment of RPE in group A, B and C were not significant (P=0.599, 0.151, 0.789). The ONL thickness in eyes with disordered RPE were decreased significantly compared to eyes with irregular bump or detachment of RPE in group B and C (P=0.025, 0.036). The ONL thickness were (139.14±26.23), (119.14±21.09), (97.61±29.92) μm after PDT, respectively. Compared with ONL thickness before PDT, there was statistically significant decreasing after PDT in group A and B (P=0.000, 0.010), but there was no statistically significant difference after PDT in group C (P=0.192). After PDT, BCVA was negatively related to ONL thickness before PDT in group A (r=-0.684, P=0.000), and was positively related to ONL thickness after PDT in group C (r=0.413, P=0.017), but was neither related to ONL thickness before nor after PDT in group C (r=0.278, 0.117; P=0.074, 0.462). ConclusionsWith the duration of symptom being longer, the rate of irregular bump or detachment of RPE and disordered RPE are increased gradually, ONL thickness is getting thinner. After PDT, the ONL thickness became thinner in eyes with symptom duration less than 6 months and has no difference in eyes with symptom duration more than 6 months. The difference of BCVA in eyes with different RPE structure is significant. The vision prognosis of CSC with duration less than 4 months or more than 6 months are related to ONL thickness.