Increased macular atrophy area with photodynamic therapy over intravitreal aflibercept at 2-year follow-up of pachychoroid neovasculopathy.

Abstract

Purpose: To compare the therapeutic outcomes of intravitreal aflibercept injection (IVA) and reduced-fluence photodynamic therapy (rfPDT) for pachychoroid neovasculopathy (PNV) over 2 years.

Study design: Observational, retrospective case series. Single-center study.

Methods: This study involved 36 eyes of 36 patients with PNV. The IVA group comprised 18 eyes treated with IVA monotherapy (injection every 3 months followed by a pro re nata regimen), whereas the rfPDT group consisted of 18 eyes treated with rfPDT monotherapy. Post-treatment changes in best-corrected visual acuity (BCVA), macular atrophy (MA) area, central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) were compared between the 2 groups.

Results: The IVA group received 8.94 ± 4.77 injections, whereas the rfPDT group received rfPDT 1.06 ± 0.24 times. The logMAR BCVA improved in both groups but did not differ between the 2 groups. The MA area increased from 0.163 ± 0.418 mm² to 0.227 ± 0.480 mm² (P = .024) and from 0.139 ± 0.402 mm² to 0.597 ± 0.939 mm² (P < .001) in the IVA and rfPDT groups, respectively, with the rfPDT group showing a greater increase than the IVA group (P = .013). The CRT was reduced in both groups but did not differ between the 2 groups. The SFCT was reduced in both groups, but the reduction was higher in the rfPDT group than in the IVA group (P = .027). The factors affecting change in the MA area were the treatment method and patient age.

Conclusions: The increase in the MA area and the decrease in the SFCT were greater in the rfPDT group than in the IVA group for PNV, suggesting that IVA may be preferred over rfPDT for PNV treatment.