Photodynamic therapy for polypoidal choroidal vasculopathy

Abstract

Photodynamic therapy (PDT) with Visudyne® was the first successful therapy for wet age-related macular degeneration (AMD). Clinical tests of PDT for wet AMD surprisingly showed a significantly better outcome for patients from Japan, Singapore, and China as compared to the results obtained on Caucasian patients. These differences pointed to the fact that patients with polypoidal choroidal vasculopathy (PCV), which is encountered more frequently in people with darker skin, had inadvertently been included among the AMD patients. As these two diseases are difficult to distinguish with the fluorescein angiography used in these trials, the switch to indocyanine green angiography (ICGA) then permitted the more specific and detailed study of PCV with Visudyne® therapy. The results of PCV treated with PDT turned out to be very good indeed, even though on the time scale of 1 year or more retreatment was needed in some patients. Anti-VEGF therapy by itself, however, did not show anywhere near the same benefit for treating PCV as was the case for the treatment of wet AMD. Recently, triple therapy with Visudyne®-PDT combined with anti-VEGF therapy and a steroid was found to give the best results for the visual acuity of patients with PCV. This chapter summarizes the data on PDT of PCV, and the effect of different combination therapies. Some of the pathological and genetic similarities and differences between PCV and wet AMD are also discussed.