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Polypoidal Choroidal Vasculopathy

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Last updated: February 6th, 2022

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Summary of Evidence

Treatment of CNV secondary to Polypoidal Choroidal Vasculopathy

Intravitreal anti-VEGF injections

 

Ranibizumab vs PDT

 

Intravitreal ranibizumab is more effective than PDT for treatment-naive PDT.(LAPTOP, 2013). {Oishi A, Kojima H, Mandai M, Honda S, Matsuoka T, Oh H, Kita M, Nagai T, Fujihara M, Bessho N, Uenishi M, Kurimoto Y, Negi A. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013 Oct;156(4):644-51.}

 

Ranibizumab + PDT vs Ranibizumab

 

Combination ranibizumab + vPDT is superior to ranibizumab monotherapy in BCVA and complete polyp regression while requiring fewer injections.(EVEREST II, 2017). {Koh A, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, Tan CS, Feller C, Margaron P, Lim TH, Lee WK; EVEREST II study group. Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: A Randomized Clinical Trial. JAMA Ophthalmol. 2017 Nov 1;135(11):1206-1213.}

 

Aflibercept + PDT vs Aflibercept

 

Improvement in visual and/or functional outcomes was achieved in more than 85% of participants who were treated with IAI monotherapy. The potential benefit of adding PDT could not be determined as fewer than 15% met the criteria of a suboptimal response to receive PDT.(PLANET, 2018). {Lee WK, Iida T, Ogura Y, Chen SJ, Wong TY, Mitchell P, Cheung GCM, Zhang Z, Leal S, Ishibashi T; PLANET Investigators. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in the PLANET Study: A Randomized Clinical Trial. JAMA Ophthalmol. 2018 Jul 1;136(7):786-793.}

 

 

Evidence

1. Background

Review

2018 Cheung et.al.

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2018
Review

Latest updates in the epidemiologic features, pathogenesis, and advances in imaging and treatment trials, with a focus on the most recent key clinical trials. {Cheung CMG, Lai TYY, Ruamviboonsuk P, Chen SJ, Chen Y, Freund KB, Gomi F, Koh AH, Lee WK, Wong TY. Polypoidal Choroidal Vasculopathy: Definition, Pathogenesis, Diagnosis, and Management. Ophthalmology. 2018 May;125(5):708-724.}

Cheung et.al.
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2. Anti-VEGF treatment

2.1 Ranibizumab

2.1.1 Ranibizumab vs PDT

Clinical Trial

2013 Oishi et.al. (LAPTOP)

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2013
Clinical Trial

Intravitreal ranibizumab is more effective than PDT for treatment-naive PDT. {Oishi A, Kojima H, Mandai M, Honda S, Matsuoka T, Oh H, Kita M, Nagai T, Fujihara M, Bessho N, Uenishi M, Kurimoto Y, Negi A. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013 Oct;156(4):644-51.}

  • Randomized controlled trial of Ranibizumab vs Verteporfin PDT in CNV (PCT and non-PCV included) secondary to AMD (93 patients)
  • Findings (2-years):
Outcome PDT RAN
VA gain 17.0% 30.4%
No change 55.0% 60.9%
VA loss 27.7% 8.7%

Oishi et.al. (LAPTOP)
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2.1.2 Ranibizumab + PDT vs Ranibizumab

Clinical Trial

2017 Koh et.al. (EVEREST II)

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2017
Clinical Trial

Combination ranibizumab + vPDT is superior to ranibizumab monotherapy in BCVA and complete polyp regression while requiring fewer injections. {Koh A, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, Tan CS, Feller C, Margaron P, Lim TH, Lee WK; EVEREST II study group. Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: A Randomized Clinical Trial. JAMA Ophthalmol. 2017 Nov 1;135(11):1206-1213.}

  • Randomized controlled trial of Ranibizumab + PDT vs Ranibizumab in PCV (322 patients)
  • Findings (1-year):
    • At 12 months, mean BCVA improvement from baseline was 8.3 letters with combination therapy vs 5.1 letters with monotherapy
    • Combination therapy was also superior to monotherapy in achieving complete polyp regression the combination therapy group received a median of 4.0 ranibizumab injections compared with 7.0 in the monotherapy group

Koh et.al. (EVEREST II)
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2.1.3 Ranibizumab dosing: PRN vs monthly

Clinical Trial

2020 Li et.al. (DRAGON)

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2020
Clinical Trial

Ranibizumab given monthly or PRN significantly improved visual acuity in Chinese patients with neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

  • Randomized controlled trial of Intravitreal ranibizumab monthly for 3 months then monthly vs PRN to month 11, then both groups PRN to month 23. (334 patients with CNV, PCV and non-PCV included, secondary to AMD,)
  • Findings (2-years):
Outcome Time point CNV type Monthly/PRN PRN
BCVA change 12 months All +12.3 +9.6
PCV +12.7 +9.4
non-PCV +12.1 +9.4
24 months All +11.3 +9.3
PCV +12.3 +9.7
non-PCV +10.6 +8.7

Li et.al. (DRAGON)
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2.2 Aflibercept

2.2.1 Aflibercept vs Aflibercept + PDT

Clinical Trial

2018 Lee et.al. (PLANET)

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2018
Clinical Trial

Improvement in visual and/or functional outcomes was achieved in more than 85% of participants who were treated with IAI monotherapy. The potential benefit of adding PDT could not be determined as fewer than 15% met the criteria of a suboptimal response to receive PDT. {Lee WK, Iida T, Ogura Y, Chen SJ, Wong TY, Mitchell P, Cheung GCM, Zhang Z, Leal S, Ishibashi T; PLANET Investigators. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in the PLANET Study: A Randomized Clinical Trial. JAMA Ophthalmol. 2018 Jul 1;136(7):786-793.}

  • Randomized controlled trial of Intravitreal Aflibercept monthly x 3 then Aflibercept vs Aflibercept + PDT in macular PCV (318 patients)
  • Findings (1-year):
    • Monotherapy with IAI was non-inferior to IAI/PDT (+10.7 VS +10.8 letters)

Lee et.al. (PLANET)
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References

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