Six-month outcomes of half-fluence photodynamic therapy combined with intravitreal Aflibercept injection for pachychoroid neovasculopathy.

PURPOSE: This study aimed to assess the six-month outcomes of patients with pachychoroid neovasculopathy (PNV) treated with half-fluence photodynamic therapy (PDT) along with a single intravitreal aflibercept injection (IVA) and to identify factors linked to persistent or recurrent subretinal fluid (SRF).

METHODS

This retrospective study included consecutive treatment-naïve PNV patients who received initial treatment with IVA and half-fluence PDT and were followed up for more than six months. Patient data, including sex, age, and baseline best-corrected visual acuity (BCVA), and imaging data, including optical coherence tomography (OCT), OCT angiography, and fundus autofluorescence (FAF), were retrospectively collected. BCVA, central macular thickness (CMT), and central choroidal thickness (CCT) were compared before and after the treatment. Additionally, we investigated factors linked to persistent or recurrent SRF.

RESULTS

63 eyes of 63 patients were included in this study. The mean BCVA before treatment was 0.13 ± 0.23 logMAR, which improved to 0.04 ± 0.18 after six months. Additionally, the CMT and CCT before treatment significantly decreased. Persistent or recurrent SRF was observed in 21 patients (33%). These patients were older and demonstrated worse baseline BCVA, larger macular neovascularization (MNV), and greater hyperfluorescent areas on FAF.

CONCLUSION

Although half-fluence PDT along with IVA effectively improved BCVA, CMT, and CCT in patients with PNV, one-third of the patients required additional treatment due to persistent SRF. Older age, larger MNV, and worse baseline BCVA were linked to persistent SRF, underscoring the requirement for tailored treatment strategies.