Background: To evaluate 5-year outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy and\ncombination therapy of anti-VEGF agents and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy\n(PCV) in a real-world Chinese population.\nMethods: Retrospective study. Fifty-three eyes of 46 patients with subtype 1 and 2 PCV followed up for at least 60\nmonths were grouped into three regimens: anti-VEGF monotherapy, PDT combining with anti-VEGF therapy initially,\nand PDT combining with deferred anti-VEGF therapy. Main outcome measure was best-corrected visual acuity\n(BCVA) using logarithm of minimal angle of resolution (logMAR).\nResults: The mean BCVA of eyes with subtype 1 PCV (n = 28) deteriorated from 0.69 logMAR at baseline to 1.25\nlogMAR at months 60 (P = 0.001), while the mean BCVA of eyes with subtype 2 PCV (n = 25) sustained stable from\n0.62 logMAR at baseline to 0.57 at months 60 (P = 0.654). No significant differences of visual outcomes were found\nbetween the 3 treatment regimens for subtype 1 PCV. Anti-VEGF monotherapy and initial combination treatment\nhad better visual outcomes in eyes with subtype 2 PCV than deferred combination group during part of follow-up\nsignificantly. Initial combination group needed a less number of PDT than deferred combination group (P < 0.001).\nConclusions: Compared with subtype 1 PCV, subtype 2 PCV has a more favorable visual outcome in real world. All\nthe regimens presented unfavorable visual outcomes for subtype 1 PCV. Anti-VEGF monotherapy and initial\ncombination therapy should be superior to deferred combination therapy in the long-term management of\nsubtype 2 PCV. Prospective randomized studies of larger size are needed to determine the long-term efficacy and\nsafety of various treatment for PCV in real world.
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