Initial Versus Delayed PDT Combination With Conbercept in PCV

Efficacy and Safety of Initial Versus Delayed Verteporfin Photodynamic Therapy in Combination With Conbercept in Patients With Symptomatic Polypoidal Choroidal Vasculopathy

To compare the initial versus delayed verteporfin photodynamic therapy (PDT) in combination with conbercept in patients with symptomatic polypoidal choroidal vasculopathy (PCV).

Polypoidal choroidal vasculopathy (PCV) is characterized by polypoidal choroidal vascular dilatation with or without abnormally branching vascular networks(BVN) on indocyanine green angiography (ICGA). It has been considered to be a subtype of wet age-related macular degeneration(wAMD). PCV is more prevalent in Asian patients than in white patients; nearly half of Chinese patients who was diagnosed with wAMD actually was PCV.

However, recently, the first choice treatment for wAMD has shifted to anti-vascular endothelial growth factor (VEGF) drugs, such as bevacizumab(Avastin,Genentech Inc), ranibizumab (Lucentis, Genentech Inc)and aflibercept (Eylea, Regeneron,Berlin,Germany) from PDT, and the vision improving effect has been confirmed regardless of race or disease subtype. Therefore, eyes with PCV can be treated initially with anti-VEGF drugs, however, they are limited in their ability to resolve polypoidal lesions, for which PDT works effectively.

Combination therapy of PDT and anti-VEGF drugs provides the complementary effects of both treatments, but it remains unknown whether PDT should have been administered at the beginning of treatment or during follow-up of anti-VEGF therapy. The purpose of this study was to compare the 12-months treatment results of initial and delayed PDT combined with conbercept (Lumitin, Chengdu Kang Hong Biotech Co., Ltd., Sichuan, China) for PCV.

Inclusion Criteria:

1. Either gender，age ≥ 40.
2. BCVA at study entry of 34 to 79 letters (Snellen Equivalent 20/200 to 20/25).
3. Naive symptomatic PCV patients.
4. Presence of PCV assessed based on ICG with active polyps with or without abnormal vascular network.
5. No refractive media opacity or small pupil narrow that influence the fundus examination.
6. Women must be using effective contraception, be post-menopausal for at least months prior to trial entry, or surgically sterile.
7. Ability to provide written informed consent and to return for all study visits.

Exclusion Criteria:

1. Active inflammation or infection in the study eye.
2. Uncontrolled intraocular pressure (>25 mmHg) in the study eye.
3. Ocular condition in the study eye which may impact vision and confound study outcomes (e.g. vitreomacular traction, epiretinal membrane with BCVA impact, ocular inflammation, retinal vascular diseases like diabetic retinopathy or diabetic macular edema).
4. Presence of centro macular scarring or atrophy indicating irreversible BCVA loss.
5. Prior treatment of the study eye with anti-VEGF therapy or systemic use of anti-VEGF products within 3 months prior to the study entry.
6. Previous vitrectomy, macular laser treatment, PDT, or intraocular steroids in the study eye.
7. Allergy to fluorescein, ICG, iodine, shellfish.
8. Pregnant or breast-feeding women.