Choroidal morphology and short-term outcomes of combination photodynamic therapy in polypoidal choroidal vasculopathy

Purpose: To investigate outcomes of combined photodynamic therapy (PDT) and intravitreal bevacizumab in association with choroidal morphology in polypoidal choroidal vasculopathy (PCV). Method: Eighty-six PCV eyes (83 patients) treated with PDT in combination with intravitreal bevacizumab and followed for 1 year were evaluated. Choroidal morphological features including subfoveal choroidal thicknesses, diameter of pachyvessel, and choroidal vascularity were analyzed for association with responsiveness and recurrence. Result: Total choroid, Haller’s layer, and pachyvessel were thicker in responders (n = 70) compared with non-responders (n = 16) at baseline (298 vs. 227 μm, 213 vs. 144 μm, and 276 vs. 210 μm, respectively; all P ≤ 0.001). Choroidal vascularity was significantly higher (0.68 vs 0.60, P < 0.001) and choroidal hyperpermeability was more frequent in responders (44 vs 13%, P = 0.018). Significant thinning of total choroid was observed in both responders and non-responders at 3 months after combination PDT (both P < 0.05), but the reduction was greater in responders (− 33 μm vs. − 10 μm, P = 0.036). In recurrent eyes (n = 26), increase in pachyvessel diameter and choroidal vascularity was observed at recurrence. Conclusion: Choroidal morphology including characteristic features of pachychoroid and high vascularity can serve as predictive factors for outcomes after combination PDT in eyes with PCV.