Indocyanine green-enhanced subthreshold transpupillary thermotherapy for the treatment of polypoidal choroidal vasculopathy

Abstract

Objective: To report the therapeutic outcomes of subthreshold transpupillary thermotherapy (TTT) using indocyanine green as an adjuvant for the treatment of polypoidal choroidal vasculopathy in a case series.
Method: A prospective interventional non-comparative pilot case series study was conducted including four eyes of four patients with polypoidal choroidal vasculopathy, diagnosed clinically, and by optical coherence tomography (OCT), between January and July 2019. All cases presented with polypoidal choroidal vasculopathy located in the macula and were refractory to treatment with intravitreous bevacizumab, which had been administered twice previously, with no evidence of functional or structural improvement. Patients received an intravenous injection of 0.5 mg/kg of indocyanine green and a single TTT session covering the whole neovascular complex as estimated by angiography and OCT angiography. Best-spectacle-corrected visual acuity and OCT values were recorded upon diagnosis and changes in these values were evaluated at months 1 and 3 postoperatively. Administration of an injection of aflibercept as rescue therapy had been decided on if there was no improvement.
Results: The total four eyes of 4 patients included evidenced structural improvement with complete subretinal fluid resorption, as well as a reduction in polyp height three months after the procedure. In addition, three eyes improved their visual acuity.
Conclusion: Indocyanine green-enhanced TTT was a safe and effective procedure for the treatment of polypoidal choroidal vasculopathy in the cases reported here.

Key words: polypoidal choroidal vasculopathy, subthreshold transpupillary thermotherapy, indocyanine green.