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Updated: Nov 23, 2025
Author Spotlight: Overcoming Anti-VEGF Resistance Through Advanced Vascular Morphology Assessment in Choroidal Neovascularization
Published on: August 11, 2023
Long-term results of rescue photodynamic therapy for type 1 neovascularization refractory to anti-vascular
Un Chul Park1,2, Bo Hee Kim1,2, Hye Rim Choe1,2
1Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
Purpose:
To evaluate long-term results of photodynamic therapy (PDT) as a rescue treatment in patients with type 1 neovascularization refractory to intravitreal anti-vascular endothelial growth factor (VEGF).
Methods:
Patients who underwent reduced-fluence PDT for refractory type 1 neovascularization, which showed persistent subretinal and/or intraretinal fluid after three or more consecutive anti-VEGF treatments, and were followed up for ≥24 months were reviewed.
Results:
Seventy-eight eyes of 78 patients were included, and 37 (47%) were classified as polypoidal choroidal vasculopathy (PCV). The mean number of anti-VEGF injections before rescue PDT was 8.5 ± 5.4, and the mean follow-up period after rescue PDT was 74.0 ± 29.4 months. At 3 months after rescue PDT, exudation completely resolved in 55 (71%) patients and vision significantly improved (p = 0.021). Resolution of exudation was associated with choroidal vascular hyperpermeability [odds ratio (OR), 3.82; p = 0.031] and lower maximal height of pigment epithelial detachment (OR, 0.69; p = 0.018). In these patients, exudation recurred in 49 (89%) after mean period of 13.5 months. Vision significantly worsened at 24 months after rescue PDT, and thereafter, and the vision decrease was more prominent in patients with PCV. Rescue PDT could be repeated for recurrent or persistent exudation without increasing the risk of complications.
Conclusion:
In patients with type 1 neovascularization refractory to anti-VEGF, reduced-fluence PDT is an effective and safe rescue treatment. Therapeutic efficacy wore off during long-term follow-up, but rescue PDT may be repeated safely.
