Do you combine anti-VEGF with PDT for polypoidal choroidal vasculopathy upfront or reserve PDT for refractory cases?

Having considered EVEREST, EVEREST II, and PLANET, I tend to start with monthly aflibercept, with a low threshold for applying PDT during the first 3 months, before the vessel complex is too established to undergo regression.

In practice, I only uncommonly encounter PCV early in its clinical course; ...

Due to how good the anti-VEGF medications are now, I only occasionally need PDT, but when I add it, it is very effective. I have been burned by cases that resolved with PDT only to have a large bleed years later, so now I do some maintenance anti-VEGF every 3 months even if I did combo PDT/antiVEGF.