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Polypoidal choroidal vasculopathy: an update on therapeutic approaches.

ABSTRACT: Polypoidal choroidal vasculopathy (PCV) is a retinal disease involving the choroidal vasculature characterized by the presence of polypoidal lesions with or without branching vascular network best seen on indocyanine green angiography (ICGA). Clinical features of PCV include recurrent subretinal hemorrhage; serosanguineous pigment epithelial detachment, subretinal exudation and serous retinal detachment. PCV is more prevalent among Asians and Blacks as compared to Caucasians and has been found to account for 25 to 50% of cases of presumed neovascular age-related macular degeneration in Asian patients. Treatment is indicated in patients with symptomatic PCV due to potentially irreversible visual loss. Various treatment modalities for symptomatic PCV have been described in the literature, including thermal laser photocoagulation, ICGA-guided photodynamic therapy (PDT) with verteporfin, anti-vascular endothelial growth factor (VEGF) therapy, and combined PDT and anti-VEGF therapy. This review aims to provide an update on the therapeutic options for PCV, with particular reference to recent studies published in the past two years.

SUBMITTER: Wong RL

PROVIDER: S-EPMC3957043 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Polypoidal choroidal vasculopathy: an update on therapeutic approaches.

Wong Raymond L M RL Lai Timothy Y Y TY

Journal of ophthalmic & vision research 20131001 4

Polypoidal choroidal vasculopathy (PCV) is a retinal disease involving the choroidal vasculature characterized by the presence of polypoidal lesions with or without branching vascular network best seen on indocyanine green angiography (ICGA). Clinical features of PCV include recurrent subretinal hemorrhage; serosanguineous pigment epithelial detachment, subretinal exudation and serous retinal detachment. PCV is more prevalent among Asians and Blacks as compared to Caucasians and has been found t ...[more]

PMID: 24653824

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Project description:PurposeTo evaluate the status and evolution of polypoidal lesions during the course of treatment of patients with symptomatic macular polypoidal choroidal vasculopathy (PCV).DesignComparative cohort study of randomly selected patients from a multicenter, randomized controlled clinical trial.ParticipantsThirty randomly selected patients from the EVEREST II study who were treated with combination ranibizumab and verteporfin photodynamic therapy (n = 15) or ranibizumab monotherapy (n = 15).MethodsAll patients were randomized at baseline and treated with a standardized treatment protocol. Indocyanine green angiography (ICGA) images were graded at the central reading center at baseline and months 3, 6, 12, and 24. Polypoidal lesions present at baseline were overlaid on ICGA images at subsequent visits to determine if these remained perfused or had regressed completely. New polypoidal lesions occurring at subsequent visits were similarly tracked to detail the evolution of each polypoidal lesion.Main outcome measuresComplete polypoidal lesion regression over time.ResultsComplete polypoidal lesion regression was higher in the combination therapy group compared with the monotherapy group at all visits (month 12, 12 of 15 patients [80%] vs. 5 of 14 patients [35.7%]; P = 0.016). Persistence of baseline polypoidal lesions was lower in the combination therapy group: 1 of 15 patients (6.7%) versus 7 of 14 patients (50%) in the monotherapy group at month 12. Recurrences of polypoidal lesions that had regressed completely at an earlier time point were uncommon: 0% in the combination therapy group and 1 patient each at months 6 and 12 in the monotherapy group. Fewer new polypoidal lesions (arising after the baseline visit) were found in the combination therapy group at all visits (combination therapy: 2 of 15 [13.3%] vs. monotherapy: 4 of 14 eyes [28.6%] at month 12). Total polypoidal lesion area was significantly smaller in the combination therapy group compared with the monotherapy group throughout the study (0.013 mm2 vs. 0.110 mm2; P < 0.01 at month 12).ConclusionsCombination therapy was associated with higher rates of complete polypoidal lesion regression and fewer persistent polypoidal lesions compared with monotherapy. Closed polypoidal lesions rarely reopened, regardless of the treatment.

Project description:BackgroundPolypoidal choroidal vasculopathy (PCV) is one of the disorders within the pachychoroid spectrum diseases. The presence of pachyvessels is one of the characteristics of pachychoroid disorders. However, the relationship between the presence of pachyvessels and the clinical characteristics of PCV eyes has not been determined. The purpose of this study was to determine the relationship between the presence of choroidal pachyvessels and the clinical characteristics of eyes with PCV.MethodsThe medical records of patients who were diagnosed with PCV and were treatment-naïve were reviewed. Fluorescein and indocyanine green angiography, fundus photography, spectral domain optical coherence tomography (SD-OCT), and enhanced depth imaging OCT (EDI-OCT) were used to obtain images of the choroid. The presence of pathologically dilated outer choroidal vessels, pachyvessels, was determined by ICGA images. These pachyvessels were confirmed to correspond with the large choroidal vessels in the EDI OCT images. The PCV eyes were divided into two groups based on the presence or absence of pachyvessels and clinical features and subfoveal choroidal thickness (SFCT) were evaluated between the two groups.ResultsEighty-six eyes of 84 patients with PCV were evaluated. Pachyvessels were detected in 48 eyes (55.8%). The mean SFCT was 203.9 ± 83.9 μm in all 86 eyes, and it was significantly thinner in eyes with pachyvessels (+) than without pachyvessels (-) (183.2 ± 58.4 μm vs 230.2 ± 103.1 μm; P = 0.01). The differences in the incidence of subretinal fluid, pigment epithelial detachments, and hemorrhages between the two groups were not significant. However, the PCV eyes in pachyvessels (+) group with hemorrhage had the thinnest choroid (P = 0.047). The choroidal features of the fellow eyes were similar to those of the PCV affected eyes, that is, the fellow eyes in pachyvessels (+) group had pachyvessels and the fellow eyes in pachyvessels (-) group did not have pachyvessels.ConclusionsPachyvessels were presented 55.8% in eyes with PCV, and these eyes had the thin SFCT. The presence of pachyvessels and attenuation of the inner choroid were probably due to the pathological changes in the eyes with PCV.

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Polypoidal choroidal vasculopathy: an update on therapeutic approaches.

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Polypoidal choroidal vasculopathy: an update on therapeutic approaches.

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