scholarly journals Dexamethasone implant improves anatomic response to anti-VEGF therapy in treatment-resistant polypoidal choroidal vasculopathy

2021 ◽  
Author(s):  
Kushanth Mallikarjun ◽  
Raja Narayanan ◽  
Rajiv Raman ◽  
Ashik Mohamed ◽  
Mahesh P. Shanmugam ◽  
...  
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Dexamethasone Implant ◽  
Treatment Resistant ◽  
Anti Vegf ◽  
Choroidal Vasculopathy

scholarly journals Dexamethasone Implant Improves Anatomic Response to Anti-VEGF Therapy in Treatment-Resistant Polypoidal Choroidal Vasculopathy

2021 ◽  
Author(s):  
Kushanth Mallikarjun ◽  
Raja Narayanan ◽  
Rajiv Raman ◽  
Ashik Mohamed ◽  
Mahesh Shanmugam ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Polypoidal Choroidal Vasculopathy ◽  
Significant Proportion ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Dexamethasone Implant ◽  
Free Interval ◽  
Anti Vegf ◽  
The Mean ◽  
Choroidal Vasculopathy

Abstract Background: A significant proportion of eyes with polypoidal choroidal vasculopathy (PCV) can be resistant to anti-vascular endothelial growth factor (VEGF) injections. We evaluated the efficacy of combination of Dexamethasone intravitreal implant (DXI) and anti-VEGF therapy in eyes resistant to anti-VEGF monotherapy. Materials and Methods: In this retrospective study, polypoidal choroidal vasculopathy (PCV) resistant to anti-VEGF injections were additionally injected with a Dexamethasone implant along with an anti-VEGF agent. Best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure, fundus evaluation and optical coherence tomography (OCT) data were analyzed. Anatomical response on OCT was the primary outcome measure. Gain in visual acuity, and injection-free interval after the Dexamethasone implant were evaluated as secondary outcome measures. Results: Twelve eyes of 11 patients were included in the study. The mean age of patients was 70.2 ± 11.8 years, and there were 8 females. The mean follow-up duration after DXI was 24.5 ±11 months. The mean number of anti-VEGF injections before DXI was 4.2 ± 1.9. The mean injection-free interval in these patients after DXI was 4.7± 0.6 months, which was significantly greater than the pre-injection mean of 1.6 ± 0.4 months (p<0.001). The median log MAR BCVA immediately prior to DXI was 0.41 (Interquartile Range IQR 0.30-1.02) and after injection was 0.60 (IQR 0.27-1.03), which was not significant (p=0.59). The median OCT thickness after DXI in was 305 microns (IQR 206-417), which was significantly less than the pre-injection OCT thickness of 547 microns (IQR 432-685) (p=0.005). The mean IOP before DXI was 14.7 ± 2.3 mm Hg, and after the injection was 14.3 ± 2.7 mm Hg (p=0.36). Conclusions: Dexamethasone implant combined with anti-VEGF treatment can prolong the treatment-free interval in eyes with PCV resistant to anti-VEGF injection, while maintaining visual acuity.

scholarly journals Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sheng-Chu Chi ◽  
Yi-No Kang ◽  
Yi-Ming Huang
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Evaluation Methodology ◽  
Combination Group ◽  
Anti Vegf ◽  
Searching Strategy ◽  
Early Combination Therapy ◽  
Choroidal Vasculopathy

AbstractPolypoidal choroidal vasculopathy (PCV) is a vision-threatening disease common in Asian populations. However, the optimal treatment for PCV remains under debate. We searched the databases with optimal searching strategy. The study included randomized clinical trials and prospective studies that recruited patients with active PCV who had received interventions, including PDT, anti-VEGF, or a combination of PDT and anti-VEGF. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used for rating the quality of evidence. Our study included 11 studies involving 1277 patients. The network meta-analysis of RCTs revealed the anti-VEGF group, early combination group, and late combination group had significant BCVA changes compared with the PDT group. Early combination therapy led to a significant decrease in CRT compared with PDT, anti-VEGF, and late combination therapy. Additionally, the early combination group had a significantly higher complete polyp regression rate than the anti-VEGF group. No significant differences were detected in the analysis of the number of anti-VEGF injections and safety profile. This network meta-analysis revealed that early combination therapy exhibited better efficacy related to anatomical outcomes than other therapies. Nonetheless, no significant differences related to BCVA change could be detected between anti-VEGF and late combination therapy.

scholarly journals CHOROIDAL VASCULARITY INDICES AND COEXISTING MORPHOLOGICAL CHANGES IN POLYPOIDAL CHOROIDAL VASCULOPATHY. A COMPARATIVE ANALYSIS BETWEEN TWO TREATMENT STRATEGIES

2021 ◽  
pp. 128-131
Author(s):  
Divya Alex
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Choroidal Thickness ◽  
Morphological Changes ◽  
Treatment Strategies ◽  
Enhanced Depth Imaging ◽  
Anti Vegf ◽  
Luminal Area ◽  
Imagej Software ◽  
Choroidal Vasculopathy

Purpose: Compare the effect of Combination therapy (PDT+Anti-VEGF) and Anti-VEGF monotherapy on choroidal vascularity indices and morphological parameters in Polypoidal Choroidal Vasculopathy (PCV). Methods: Retrospective, cohort study involving 33eyes with a diagnosis of PCV and had visible sclerochoroidal boundary on enhanced depth imaging. Cases were treated either with combination (n=17) or Anti-VEGF monotherapy (n=16). Demographic details, visual acuity assessment, OCT analysis was considered from baseline to the 3rd and 6th month follow-up visits. Choroidal vascularity analysis including choroidal thickness, Total Choroidal Surface Area (TCSA), Total Stromal area (TSA), Total Luminal Area (TLA) and Choroidal Vascularity Index (CVI) assessment were done with ImageJ software using the technique of image binarization. Results: Disease activity was significantly higher in the Anti-VEGF monotherapy arm compared to the combination therapy arm both at 3 and 6 months. When compared to baseline values, there was statistically significant decrease in choroidal thickness, Double layer sign (DLS) width, TCSA, TSA and TLA (P<0.05) in the combination therapy arm. Whereas, Anti-VEGF monotherapy arm showed an increase in the mean sub foveal choroidal thickness and DLS width at both visits. Complete collapse of PED, reduction in DLS width which was achieved only in combination therapy arm showed significant positive correlation with the resolution of the disease. CVI did not show a statistically significant reduction in both the arms. Conclusion: In view of better outer retinal and choroidal morphological changes and vascular remodelling, our study strongly supports the superiority of combination therapy over Anti-VEGF monotherapy in PCV

scholarly journals Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy

2018 ◽  
Vol 103 (5) ◽  
pp. 617-622 ◽  
Author(s):  
Manabu Miyata ◽  
Sotaro Ooto ◽  
Kenji Yamashiro ◽  
Hiroshi Tamura ◽  
Masayuki Hata ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Fundus Photography ◽  
Combination Group ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Choroidal Vasculopathy

Background/aimsTo evaluate the 5-year visual and anatomical outcomes after anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy (PDT), followed by pro re nata (PRN) anti-VEGF therapy with or without PDT, for polypoidal choroidal vasculopathy (PCV).MethodsThis retrospective, observational study included 61 consecutive patients with treatment-naïve symptomatic PCV who were followed for 5 years. Twenty eyes (20 patients) initially received PDT and intravitreal injection of ranibizumab (IVR), followed by a PRN regimen of anti-VEGF therapy with or without PDT (combination group), while 41 eyes (41 patients) initially received only IVR every 3 months, followed by a PRN regimen of anti-VEGF monotherapy (IVR group). Macular atrophy including the fovea was confirmed using colour fundus photography and spectral-domain optical coherence tomography.ResultsIn both groups, the visual acuity (VA) at 1 year was better than the baseline VA, whereas the 3-year, 4-year and 5-year VA values were similar to the baseline VA. There was no significant difference in the 5-year VA, 5-year central retinal thickness and incidence of macular atrophy between the two groups (p=0.63, 0.72 and 0.06, respectively). In the combination group, the 5-year VA was correlated with the 5-year incidence of macular atrophy (p=0.02, r=0.51).ConclusionsA PRN regimen for PCV may have a limited effect for the long-term maintenance of improved VA. Macular atrophy may occur more frequently with combination therapy and is possibly associated with the 5-year VA. Thus, combination therapy should be carefully selected for patients susceptible to macular atrophy.

scholarly journals Long-Term Follow-Up of Polypoidal Choroidal Vasculopathy Secondary to Angioid Streaks Treated by Intravitreal Aflibercept and Ranibizumab

2017 ◽  
Vol 8 (1) ◽  
pp. 221-231 ◽  
Author(s):  
James G. Wong ◽  
Katherine Yu Qian
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Angioid Streaks ◽  
Case Review ◽  
Retrospective Case ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Intravitreal Aflibercept ◽  
Choroidal Vasculopathy

Purpose: Angioid streaks (AS) are dehiscences in Bruch’s membrane that may be idiopathic or associated with numerous systemic illnesses. Polypoidal choroidal vasculopathy (PCV) is an underdiagnosed exudative chorioretinopathy often characterised by serosanguineous detachments of the pigmented epithelium. The use of the anti-VEGF agents ranibizumab and aflibercept in the management of PCV secondary to AS has not been previously documented. We report 3 patients with active PCV secondary to AS, 1 of which had a family history of PCV secondary to AS, not previously reported in the literature. All patients were symptomatic and treated with intravitreal anti-VEGF therapy with and without combination photodynamic therapy (PDT). Methods: This is a long-term retrospective case review of 3 eyes of 3 patients with AS and clinical features of PCV. The patients were examined using fundoscopy, spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All patients were managed with intravitreal anti-VEGF using a treat-and-extend protocol according to specific retreatment criteria. One patient had 1 session of PDT in combination with anti-VEGF injections. Results: The mean follow-up time in all patients was 4 years. In all 3 cases, the treatment resulted in improved visual acuity and regression of active PCV lesions with a longer duration between injections. Conclusion: The treat-and-extend protocol with intravitreal aflibercept or ranibizumab with or without PDT is effective and safe for PCV secondary to AS.

scholarly journals Modern aspects of polypoidal choroidal vasculopathy diagnosis and treatment

2019 ◽  
Vol 12 (3) ◽  
pp. 93-100
Author(s):  
Konstantin V. Sokolov ◽  
Alexey K. Smirnov
Keyword(s):  
Clinical Practice ◽  
Polypoidal Choroidal Vasculopathy ◽  
European Population ◽  
Age Related Macular Degeneration ◽  
Universal Method ◽  
Distinctive Features ◽  
Anti Vegf ◽  
Age Related ◽  
Branching Vascular Network ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is one of the choroidal neovascularization forms, being a subtype of neovascular age-related macular degeneration (nAMD). These two conditions share many characteristics, while PCV has some distinctive features with aneurysmal dilatations (polyps) at the end of abnormal branching vascular network being the most specific of them. Low documented incidence of PCV in European population (up to 13%) may be related to the absence of indocyanin-green angiography (ICG) the only reliable method for PCV diagnosis confirmation in routine clinical practice. In that regard, there should be a universal method of treatment suitable for any patient with nAMD irrespectively of whether he or she has PCV. To date, there is no common approach to PCV treatment anti-VEGF therapy, photodynamic therapy (PDT), and combination of these methods are used in clinical practice. Key diagnostic criteria helping to suspect the presence of PCV without ICG as well as results of clinical trials aimed at assessing effectiveness of different anti-VEGF agents as monotherapy or in combination with PDT are described in this article.

scholarly journals Genetic Variants Affecting Anti-VEGF Drug Response in Polypoidal Choroidal Vasculopathy Patients: A Systematic Review and Meta-Analysis

Genes ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 1335
Author(s):  
Xando Díaz-Villamarín ◽  
David Blánquez-Martínez ◽  
Ana Pozo-Agundo ◽  
Ana María Pérez-Gutiérrez ◽  
José Ignacio Muñoz-Ávila ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Response ◽  
Genetic Variants ◽  
Polypoidal Choroidal Vasculopathy ◽  
Drug Response ◽  
Meta Analysis ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Arms2 A69s ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is usually regarded as a subtype of choroidal neovascularization (CNV) that is secondary to age-related macular degeneration (AMD) characterized by choroidal vessel branching, ending in polypoidal lesions. Despite their close association, PCV and neovascular AMD have shown differences, especially regarding patients’ treatment response. Currently, antivascular endothelial growth factor (anti-VEGF) drugs, such as ranibizumab, bevacizumab and aflibercept, have demonstrated their efficacy in CNV patients. However, in PCV, anti-VEGF treatments have shown inconclusive results. Many genetic polymorphisms have been associated with a variable response in exudative/wet AMD patients. Thus, the aim of this study is to explore the genetic variants affecting anti-VEGF drug response in PCV patients. In this regard, we performed a systematic review and meta-analysis. We found four variants (CFH I62V, CFH Y402H, ARMS2 A69S, and HTRA1-62A/G) that have been significantly related to response. Among them, the ARMS2 A69S variant is assessed in our meta-analysis. In conclusion, in order to implement anti-VEGF pharmacogenetics in clinical routines, further studies should be performed, distinguishing physio-pathogenic circumstances between PCV and exudative AMD and the combined effect on treatment response of different genetic variants.

Structural and vascular changes of the choroid in polypoidal choroidal vasculopathy after intravitreal anti-VEGF therapy

2021 ◽  
Author(s):  
Daniela Montorio ◽  
Mariapaola Giordano ◽  
Marina Concilio ◽  
Gilda Cennamo
Keyword(s):  
Functional Response ◽  
Polypoidal Choroidal Vasculopathy ◽  
Visual Outcome ◽  
Predictive Biomarker ◽  
Structural Features ◽  
Intravitreal Injections ◽  
Enhanced Depth Imaging ◽  
Control Group ◽  
Anti Vegf ◽  
Choroidal Vasculopathy

Introduction: To identify the changes in vessel density (VD) of choriocapillaris (CC) and in subfoveal choroidal thickness (SFCT) and to evaluate their correlation with functional response after three monthly intravitreal injections of Ranibizumab (loading phase) in patients affected by Polypoidal Choroidal Vasculopathy (PCV). Methods: A total of 30 eyes of 30 PCV patients and 30 eyes of 30 healthy subjects as control group were enrolled in this prospective study. The best corrected visual acuity (BCVA) was measured at baseline and after one month from third intravitreal injections in each patient. The VD of CC was evaluated in macular area by means of Optical Coherence Tomography Angiography (OCTA). Central macular thickness (CMT) and SFCT were analyzed by Enhanced Depth Imaging (EDI)-OCT. Results: The VD of CC showed statistically lower values in PCV patients at baseline respect to after loading phase (LP) and normal eyes (p<0.001). CMT and SFCT revealed a statistically significant reduction after LP (p<0.001). Multiple regression analysis revealed a significant negative correlation between the reduced SFCT, CMT at baseline and the improvement of BCVA after LP (p<0.05). Conclusion: The close relationship between the thinner SFCT and better visual outcome after LP reveals the role of the EDI-OCT assessment of choroid as predictive biomarker of functional response to anti-VEGF therapy. This tool could provide a quantitative evaluation of structural features of choroid avoiding mistakes of evaluation at OCTA.

Sign in / Sign up

Export Citation Format

Share Document