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 Polypoidal Choroidal Vasculopathy Treatment: Photodynamic Therapy, Anti-VEGF Monotherapy or Combination. Review of Clinical Studies

2019 ◽  
Vol 16 (2) ◽  
pp. 151-158
Author(s):  
E. K. Pedanova ◽  
A. V. Doga
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Antiangiogenic Therapy ◽  
Age Related Macular Degeneration ◽  
Long Term Results ◽  
Anti Vegf ◽  
Age Related ◽  
Number Of Patients ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a rare subtype of neovascular age-related macular degeneration (AMD), its specific features are abnormal branching vascular network with aneurysmal dilatations (polyps), it can be diagnosed in indocyanine green angiography. PCV differs from typical AMD by some ophthalmoscopic manifestations, multimodal imaging data as angiography, OCT with the ability to visualize the choroid, OCT-angiography and expression of VEGF. Despite the different response to antiangiogenic therapy, the presence of pathological neovascularization requires anti-VEGF treatment for both AMD types. In this review, we summarize the latest literature data on the treatment of polyphoidal choroidal vasculopathy: anti-VEGF monotherapy, photodynamic monotherapy, and their combinations. Special attention is paid to the results of multicenter randomized clinical trials with a large number of patients evaluating efficacy of Ranibizumab and Aflibercept (EVEREST 2 and PLANET). The short-term and long-term results of treatment are presented, taking into account the dosing regimens, the number of required injections and the requirement for a combination of anti-VEGF monotherapy with photodynamic therapy. The results of randomized clinical trial are providing high level evidence to guide clinical specialists in choosing the most appropriate therapy for PCV.

scholarly journals One-Year Outcome of Aflibercept and Photodynamic Therapy in a Caucasian Patient with Polypoidal Choroidal Vasculopathy Refractory to Ranibizumab and Photodynamic Therapy

2018 ◽  
Vol 9 (1) ◽  
pp. 172-178 ◽  
Author(s):  
Marta Medina-Baena ◽  
María Jesús Huertos-Carrillo ◽  
Laura Rodríguez ◽  
Juan Ignacio García-Pulido ◽  
Carlos Cornejo-Castillo ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Age Related Macular Degeneration ◽  
Vascular Lesions ◽  
Caucasian Woman ◽  
Intravitreal Ranibizumab ◽  
Asian Populations ◽  
Anti Vegf ◽  
Age Related ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration characterised by an abnormal branching vascular network with aneurysmal polypoidal choroidal vascular lesions. PCV is more prevalent in Asian populations than in Caucasians, which may explain its underdiagnosis in Western countries. Evidence regarding the efficacy of different anti-vascular endothelial growth factor (anti-VEGF) agents on PCV is scarce, with most of these studies being conducted in Asian treatment-naïve patients. Ranibizumab was the first anti-VEGF agent to demonstrate the superiority of a combination of photodynamic therapy (PDT) and anti-VEGF over PDT or anti-VEGF monotherapy for inducing polyp regression in Asian patients with PCV. The efficacy of other anti-VEGF agents has been less studied. Resistance to ranibizumab has been described. Aflibercept offers another mechanism of targeting choroidal neovascular lesions. A 75-year-old Caucasian woman presenting to our office was diagnosed with PCV using indocyanine green angiography. Combination therapy with a loading dose of 0.5 mg intravitreal ranibizumab followed by PDT at standard fluence at month 4 and a fourth dose of ranibizumab at month 5 yielded no visual or anatomic outcomes. Treatment was switched to intravitreal aflibercept at month 6 (3 monthly loading doses of 2.0 mg) followed by half-fluence PDT (month 9). Optical coherence tomography revealed remission of the anatomic lesions. Right-eye visual acuity increased to 0.6. Aflibercept injections were administered bimonthly afterwards. Follow-up during 1 year has shown functional and anatomic stability.

scholarly journals One-year outcomes of fixed-dosing Aflibercept therapy for pre treated and naive polypoidal choroidal vasculopathy patient

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hun Gu Choo ◽  
Jin Hae Lee ◽  
Hyun Sub Oh ◽  
Soon Hyun Kim ◽  
Yong Sung You ◽  
...  
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Vision Loss ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Research Information ◽  
Age Related ◽  
Case Series Study ◽  
Treatment Naïve ◽  
One Year ◽  
Choroidal Vasculopathy

Abstract Background Polypoidal choroidal vasculopathy (PCV) is a type of age-related macular degeneration that can cause permanent vision loss. The purpose of this paper was to report the one-year outcomes of fixed-dosing aflibercept therapy for the treatment of PCV. Methods This was a prospective, single-arm, interventional case series study of 25 PCV patients; 12 pre-treated and 13 treatment-naïve patients. The patients were treated and monitored for 12 months. Each patient was administered with an aflibercept (2.0 mg) injection every month for the first 3 months (the loading phase), and thereafter, once every 2 months. At every follow-up visit, best-corrected visual acuity (BCVA) test, fundus examination, and optical coherence tomography for measuring the central subfield macular thickness (CSMT) were performed. Fluorescein and indocyanine green angiography were conducted at baseline and at 4 and 12 months. Results After 12 months of aflibercept therapy, the mean BCVA of the patients significantly improved from 65.48 letters at baseline to 69.91 letters (p=0.001), and the CSMT significantly decreased from 406.92 um at baseline to 276.12 um (p< 0.001). Additionally, ten patients (40%) showed complete polyp regression. The treatment-naïve patients showed a statistically significant improvement in BCVA from 66.58 letters at baseline to 76.36 letters at 12 months, and a significant decrease in CSMT, from 462 to 243 um. In the pre-treated group, there was no change in BCVA (64.46 letters), and the decrease in CSMT from 356.08 to 303.69 um was not statistically significant. Conclusions The fixed-dosing aflibercept regimen is effective for treating patients with PCV and is more effective in treatment-naïve patients than in pre-treated patients. Trial registration Clinical Research Information Service (CRiS), Republic of Korea. Identifer: KCT0005798, Registered: Jan 20, 2021. Retrospectively registered, URL: https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=18546

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