Choroidal Vascular Hyperpermeability as a Predictor of Treatment Response for Polypoidal Choroidal Vasculopathy

Yanagi, Yasuo; Ting, Daniel Shu Wei; Ng, Wei Yan; Lee, Shu Yen; Mathur, Ranjana; Chan, Choi Mun; Yeo, Ian; Wong, Tien Yin; Cheung, Chui Ming Gemmy

doi:10.1097/iae.0000000000001758

Cited by 54 publications

(59 citation statements)

References 41 publications

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“…Choroidal hyperpermeability is believed to result from increased extravasation of fluid and lipoprotein-bound ICGA from the choriocapillaris or the larger choroidal vessels into the surrounding choroidal stroma. Previous studies have reported choroidal hyperpermeability to be present in >90% of eyes with PPE and CSC [27], and in 10-50% of eyes with PCV [2,18]. Punctate hyperfluorescence spots have also been observed in the mid to late phase of ICGA in eyes with CSC and PCV [18,31].…”

Section: Choroidal Vascular Hyperpermeabilitymentioning

confidence: 92%

“…Advances in imaging technology over the past decade have led to new insights and understanding of changes within the choroid in diseases previously identified predominantly by their retinal manifestations [1,2]. Hyperpermeable and dilated choroidal vessels have been observed using indocyanine green angiography (ICGA) in eyes with central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV) [3].…”

Section: Methodsmentioning

confidence: 99%

“…At 12 months, better visual acuity and better visual acuity improvement were significantly associated with a greater subfoveal choroidal thickness at baseline in eyes treated with photodynamic therapy combined with intravitreal ranibizumab or Aflibercept. Other studies suggest that eyes with thicker and/or hyperpermeable choroids are more likely to respond poorly to intravitreal anti-VEGF monotherapy [2,18].…”

Section: Treatment Of Symptomatic Pcv/at1mentioning

confidence: 99%

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Pachychoroid disease

Cheung

Lee

Koizumi

et al. 2018

Eye

513

525

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Pachychoroid is a relatively novel concept describing a phenotype characterized by attenuation of the choriocapillaris overlying dilated choroidal veins, and associated with progressive retinal pigment epithelium dysfunction and neovascularization. The emphasis in defining pachychoroid-related disorders has shifted away from simply an abnormally thick choroid (pachychoroid) toward a detailed morphological definition of a pathologic state (pachychoroid disease) with functional implications, which will be discussed in this review. Several clinical manifestations have been described to reside within the pachychoroid disease spectrum, including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, focal choroidal excavation, peripapillary pachychoroid syndrome. These conditions all exhibit the characteristic choroidal alterations and are believed to represent different manifestations of a common pathogenic process. This review is based on both the current literature and the clinical experience of our individual authors, with an emphasis on the clinical and imaging features, management considerations, as well as current understanding of pathogenesis of these disorders within the context of the recent findings related to pachychoroid disease.

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Section: Choroidal Vascular Hyperpermeabilitymentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Treatment Of Symptomatic Pcv/at1mentioning

confidence: 99%

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Pachychoroid disease

Cheung

Lee

Koizumi

et al. 2018

Eye

513

525

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“…139e141 Other results suggest that the presence of choroidal vascular hyperpermeability may predict more favorable response to combination therapy. 142 However, these biomarkers have been evaluated in just small clinical case series. The current body of evidence is insufficient to allow us to provide recommendations and guidance in these aspects of management.…”

Section: Future Research and Gapsmentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy

et al. 2018

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Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. Previous studies have suggested disparity in response to intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents between PCV and typical AMD, and thus, the preferred treatment for PCV has remained unclear. Recent research has provided novel insights into the pathogenesis of PCV, and imaging studies based on OCT suggest that PCV belongs to a spectrum of conditions characterized by pachychoroid, in which disturbance in the choroidal circulation seems to be central to its pathogenesis. Advances in imaging, including enhanced depth imaging, swept-source OCT, en face OCT, and OCT angiography, have facilitated the diagnosis of PCV. Importantly, 2 large, multicenter randomized clinical trials evaluating the safety and efficacy of anti-VEGF monotherapy and combination with photodynamic therapy (PDT) recently reported initial first-year outcomes, providing level I evidence to guide clinicians in choosing the most appropriate therapy for PCV. In this review, we summarize the latest updates in the epidemiologic features, pathogenesis, and advances in imaging and treatment trials, with a focus on the most recent key clinical trials. Finally, we propose current management guidelines and recommendations to help clinicians manage patients with PCV. Remaining gaps in current understanding of PCV, such as significance of polyp closure, high recurrence rate, and heterogeneity within PCV, are highlighted where further research is needed.

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“…11 Choroidal vascular hyperpermeability (CVH) might be associated with the occurrence of PCV, 12 as well as the treatment response to intravitreal injections of anti-VEGF; however, inconsistent outcomes were obtained in two studies. 13,14 Recently, a new kind of drusen-like deposit called pachydrusen was reported in PCV patients. 10,15 The study of precursor lesions and risk factors in different subtypes of neovascular AMD would help to elucidate the pathogenesis of the disease and improve the visual prognosis of patients.…”

mentioning

confidence: 99%