Polypoidal choroidal vasculopathy: An update on current management and review of literature

Abstract

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.

Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and Aflibercept

“…PCV was rst treated with vPDT, which has good e cacy in closing polyps and reducing exudation, but recurrences of disease activity, i.e. exudation or hemorrhages, account for even more than 50% of cases during the rst year of observation [18][19].…”

A Case of Polypoidal Choroidal Vasculopathy Associated With Optic Disc Drusen

“…The presence of prominent hemorrhage should lead to the consideration of PCV, particularly if there is an absence of drusen and the patient is relatively young and Asian or black. ICGA is essential for the definitive diagnosis of PCV [4,6,7].…”

“…The management of PCV varies according to the clinical-pathological manifestations of the disease. It includes monotherapy with intravitreal anti-VEGF, verteporfin PDT, and combined therapy with anti-VEGF and PDT [7]. Combination therapy showed encouraging results based on complete polyp regression and also in terms of achieving best-corrected visual acuity compared to anti-VEGF monotherapy [6].…”

Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy

“…PCV was regarded as a subtype of nvAMD characterized by aneurysmal type 1 choroidal neovascularization. Recently the feature of pachychoroid in PCV eyes led some investigators to recommend PCV falls within the pachychoroid spectrum, which might have a different cause of AMD [26]. As the pathogenesis and clinical features of PCV are distinct from those of nvAMD, the management of PCV consist a wide spectrum of treatment options, including verteporfin photodynamic therapy (PDT), anti-vascular endothelial growth factor (VEGF) therapy, focal laser photocoagulation, and various combinations of these therapies.…”

“…On the contrary, intravitreal anti-VEGF therapy was the mainstay of treatment for typical nvAMD. When compared with typical nvAMD, the prognosis of PCV varies with various clinical and imaging features and the choice of treatment regimens in clinical practice [1, 26, 27]. Therefore, it is crucial to distinguish PCV from typical nvAMD accurately.…”