Polypoidal choroidal vasculopathy causing massive suprachoroidal haemorrhage

Tan, Colin S.; Wong, Hon Tym; Lim, Bee Jik; Hee, Owen Kim; Lim, Tock Han

doi:10.1038/sj.eye.6702455

Cited by 33 publications

(31 citation statements)

References 7 publications

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“…For this reason, fi rst-visit patients may be more likely to be hemorrhagicpattern patients. 20,28 PCV pathogenesis remains a controversial subject. PCV has been suggested to be a variant of CNV or an abnormality of choroidal vasculature that is not true CNV.…”

Section: Discussionmentioning

confidence: 99%

Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients

et al. 2008

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“…Rarely, PCV may present with massive spontaneous suprachoroidal haemorrhage. 6 Although significant drusen in the affected or fellow eye is less common among PCV patients compared to exudative AMD due to choroidal neovascularization (CNV), their presence is not uncommon, ranging from 26.7 7 to 33%. 8 …”

Section: Clinical Presentationmentioning

confidence: 99%

Polypoidal choroidal vasculopathy: an angiographic discussion

Lim

Laude

Tan

2010

Eye

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The understanding of polypoidal choroidal vasculopathy has evolved rapidly in the past three decades. The hallmark of the disease is the presence of typical hyperfluorescent nodules in the early phase of indocyanine green angiography. Although the classical clinical presentation is recurrent serosanguinous detachment of the retinal pigment epithelium, it may present with clinical features indistinguishable from exudative age-related macular degeneration secondary to choroidal neovascularization. Some cases may present initially with submacular haemorrhage, but later with features of exudative age-related macular degeneration. Studying the associated network of vessels using confocal scanning laser ophthalmoscopy indocyanine green dynamic angiography revealed in many cases feeder vessels, branching pattern, and leakage similar to choroidal neovascularization. Owing to the overlap of clinical and angiographic features, it may be considered as a vascular subtype of exudative age-related macular degeneration. However, having seemingly better natural history, better response to photodynamic therapy, and incomplete response to antivascular endothelial growth factor therapy suggests that it should be studied as a separate entity from choroidal neovascularization. Combining angio-occlusion of the polyps using photodynamic therapy and antipermeability effect of anti-vascular endothelial growth factor therapy on the branching vascular network may provide a synergistic effect. We await the result of EVEREST trial, a multi-centre randomized controlled trial comparing photodynamic therapy, with or without ranibizumab, with ranibizumab monotherapy.

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“…Moreover, as the one of the major difficulties in treating CNV secondary to AS is recurrence, 2 it may be that aflibercept offers an additional benefit over other anti-VEGF agents as it has a higher affinity for VEGF-A as well as the ability to bind VEGF-B and placental growth factor, resulting in a more effective inhibition of the pathological angiogenic process. 4,5 Further longitudinal studies with a larger cohort of patients are required to verify this hypothesis.…”

Section: Commentmentioning

confidence: 99%

“…Polyp closure is an important consideration in the management of PCV because some patients may suffer massive hemorrhages, with severe loss of vision. 5 In summary, we congratulate the authors on describing the risk factors for PCV outcomes, which highlights the need to consider various categories and subtypes of this disease.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Intravitreal aflibercept for choroidal neovascularisation in angioid streaks

Vaz-Pereira¹,

Collaço²,

Salvo

et al. 2015

Eye

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Sir, Intravitreal aflibercept for choroidal neovascularisation in angioid streaksChoroidal neovascularisation (CNV) is a well-known complication of angioid streaks (AS). It affects 42-86% of patients and if untreated can result in significant vision loss. 1 Treatment options have included laser photocoagulation and photodynamic therapy; 1,2 with the advent of anti-vascular endothelial growth factor (VEGF) therapies, off-label anti-VEGF has become the treatment of choice and both bevacizumab and ranibizumab have been shown to be effective. [1][2][3] We describe the off-label use of 2 mg intravitreal aflibercept in two patients as primary treatment for AS-associated CNV (AS-CNV). Case reportThe first is a 57-year-old woman with recent left eye (OS) distortion. Visual acuities (VA) were 20/20 right and 20/25 left. Fundoscopy showed bilateral AS and a classic CNV OS (Figures 1a and b). Fluorescein angiography (FA) and CORRESPONDENCE Figure 1 Colour fundus photographs of the first patient, whose sister was known to be affected by AS and pseudoxanthoma elasticum, show bilateral AS, OD (a) and OS (b), along with an extrafoveal greyish area of CNV, with associated subretinal haemorrhages in OS. Early-phase fundus fluorescein angiography demonstrates a well-demarcated lesion (c) with late leakage (d) in OS, compatible with a classic CNV. Spectral-domain optical coherence tomography reveals a neurosensory detachment involving the fovea (e) and a hyperreflective lesion with subretinal fluid above the retinal pigment epithelium in the cross-section through the lesion. After treatment, there was resolution of the foveal subretinal fluid (f) with scarring of the CNV (g).

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Polypoidal choroidal vasculopathy causing massive suprachoroidal haemorrhage

Cited by 33 publications

References 7 publications

Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients

Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients

Polypoidal choroidal vasculopathy: an angiographic discussion

Intravitreal aflibercept for choroidal neovascularisation in angioid streaks

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