Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments

Abstract

There have been recent advances in basic research and clinical studies in polypoidal choroidal vasculopathy (PCV). A recent, large-scale, population-based study found systemic factors, such as male gender and smoking, were associated with PCV, and a recent systematic review reported plasma C-reactive protein, a systemic biomarker, was associated with PCV. Growing evidence points to an association between pachydrusen, recently proposed extracellular deposits associated with the thick choroid, and the risk of development of PCV. Many recent studies on diagnosis of PCV have focused on applying criteria from noninvasive multimodal retinal imaging without requirement of indocyanine green angiography. There have been attempts to develop deep learning models, a recent subset of artificial intelligence, for detecting PCV from different types of retinal imaging modality. Some of these deep learning models were found to have high performance when they were trained and tested on color retinal images with corresponding images from optical coherence tomography. The treatment of PCV is either a combination therapy using verteporfin photodynamic therapy and anti-vascular endothelial growth factor (VEGF), or anti-VEGF monotherapy, often used with a treat-and-extend regimen. New anti-VEGF agents may provide more durable treatment with similar efficacy, compared with existing anti-VEGF agents. It is not known if they can induce greater closure of polypoidal lesions, in which case, combination therapy may still be a mainstay. Recent evidence supports long-term follow-up of patients with PCV after treatment for early detection of recurrence, particularly in patients with incomplete closure of polypoidal lesions.

Verteporfin Photodynamic Therapy for the Treatment of Chorioretinal Conditions: A Narrative Review

“…Polypoidal choroidal vasculopathy, a clinically distinct subtype of exudative AMD, is characterized by subretinal polypoidal orange-yellow vascular lesions associated with serous and hemorrhagic RPE and retinal detachments. 20,42,43,[47][48][49] Diagnosis of PCV is based on the presence of polypoidal dilatations, which can be observed using optical coherence tomography but more readily with indocyanine green angiography; otherwise, differentiating PCV from AMD can be difficult. 50 The etiology and pathophysiology of PCV are not well understood.…”

Six-Year Outcomes in Subjects with Polypoidal Choroidal Vasculopathy in the EVEREST II Study

“…However the risk factors for recurrence remain poorly understood. A key unanswered question from the 2-year EVEREST II study is whether the functional and anatomical benefits following combination therapy continue in the long term [ 15 , 16 ].…”

Advances in multi-modal non-invasive imaging techniques in the diagnosis and treatment of polypoidal choroidal vasculopathy

“…Compared to wet age-related macular degeneration (wAMD), PCV has the characteristics of recurrent hemorrhage, subretinal hemorrhage, lower age of onset, and poor response to anti-VEGF therapies. The mechanism of PCV is still unclear, and it is a difficult and hot topic in the field of retinal research due to its serious harm (5,6).…”