Active Polypoidal Choroidal Vasculopathy Research Articles

Comparison of Indocyanine Green Angiography and Optical Coherence Tomography Angiography for Polypoidal Choroidal Vasculopathy

Purpose: To assess the diagnostic value of optical coherence tomography angiography (OCTA), and the factors affecting the diagnosis of polypoidal choroidal vasculopathy (PCV) by OCTA and indocyanine green angiography (ICGA). Methods: The numbers and area of polyps, and the presence and area of a branched vascular network (BVN) as revealed by ICGA and OCTA, were retrospectively analyzed in 43 patients with active PCV. The patients were divided into two groups according to whether the number of polyps matched between the two methods: group 1, equal number of polyps revealed by ICGA and OCTA; group 2, different number of polyps revealed by ICGA and OCTA. Results: In 43 PCV patients, the total number of polyps was 1.47 ± 0.83 in ICGA and 1.07 ± 0.91 in OCTA (<i>p</i> < 0.001), and the polyp area was 0.27 ± 0.42 mm<sup>2</sup> in ICGA and 0.17 ± 0.15 mm<sup>2</sup> in OCTA (<i>p</i> = 0.023). BVN was found in 33 eyes (76.7%) by ICGA and 29 eyes (67.4%) by OCTA (<i>p</i> < 0.001). The BVN area was 3.61 ± 2.59 mm<sup>2</sup> in ICGA and 2.74 ± 2.76 mm<sup>2</sup> in OCTA (<i>p</i> = 0.002). Central retinal thickness and central choroidal thickness were significantly greater in group 2 than group 1 (<i>p</i> < 0.001, respectively). Subretinal fluid (SRF) (<i>p</i> = 0.009) and subretinal hemorrhage (SRH) (<i>p</i> = 0.005) were significantly more prevalent in group 2 than group 1. Polyp height (<i>p</i> = 0.022) and diameter (<i>p</i> = 0.042) were significantly greater in group 2 than group 1. Conclusions: OCTA is a supplementary diagnostic technique for detecting PCV. The presence of SRF and SHR, and large polyp height and diameter, were associated with the polyp detection rate of OCTA for PCV.

Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a vision-threatening disease common in Asian populations. However, the optimal treatment for PCV remains under debate. We searched the databases with optimal searching strategy. The study included randomized clinical trials and prospective studies that recruited patients with active PCV who had received interventions, including PDT, anti-VEGF, or a combination of PDT and anti-VEGF. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used for rating the quality of evidence. Our study included 11 studies involving 1277 patients. The network meta-analysis of RCTs revealed the anti-VEGF group, early combination group, and late combination group had significant BCVA changes compared with the PDT group. Early combination therapy led to a significant decrease in CRT compared with PDT, anti-VEGF, and late combination therapy. Additionally, the early combination group had a significantly higher complete polyp regression rate than the anti-VEGF group. No significant differences were detected in the analysis of the number of anti-VEGF injections and safety profile. This network meta-analysis revealed that early combination therapy exhibited better efficacy related to anatomical outcomes than other therapies. Nonetheless, no significant differences related to BCVA change could be detected between anti-VEGF and late combination therapy.

Comparison between non-visualized polyps and visualized polyps on optical coherence tomography angiography in polypoidal choroidal vasculopathy.

To determine the underlying reasons for the non-visualization of polyps on en face optical coherence tomography angiography (OCTA) in patients with polypoidal choroidal vasculopathy (PCV). A cross-sectional study of consecutive treatment-naïve 30 eyes with active PCV was included. Results of fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), spectral domain optical coherence tomography (SD-OCT), and en face OCTA were analyzed. A total of 64 active polyps were found on FFA and ICGA in 30 eyes. On OCTA, 42/64 (65.6%) polyps were visualized, while 22/64 (34.4%) polyps were non-visualized. There were no significant differences in the size (P = 0.723) and filling time of polyps (P = 0.558) between the two groups. However, polypoidal lesions were less common in the non-visualized group (P< 0.001). The height of the polyps on SD-OCT was 243.95 ± 114.24μm in the non-visualized group, which was higher than those (188.00 ± 87.93μm) in the visualized group (P = 0.048). Moreover, more pulsatile polyps (72.7%) were found in the non-visualized group than those (2.4%) in the visualized group (P< 0.001). Four of the 22 polyps in the non-visualized group (18.2%) were located under a thick subretinal hemorrhage, and two of 22 invisible polyps (9.6%) located under and parallel to the retinal vessel in the inner layer of retina. Our results revealed that the height of the polyps, and not the size and pulsation of the polyps, correlated with the visualization of the polyps on OCTA. Polyps that were pulsating in early ICGA were difficult to be visualized on OCTA, which is the most possible reason for the non-visualization. Coverage with thick subretinal hemorrhage or retina vessels was another reason for the non-visualization of the polyps in active PCV on OCTA.

Intravitreal aflibercept for active polypoidal choroidal vasculopathy without active polyps

The purpose of this study was to evaluate the efficacy of intravitreal aflibercept for active polypoidal choroidal vasculopathy (PCV) without active polyps and to identify prognostic factors. We enrolled 40 eyes from 40 patients who manifested PCV with exudation but without active polyps after prior treatment with photodynamic therapy (PDT) and/or anti-vascular endothelial growth factor (VEGF) other than aflibercept. Participants were initially given three consecutive intravitreal injections of aflibercept at 1-month intervals, followed by injections every 2 months in the maintenance phase. Spectral-domain optical coherence tomographic and indocyanine green angiographic features were assessed to determine associations between anatomical parameters and visual outcomes 14 months later. Mean visual acuity improved from 61.5 ± 11.1 letters at baseline to 68.1 ± 13.6 letters at 14 months (P = 0.001). Better vision and a smaller branching vascular network at baseline and 1 month after three monthly injections (visit 4) were associated with better final vision (P < 0.001). The presence of an inner retinal cyst at visit 4 was significantly related to worse final vision (P = 0.011). Intravitreal aflibercept improved the visual and anatomical outcomes of PCV with exudation from BVN after pre-treatment with PDT and/or anti-VEGF other than aflibercept. Better vision, smaller lesion size, and absence of an inner retinal cyst after induction therapy may predict better visual outcome.

Polypoidal Choroidal Vasculopathy.

The aim of this review is to summarize developments in the treatment of active polypoidal choroidal vasculopathy (PCV). PCV is associated with a poor visual prognosis as a consequence the condition's hallmark polypoidal dilatation and a branching network resulting in recurrent hemorrhages and serous leakage. Recent research has provided new insights into the pathogenesis of PCV. While still considered a subtype of age-related macular degeneration, suggestions that PCV belongs to a spectrum of conditions that present with a pachychoroid are increasingly well accepted. Treatment remains challenging. Combination therapy (photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (VEGF)) is associated with higher polyp closure rate, but polyp closure rate has not been correlated with superior visual outcomes. Current data points to non-inferiority of anti-VEGF alone versus combined with PDT when final vision acuity is the study outcome. PCV remains a clinical challenge. Classification and treatment of the condition continues to evolve. Combination therapy may not be superior to anti-VEGF treatment alone in terms of visual acuity outcome, however data on long-term recurrence should be compared in formulating preferred treatment plans.

Characteristic appearances of fundus autofluorescence in treatment-naive and active polypoidal choroidal vasculopathy: a retrospective study of 170 patients.

To investigate the characteristic appearances of fundus autofluorescence (FAF) in patients with treatment-naive and active polypoidal choroidal vasculopathy (PCV). Cases with the diagnosis of treatment-naive and active PCV from November 2012 to May 2017 at Peking Union Medical College Hospital were retrospectively reviewed. All patients underwent comprehensive ophthalmologic examination. Autofluorescence (AF) findings were described at the retinal sites of the corresponding lesions identified and diagnosed using indocyanine green angiography and spectral-domain optical coherence tomography. One hundred seventy patients with 192 affected eyes were included. The logMAR BCVA of the patients were 0.53 ± 0.28. The six AF patterns of 243 polypoidal lesions were confluent hypo-AF with hyper-AF ring (49.8%), confluent hypo-AF (22.6%), hyper-AF with hypo-AF ring (3.7%), granular hypo-AF (7.0%), blocked hypo-AF due to hemorrhage (8.6%), and polyps without apparent AF changes (8.2%). For 146 branching vascular networks (BVNs), 97.3% were granular hypo-AF, and others were blocked hypo-AF due to hemorrhage. In eyes with treatment-naive and active PCV, the polypoidal lesions and BVNs induce characteristic FAF changes. FAF images provide reliable adjunct reference for the diagnosis of PCV.

Polypoidal choroidal vasculopathy

The article presents literature review devoted to the issue of polypoidal choroidal vasculopathy. The studies of Russian and foreign researchers were reviewed. Epidemiological and clinical characteristics of polypoidal choroidal vasculopathy, diagnostic features and modern treatment methods, the results of clinical studies are presented. Polypoidal choroidal vasculopathy is a subtype of neoascular AMD with specific characteristics including predisposition of certain races, clinical features, serosanguineous complications of different severity, tendency to relapsing course of neovascularization and development of secondary serosanguineous exfoliation. It was registered most frequently in patients aged 50 to 65 years. Prevalence among Caucasians is 4 to 9.8%, and among Asians - 23.9 to 54.7%. Diagnosis of polypoidal choroidal vasculopathy requires the use of fluorescent angiography, indocyanine green angiography and optical coherence tomography. Polyps regression accordng to angiography is considered one of the aims of initial therapy of active polypoidal choroidal vasculopathy. According to Expert group of polypoidal choroidal vasculopathy, while using laser photocoagulation and photodynamic therapy, affecting both polyps and vasculature is required. As a result of the analysis of population studies, the results of treatment with laser coagulation, photodynamic therapy (independently and in combination with angiogenesis inhibitors) and monotherapy with angiogenesis inhibitors were demonstrated. Regardless of the achieved results of polypoidal choroidal vasculopathy diagnosis, the treatment issues require further investigation. Additional studies are required to evaluate long-term correlation between initial polyp regression, relapses, response to repeated therapy and functional results.

Characteristics of Fundus Autofluorescence in Active Polypoidal Choroidal Vasculopathy.

Objectives:To define characteristic fundus autofluorescence (FAF) findings in eyes with active polypoidal choroidal vasculopathy (PCV).Materials and Methods:Thirty-five eyes of 29 patients with active PCV who were diagnosed at Ege University Faculty of Medicine, Department of Ophthalmology, Retina Division between January 2012 and November 2014 were included in the study. All the patients underwent a complete ophthalmological examination including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, FAF photography, and indocyanine green angiography (ICGA). ICGA was used to diagnose active PCV and identify lesion components. FAF findings were described at the retinal site of the corresponding lesions identified and diagnosed using ICGA.Results:The mean age of the 29 study patients (15 men, 14 women) was 64.6±7.5 years (range, 54-82 years). ICGA revealed active PCV in 35 eyes, consisting of polypoid lesions in 11 eyes (31.4%), branching vascular networks (BVN) in 10 eyes (28.6%), and a combination of polypoid lesions and BVNs in 14 eyes (40%). On FAF images, 4 different patterns were detected at the corresponding retinal sites of 25 polypoid lesions detected by ICGA: confluent hypoautofluorescence with a hyperautofluorescent ring in 18 eyes (72%), hyperautofluorescence with hypoautofluorescent ring in 2 eyes (8%), confluent hypoautofluorescence in 1 eye (4%), and granular hypoautofluorescence in 1 eye (4%). The remaining 3 eyes (12%) demonstrated blocked hypoautofluorescence because of the excessive hemorrhaging in the macula. The FAF images showed the granular hypoautofluorescent FAF pattern in all 24 BVNs (100%) consistent with the location of the lesions on ICGA.Conclusion:The typical PCV lesions, polypoid lesions and BVNs had characteristic autofluorescent findings on FAF imaging. Non-invasive, quick, and repeatable FAF imaging can be considered a reliable and helpful diagnostic technique for the diagnosis of active PCV.

DISTINGUISHING POLYPOIDAL CHOROIDAL VASCULOPATHY FROM TYPICAL NEOVASCULAR AGE-RELATED MACULAR DEGENERATION BASED ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY.

To investigate the sensitivity and specificity of spectral domain optical coherence tomography in distinguishing polypoidal choroidal vasculopathy (PCV) from typical neovascular age-related macular degeneration (nAMD). One hundred and eighty-eight eyes in 156 patients with active PCV or typical nAMD were enrolled prospectively. Three spectral domain optical coherence tomography manifestations, pigment epithelium detachment, double-layer sign, and thumb-like polyps were estimated in all the eyes. A diagnostic test to differentiate PCV from nAMD based on spectral domain optical coherence tomography was performed. Furthermore, the sensitivity and specificity was validated in a retrospective series of patients. Pigment epithelium detachment, double-layer sign, and thumb-like polyps were more common in PCV eyes than in nAMD eyes. When the cutoff point was set as at least 2 positive signs out of 3 in the diagnostic test, the sensitivity was 89.4% and specificity was 85.3%. The results of the validation test further confirmed the strategy, with satisfying sensitivity (87.5%) and specificity (86.2%). Spectral domain optical coherence tomography is sensitive and specific in distinguishing PCV from nAMD. From these results, the presence of at least two out three signs (pigment epithelium detachment, double-layer sign, and thumb-like polyps) indicates a positive test and is therefore suggested to be the screening strategy for PCV.

Morphologic Characteristics of Choroid in the Major Choroidal Thickening Diseases, Studied by Optical Coherence Tomography.

We investigated morphologic features of choroid in the choroidal thickening diseases, including central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV), and Vogt-Koyanagi-Harada disease (VKH), by a novel tomographic classification system of the choroid. This cross-sectional study involved 30 patients with active CSC, 30 patients with active PCV, and 27 patients with active VKH, and 30 normal controls. Utilizing enhanced depth imaging optical coherence tomography, we classified the morphology of the choroid into five categories: 1) Standard (S), 2) Dilated outer layer and Attenuated inner layer (DA), 3) Darkened (D), 4) Marbled (M), and 5) Pauci-Vascular (PV) types. Additional tomographic characteristics of the choroid such as choroidal vascular dilation, convolution, scleral invisibility, and choroidal hyper- or hypo-thickening were identified as well. The distribution of five choroidal tomographic morphology and additional tomographic characteristics in each group were analyzed. The DA type was observed in the CSC group more frequently than in the normal control group (53.3% vs 3.3%, P < 0.001). Additional tomographic characteristics, such as choroidal vascular dilation (76.7%), and choroidal hyper-thickening (36.7%), were more prevalent in the CSC group than in the control group. The PCV group showed higher prevalence of DA type (33.3% vs. 3.3%, P = 0.006) than the control group. The VKH group showed a significantly higher frequency of the D type (63.0%), convolution (40.7%), and scleral invisibility (70.4%) than controls (0% for all three findings). In conclusion, CSC and PCV shared common morphologic characteristics of choroid, including dilated outer vascular layer and focally attenuated innermost layer. Dense hypo-reflectivity and convolution of choroid were the specific tomographic markers for acute VKH. A new tomographic classification system of choroid may provide discrimination ability and insight into major pachychoroidopathies.

Therapeutic approaches‐ aflibercept first french results of intravitreous aflibercept for active naïve polypoidal choroidal vasculopathy‐6 months follow up

AbstractTo evaluate the anatomical and functional effect of intravitreous aflibercept (IAI) for the treatment of polypoidal choroidal vasculopathy (PCV) associated with exudative AMD, with a follow up of 3 months.This is a case series study that included 22 eyes with active PCV. All eyes were naive to treatment before inclusion in the study. The treatment protocol consisted of an induction phase of 3 IAI, then the injections were done every 2 months. A complete ophthalmologic workup was done for every patient and included: best corrected visual acuity (ETDRS scale), Fluorescein and Indocyanine Green Angiography, EDI‐OCT (Spectralis HRA+OCT®, Heidelberg engineering). All results were analyzed at inclusion and at 3 months.The mean age was 76.3 +/‐ 11.3. Male to female ratio was 1. The BCVA improved at 3 months (0.58 +/‐ 0.39logMAR vs 0.20±0.27 log MAR; p= 0.01). The patients gained a mean of 15 letters in the BCVA. No loss of BCVA was noted in any patient. The central macular thickness improved significantly from 376.77+/‐99.54 to 279.80±82.53 at 3 months (p= 0.043).The polyp’s regression started at one month after the first injection and was almost complete at 3 months. A significant improvement of retinal pigment epithelium detachment

INTRAVITREAL RANIBIZUMAB FOR POLYPOIDAL CHOROIDAL VASCULOPATHY IN NON-ASIAN PATIENTS

To determine safety, tolerability, and efficacy of intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy in a non-Asian population. Phase I/II, prospective, open-label, single-center, nonrandomized, uncontrolled, consecutive, interventional case series of 20 eyes in 19 patients with exudative active polypoidal choroidal vasculopathy. Eyes received 3 monthly intravitreal ranibizumab injections (0.3 or 0.5 mg), with additional ranibizumab injections, observation, or alternative treatments at investigators' discretion, through 24 months. Main outcome measures were ocular and systemic safety and mean change from baseline in best-corrected visual acuity and center point thickness. Visually significant ocular adverse events included cataract progression (n = 3), mild vitreous hemorrhage (n = 2), and macular hole (n = 1). No systemic drug-related adverse events were observed. Mean baseline best-corrected visual acuity was 20/127 (range, 20/16-20/500) and center point thickness was 298 μm. Mean best-corrected visual acuity increased from baseline by 1.2 Snellen lines at 12 months and 24 months. Mean center point thickness decreased by 53 μm and 67 μm from baseline at 12 months and 24 months, respectively. Intravitreal ranibizumab was well tolerated in non-Asian patients with polypoidal choroidal vasculopathy; the majority of eyes experienced improvements in best-corrected visual acuity and center point thickness after ranibizumab treatment.

Anatomical location of polypoidal choroidal vasculopathy lesions inferred from simultaneous ICGA‐OCT

AbstractPurpose To identify the spatial location of polypoidal choroidal vasculopathy (PCV) lesions including branching vascular network (BVN) and late geographic hyperfluorescence (LGH).Methods This retrospective study involved 15 eyes (15 subjects) affected by active PCV. Utilizing innate software for simultaneous indocyanine green angiography (ICGA) and optical coherence tomography (OCT), we identified the corresponding tomographic locations of BVN and LGH on ICGA.Results LGH was noted in 9 eyes, and the extent of LGH was the same (5 eyes) as or larger (4 eyes) than the extent of BVN. The extent of ‘double layer sign’ on OCT coincided exactly with the extent of LGH on ICGA. Image analysis revealed that larger vessels of BVN located not in‐between retinal pigment epithelium and Bruch’s membrane but within choroidal layer.Conclusion This study indicates that, at least, a part of BVN locates within choroidal layer. And the tomographic location of the lesion corresponding to LGH lies above Bruch’s membrane. The origin of LGH would be fluorescein staining of the lesion above Bruch’ membrane, possibly due to exudation from BVN.

Development of polypoidal choroidal vasculopathy in unaffected fellow eyes

PurposeTo assess longitudinal changes and determine their angiographic risk factors in the fellow eyes of patients with unilateral polypoidal choroidal vasculopathy (PCV).MethodsWe reviewed the medical records of 47 patients with...

Verteporfin Photodynamic Therapy Combined with Intravitreal Ranibizumab for Polypoidal Choroidal Vasculopathy Controversy Concerning Long-Term Followup

Purpose. To show the long-term results of intravitreal ranibizumab combined with photodynamic therapy (PDT) for the treatment of polypoidal choroidal vasculopathy (PCV). Methods. We analyzed the progress of two patients for 36 and 58 months, respectively. We only used PDT for the treatment in the area of the active PCV or “hot spot” evident on the indocyanine green angiography (ICGA). The spot size was chosen so as to cover only the active neovascular lesion. We combined intravitreal ranibizumab with PDT when PCV remained active without visible polyps in ICGA or without a response to PDT. Conclusion. Administration, as required, of verteporfin photodynamic therapy combined with intravitreal ranibizumab is an effective treatment for symptomatic polypoidal choroidal vasculopathy. These data need to be confirmed in large, prospective, and controlled clinical trials which are randomized and carried out over a long period.

RETINAL MICROSTRUCTURAL ABNORMALITIES IN CENTRAL SEROUS CHORIORETINOPATHY AND POLYPOIDAL CHOROIDAL VASCULOPATHY

To compare retinal morphologic alterations in eyes with polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC) using speckle noise-reduced spectral-domain optical coherence tomography. We retrospectively reviewed 63 eyes of 62 patients with active PCV and 38 eyes of 38 patients with active CSC. Patients underwent fundus photography, angiography, and speckle noise-reduced spectral-domain optical coherence tomography examinations, and retinal morphologic alterations were evaluated. Cystoid macular edema, lipid deposits, subretinal hemorrhage, and hemorrhagic pigment epithelial detachment were not seen in any eye with CSC but were seen in eyes with PCV. In PCV, mean visual acuity was significantly poorer in eyes with fibrin infiltration (P = 0.027) or hemorrhagic infiltration (P = 0.002) in the fovea than in eyes without fibrin or hemorrhagic infiltration. Differentiating factors between PCV and CSC noted on spectral-domain optical coherence tomography include a lack of cystoid macular edema, lipid deposition, subretinal hemorrhage, and hemorrhagic pigment epithelial detachment in eyes with CSC, which makes spectral-domain optical coherence tomography helpful in differentiating CSC from PCV. More severe retinal alterations were seen in PCV than in CSC because of infiltration of fibrin and hemorrhage in the outer retina, which also correlated with poorer vision.

Photodynamic therapy combined with ranibizumab for polypoidal choroidal vasculopathy: results of a 1-year preliminary study

Background/aimsTo determine the potential efficacy and safety of combined verteporfin photodynamic therapy (PDT) with ranibizumab for the treatment of polypoidal choroidal vasculopathy (PCV).MethodsIn this prospective, non-comparative, interventional study, 12 eyes...

RESULTS OF VITRECTOMY FOR BREAKTHROUGH VITREOUS HEMORRHAGE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY

The purpose of this study was to evaluate the results of vitrectomy in patients with vitreous hemorrhage associated with age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). A retrospective review was conducted of consecutive cases of patients undergoing pars plana vitrectomy for nonclearing vitreous hemorrhage associated with neovascular AMD or PCV. Twenty-four eyes of 23 patients were included. The mean length of time from the onset of vitreous hemorrhage to operation was 4.3 months. Twelve eyes had AMD, and 12 eyes of 11 patients had PCV. Additional treatments for active choroidal neovascularization or PCV were required in 12 eyes during follow-up. The mean visual acuity improved significantly from a logarithm of the minimum angle of resolution of 2.79 +/- 0.85 before operation to 1.61 +/- 0.98 at 2 months after operation (P < 0.001). Visual acuity was >or=20/200 in 9 eyes (37.5%) at 2 months after operation; 1 eye was in the AMD group, and the other eyes were in the PCV group. Improvement was more frequently observed in the PCV group (P = 0.005). In this series, the functional outcomes of vitrectomy for vitreous hemorrhage associated with AMD were inferior to outcomes of the PCV group. Vitrectomy is beneficial for improving visual function in select cases of breakthrough vitreous hemorrhage.

Thickness of photoreceptor layers in polypoidal choroidal vasculopathy and central serous chorioretinopathy

To evaluate retinal thickness using spectral-domain optical coherence tomography (SD-OCT) with reduced speckle noise in eyes with polypoidal choroidal vasculopathy (PCV) compared to those with normal eyes and those with central serous chorioretinopathy (CSC). We retrospectively reviewed cases of foveal serous retinal detachment in 36 eyes of 36 patients with active CSC and 23 eyes of 23 patients with active PCV, and 44 eyes of 44 normal subjects. Patients were examined using SD-OCT with reduced speckle noise, and the thickness of the outer nuclear layer (ONL), photoreceptor inner segment (IS), and photoreceptor outer segment (OS) were measured. The ONL and IS were thicker in normal eyes than in eyes with CSC or PCV (P < 0.001). The OS was significantly less thick in eyes with PCV than in normal eyes (P < 0.001), whereas there was no significant difference between eyes with CSC and normal eyes. The thickness of IS and OS in eyes with PCV was related to fibrin or hemorrhage being present in the subretinal space. In eyes with PCV, best-corrected visual acuity at baseline correlated with IS thickness (P = 0.023). Thinning of each photoreceptor layer was observed in the eyes of PCV patients as compared to that observed in the case of normal individuals. The differentiating factors between PCV and CSC, observed using SD-OCT, include the thinning of the OS in eyes with PCV, which makes SD-OCT helpful in differentiating PCV from CSC. More severe photoreceptor alterations were seen in PCV, because fibrin and hemorrhage were present in the subretinal space, which correlated with poorer vision.

TWO-YEAR VISUAL OUTCOMES AFTER PHOTODYNAMIC THERAPY IN AGE-RELATED MACULAR DEGENERATION PATIENTS WITH OR WITHOUT POLYPOIDAL CHOROIDAL VASCULOPATHY LESIONS

To describe the visual outcomes 2 years after photodynamic therapy in Japanese patients with age-related macular degeneration (AMD) with or without polypoidal choroidal vasculopathy (PCV) lesions. Sixty-three eyes of 63 consecutive patients with AMD or AMD + PCV who underwent photodynamic therapy were included in this study. Fluorescein and indocyanine green angiography were performed to diagnose AMD and AMD + PCV. Change in mean visual acuity and recurrence of active lesion during the follow-up period up to 2 years were assessed. Patients with typical AMD maintained visual acuity for 2 years after photodynamic therapy. For patients with AMD + PCV, the visual acuity was maintained during the first year but started decreasing by 0.09 logarithm of the minimum angle of resolution units per 3 months (95% confidence intervals [CI], 0.06-0.14) after 1 year. Moreover, patients with AMD + PCV had 82% higher risk of a recurrence of active lesions for each increase in 3 months of follow-up time after 1 year; this suggested that the risk of recurrence had increased later in follow-up after 1 year. Recurrence of active PCV lesions and massive subretinal hemorrhages were the main reasons for the late worsening of visual acuity. The visual acuity after photodynamic therapy in AMD patients was maintained for 2 years after the initial treatment. Patients with AMD + PCV had stable visual outcome within 1 year but not after 1 year; there are risks of late recurrences and massive hemorrhages after 1 year in patients with AMD + PCV.