Regression Of Polypoidal Lesions Research Articles

Focal laser photocoagulation treatment in polypoidal choroidal vasculopathy: Long‐term follow‐up

AbstractPurpose: To report the long‐term effect and safety of focal laser photocoagulation treatment (FLPT), in a case of polypoidal choroidal vasculopathy (PCV).Methods: We reviewed a 56‐month follow‐up (April 2017–January 2022) of a 54‐year‐old woman with PCV. The diagnosis was made using indocyanine green angiography (ICG‐A). The measured outcomes of the effect of FLPT were changes in best‐corrected visual acuity (BCVA), complications, regression, and recurrence of polypoidal lesions based on fundoscopy, B‐scan swept source optical coherence tomography (SS‐OCT) and ICG‐A.Results: At the time of diagnosis, the patient had extensive subretinal exudation and haemorrhage in the right eye (RE) related to foveal and juxtapapillary polypoidal lesions. She received 12 bevacizumab intravitreal injections and treatment was interrupted because of extensive macular fibrosis. In the left eye (LE), she had extrafoveal polypoidal lesions with a BCVA of 20/25. At 8 months follow‐up, a decrease in BCVA to 20/50 was noted. Therefore, a first round of FLPT associated with three bevacizumab intravitreal injections, was performed. Four months post‐FLPT, regression of the polypoidal lesions was obtained with a BCVA of 20/25. BCVA and multimodal imaging remained stable for 2 years. The left eye showed recurrence of extrafoveal polypoidal lesions 35 months after FLPT, with a BCVA of 20/50. A second round of FLPT was performed, with a regression of the polypoidal lesions after 1 month, and a stabilization of BCVA at 20/30. After 14 months, BCVA was 20/50, and no signs of recurrence were detected on multimodal imaging. No complications were observed after the two rounds of FLPT.Conclusions: FLPT can be efficient and safe in treating eyes with PCV with extrafoveal polypoidal lesions. In this case, it allowed us to obtain the regression of polypoidal lesions and to maintain visual acuity without serious hemorrhagic complications during the 56‐month follow‐up.

One-year outcome of combination therapy with intravitreal aflibercept and photodynamic therapy for polypoidal choroidal vasculopathy

BackgroundTo investigate the one-year visual and anatomical outcomes of combination therapy with intravitreal aflibercept (IVA) and photodynamic therapy (PDT) for treating polypoidal choroidal vasculopathy (PCV).MethodsThis was a retrospective case-series study, including 30 eyes from 30 patients with treatment-naïve PCV treated by combination therapy with IVA and PDT. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), complete polyp regression rate, and dry macula rate were recorded every 3 months during 12-month follow-up. Clinical factors associated with final visual outcome and retreatment were investigated.ResultsThe mean LogMAR BCVA was significantly improved from 0.73 ± 0.65 at baseline to 0.51 ± 0.60 (p = 0.01), and the mean CRT was also significantly improved from 339 ± 96 μm at baseline to 244 ± 43 μm at 12-month follow-up (p < 0.001). Complete regression of polypoidal lesions was 76.7%, and dry macula rate was 100% at 12 months. Better final BCVA was associated with younger age and better baseline BCVA (p = 0.02 and p < 0 001). The patients without complete polyp regression at 3-month follow-up were associated with retreatment (p = 0.03).ConclusionIn this study, combination therapy with IVA and PDT had significant visual and anatomical improvements to PCV patients during one-year follow-up. Better baseline BCVA and younger age were found to be associated with better visual outcome.

Two-year results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy.

To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve polypoidal choroidal vasculopathy (PCV). In a retrospective interventional case series of 58 eyes of 58 patients with PCV, we assessed best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and number of injections for 2years. Polypoidal lesions were also evaluated before treatment and after the loading phase by indocyanine green angiography. BCVA significantly improved after the loading phase and was maintained in the maintenance phase. CMT and CCT significantly reduced after the loading phase and were maintained throughout the follow-up period. The number of injections averaged 7.72 in the first year and 4.67 in the second year. The average number of polypoidal lesions per patient was 2.43 before treatment. In 32 patients (55.2%), polypoidal lesions regressed completely after the loading phase; these patients also needed significantly fewer injections compared to other patients. CCT at baseline was positively correlated with the decreased amount of CCT after 2years and negatively correlated with the number of injections for 2years. Treat-and-extend intravitreal therapy with aflibercept may be effective for improving BCVA and exudative change in eyes with PCV. The regression of polypoidal lesions after the loading phase and thicker choroid at baseline might lead to fewer total number of intravitreal injections of aflibercept.

Combined argon laser photocoagulation and antivascular endothelial growth factor for management of macular polypoidal choroidal vasculopathy.

Aim:To evaluate the efficacy of combination therapy of argon laser photocoagulation and intravitreal antivascular endothelial growth factor (VEGF) injection in idiopathic polypoidal choroidal vasculopathy (PCV) involving macula.Materials and Methods:A retrospective interventional study involving 12 eyes of 11 patients diagnosed with PCV involving the macula on indocyanine green angiography (ICGA). Intravitreal anti-VEGF was given in eyes with significant subretinal/sub retinal pigment epithelium hemorrhage or exudation. ICGA-guided focal laser was done to extrafoveal leaking polyps. Mean change in best-corrected visual acuity (BCVA) and regression of polyp as seen on ICGA were evaluated at the final follow-up.Statistical Analysis:It was done using SPSS 17.0. – Mann-Whitney test.Results:12 eyes of 11 patients underwent argon laser with intravitreal anti-VEGF injection. Ten patients were males and one female. Mean age was 65.75 ± 5.2 years. The mean number of injections given was 3.66 ± 1.5 (2–6) per eye. Mean number of laser sessions required was 1.33 ± 0.65 (1–3) per eye. BCVA improved in 25% (n = 3), remained stable in stable in 50% (n = 6) eyes, and decreased in 25% (n = 3) eyes. The regression of polypoidal lesions on ICGA was seen in 75% (n = 9) of eyes. Persistent subretinal fluid seen in 25% (n = 3) of eyes. The mean duration of follow-up was 15.41 ± 10.27 (3–36) months.Conclusion:Combined argon laser photocoagulation with intravitreal anti-VEGF injection helps in decreasing exudation and results in stabilization of the disease with visual improvement in eyes with PCV involving macula.

Six-month results of intravitreal aflibercept injections for patients with polypoidal choroidal vasculopathy

BackgroundThis study aims to evaluate the therapeutic effect of intravitreal aflibercept injection for polypoidal choroidal vasculopathy (PCV).MethodsEighteen eyes of 17 consecutive patients with PCV received three consecutive monthly intravitreal injections...

Factors associated with polyp regression after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy.

To investigate the predictive factors of polyp regression after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy (PCV). Sixty-nine eyes (69 patients) with treatment-naïve PCV received an initial series of 3-monthly intravitreal ranibizumab injections, followed by as-needed injections. Polyp regression was determined after 6 months from baseline by means of indocyanine angiography and correlated with clinical characteristics at baseline. After treatment, 26.1% (18 out of 69 eyes) achieved complete polyp regression and 73.9% (51 out of 69 eyes) showed persistent polyps. The mean logarithm of the minimum angle of resolution (logMAR) of best-corrected visual acuity (BCVA) was significantly improved in both groups (P = 0.02). No statistically significant difference in BCVA improvement was observed between the groups. However, the proportion of subjects with BCVA improvement by more than three lines was significantly higher in the polyp regression group (P = 0.02). Univariate analysis of the baseline characteristics identified the number of polyps (P = 0.02), the total polyp area (P = 0.009) and the polyp pattern (P = 0.01) as predictive factors for polyp regression. Multivariate logistic regression identified the total polyp area (P = 0.01) as an independent predictor for polyp regression after intravitreal ranibizumab injections. The regression of polypoidal lesions in PCV patients after intravitreal ranibizumab injections was associated with a smaller total polyp area. This result could be helpful in predicting polypoidal changes after ranibizumab treatment and in deciding the best treatment strategy for PCV patients.

Responses to Photodynamic Therapy in Patients With Polypoidal Choroidal Vasculopathy Consisting of Polyps Resembling Grape Clusters

To investigate the responses to photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV) that show large aneurysmal dilation with internal angio-architecture consisting of diverse patterns of curvilinear vessels and polyps resembling grape clusters. Retrospective, interventional case series. Twenty-two eyes of 22 patients were included. All patients initially received PDT monotreatment. The main outcome measures were the rates of complete polyp regression on indocyanine green angiography and initial favorable responses observed clinically. Also, the rates of recurrent exudative changes were evaluated at the 2-year follow-up. We focused on changes in the vascular features and their clinical association. Complete regression of polypoidal lesions was observed in 21 eyes (95%) after a mean of 1.7 PDTs. However, favorable clinical responses were achieved in only 9 eyes (41%), and 6 of them had recurrent exudation. Main vessels, previously consisting of the polypoidal lesion frame, persisted. Additionally, aberrant vessels with a thin radiating or tortuous configuration were observed in the area where large aneurysmal dilation was present. Leakage from this vascular complex or an expanded vascular complex was observed in a total of 14 eyes (64%) during the 2-year follow-up, contributing to persistent (8 eyes) or recurrent (6 eyes) exudation. This seemed to represent secondary choroidal neovascularization (CNV). In another 4 eyes (18%), fibrous changes developed immediately after PDT. Polyps recurred in 8 eyes (38%). This PCV pattern frequently evolved into typical CNV after PDT, resulting in persistent or recurrent exudation despite the disappearance of polypoidal structures.

Bevacizumab for serous changes originating from a persistent branching vascular network following photodynamic therapy for polypoidal choroidal vasculopathy

To report the efficacy of intravitreal bevacizumab for either recurrent or persistent serous changes originating from a persistent branching vascular network or secondary choroidal neovascularization after photodynamic therapy for polypoidal choroidal vasculopathy, despite regression of polypoidal lesions. Twenty eyes of 20 patients with at least 12 months of regular follow-up were retrospectively reviewed. Intravitreal bevacizumab was administered on an as-needed basis, guided by optical coherence tomography (OCT), after the first injection. Seventeen (85%) of 20 eyes showed resolution of macular fluid after a mean of 1.9 (range 1-3) consecutive injections; however, 15 (88%) of them had relapsing episodes of fluid collection. The mean number of injections needed was 4.2 (range 1-6) over a period of 12 months. At 12 months, 10 eyes (50%) had no fluid accumulation on OCT, while 10 eyes (50%) had some residual fluid. The mean central foveal thickness improved significantly from 280 ± 37 to 226 ± 62 μm (P = 0.002). Visual acuity was maintained or improved in 16 eyes (80%). Intravitreal bevacizumab appears to be effective in resolving intraretinal and subretinal fluid originating from these lesions. However, the favorable effect was maintained for only a limited period of time and required repeated injections.

Clinical observation of polypoidal choroidal vasculopathy

To observe the natural course and evaluate the prognostic factors influencing the follow-up visual acuity of polypoidal choroidal vasculopathy (PCV). It was a retrospective case series. Forty-five consecutive patients (51 eyes) who were diagnosed with PCV by fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were followed up with (11.1 ± 2.0) months (mean ± SD). Age, baseline visual acuity, the presence of pigment epithelium detachment (PED), lesion size, the polypoidal lesions involving the fovea and the regression of polypoidal lesions were recorded. Multi-factor regression analysis of visual acuity at follow up was applied with SPSS 16.0 statistics software. Among the 45 patients (51 eyes), the hemorrhage or exudation were increased in 15 eyes (29.4%), decreased in 25 eyes (49.0%), 5 eyes (9.8%) developed macula scar and 6 eyes (11.8%) macula atrophy. During the follow-up period, the visual acuity was improved in 11 eyes (21.6%), stable in 21 (41.2%) and regressed in 19 (37.2%). Twenty-five eyes (49.0%) demonstrated polypoidal lesions involving the fovea and 26 eyes (51.0%) did not. ICGA revealed that the polypoidal lesions were unchanged in 18 eyes (35.3%), regressed in 13 (25.5%), grew in 13 (25.5%), and mixed in 7 eyes (13.7%). The changes of visual acuity at follow up were related to the age, baseline visual acuity, and polypoidal lesions involving in the fovea (b = -0.005, 0.382 and -0.430; P = 0.034, 0.000 and 0.000). Improvement of visual acuity at follow up was related to the regression of polypoidal lesions (b = 2.259, P = 0.019, OR = 9.578). There is a large variation in the visual prognosis in Chinese patients with PCV. The presence of PED and the lesion size had no effect on the visual prognosis of PCV. Better visual acuity during follow-up period is correlated with younger age, better baseline visual acuity, polypoidal lesions not involving the fovea and a regression of polypoidal lesions.