Therapy For Polypoidal Choroidal Vasculopathy Research Articles

441 Vasculopathie polypoïdale choroïdienne : Comment traiter ?

Polypoidal choroidal vasculopathy is a disease with characteristic choroidal vascular abnormalities. Although the polypoidal choroidal vasculopathy and age-related macular degeneration have been known to share common genetic factors, clinical characteristics suggest that polypoidal choroidal vasculopathy is a separate clinical entity from age-related macular degeneration. Indocyanine green angiography is essential for diagnosis. The prevalence is higher in Asian people than in Caucasians. In some cases, a spontaneous resolution can occur with no treatment at all. The results of photodynamic therapy for polypoidal choroidal vasculopathy are encouraging. The lower efficacy of Bevacizumab has been shown for polypoidal choroidal vasculopathy Recurrence may affect vision over time. Two females of 50 and 75 years old with subacute visual loss were examined. ICG angiography demonstrates the presence of polypoidal choroidal vasculopathy. In one case the polypoidal lesion disappears without treatment. The other case is treated with focal PDT showing a complete resolution of the lesion. The visual acuity in both cases is recovered partially and it is stable 9 months later with no recurrence of the lesion. As Polypoidal choroidal vasculopathy has a difficult management, when the polypoidal lesion is out of the fovea, it is fair to wait and see its behaviour. In case treatment is needed, the PDT is the best option. The way to manage Polypoidal Choroidal Vasculopathy remains controversial. Several treatments have been used but at the moment observation or PDT is the best option. A treatment that stops recurrences is not available yet.

Transitions of multifocal electroretinography following combined intravitreal bevacizumab and photodynamic therapy for polypoidal choroidal vasculopathy

To investigate the changes in the multifocal electroretinography (ERG) after combined intravitreal bevacizumab and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) patients. Thirteen eyes of 13 patients were included in the study. The latencies and average response densities of all the six ring retinal regions were measured and compared before treatment and 1, 3, and 6 months after treatment. The latencies of the N1 and P1 waves in all the six rings remained unchanged compared with pre-treatment. Significant increase of average response densities of both P1 in ring 1 (P = 0.023) and N1, P1 in ring 2 (P = 0.028 and 0.046, respectively) were detected at 3 months post-treatment. The increase of P1 amplitude densities in ring 1 (P = 0.015) and N1, P1 amplitude densities in ring 2 (P = 0.031 and 0.034, respectively) were also significant at 6 months post-treatment. In conclusion, combined intravitreal bevacizumab and PDT is associated with an increase of multifocal ERG centrally in PCV patients.

Short-Term Safety and Efficacy of a Single Intravitreal Bevacizumab Injection for the Management of Polypoidal Choroidal Vasculopathy

Aims: To evaluate the short-term safety and efficacy of a single intravitreal bevacizumab injection in patients with polypoidal choroidal vasculopathy (PCV). Methods: The records of patients treated with intravitreal bevacizumab for PCV were retrospectively reviewed. All patients were evaluated by complete ophthalmic examination, optical coherence tomography and fluorescein and indocyanine green angiography. Changes in visual acuity and central retinal thickness (CRT) over 3 months were the main outcome measures. Results: Nineteen eyes of 18 patients were included. No serious ocular or systemic adverse events were observed. The median baseline visual acuity and CRT were 20/100 and 230 μm, respectively. After 1 month, there was no significant improvement in median visual acuity (20/80⁺¹; p = 0.055), but median CRT had decreased significantly (160 μm; p < 0.001). After 3 months (data available for 17 eyes), both median visual acuity (20/63^–2; p = 0.001) and CRT (190 μm; p = 0.007) showed significant improvements over baseline values. Conclusions: Intravitreal bevacizumab therapy for PCV was well tolerated over the 3-month follow-up period. Short-term results are promising, but further studies are necessary to evaluate long-term efficacy.

Transient serous retinal detachment after photodynamic therapy for polypoidal choroidal vasculopathy

Transient serous retinal detachment after photodynamic therapy for polypoidal choroidal vasculopathy

Two-Year Results of Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To report on the two-year visual outcomes of indocyanine green angiography-guided photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) patients. Retrospective case study. A retrospective analysis that examined the clinical and angiographic data related to 41 eyes of 38 PCV patients (25 males, 13 females; average age +/- standard deviation [SD], 72.9 +/- 7.4 years) with follow-up periods of 24 months or more. The average number of PDT treatments was 1.65. After the 12-month follow-up, 12 eyes required retreatment. Although the mean visual acuity (VA) +/- SD before PDT (0.55 +/- 0.38 logarithm of the minimum angle of resolution units) improved to 0.46 +/- 0.41 at 12 months after the initial PDT, at 24 months, it declined significantly to 0.59 +/- 0.44 (P = .0018). Although only seven of 41 eyes exhibited VA deterioration at the 12-month follow-up examination, a decreased VA was noted in 18 eyes during the period starting from the 12-month follow-up until the final examination. The cases were bilateral in 11 (61.1%) of the 18 eyes. At the final examination, the mean VA of the bilateral cases but not the unilateral cases was significantly lower than that observed for the initial VA. PDT is an effective treatment against PCV over the short-term for both unilateral and bilateral cases. However, the VA prognosis may not the same after 12 months, especially for those PCV patients who have exudative age-related macular degeneration in contralateral eye.

Polypoidal choroidal vasculopathy and treatments

This review assesses the current knowledge of the clinical characteristics of polypoidal choroidal vasculopathy and treatments. Polypoidal choroidal vasculopathy is a disease with characteristic choroidal vascular abnormalities. Indocyanine green angiography is essential for diagnosis. The prevalence is higher in Asian people than in Caucasians. Photodynamic therapy is efficacious for treating polypoidal choroidal vasculopathy; 1-year results have shown greater benefit of photodynamic therapy than choroidal neovascularization secondary to age-related macular degeneration. Recurrence, however, seriously affects vision long term during follow-up after photodynamic therapy. The lower efficacy of bevacizumab- a full-length antibody of vascular endothelial growth factor- has been shown for polypoidal choroidal vasculopathy. Although the polypoidal choroidal vasculopathy and age-related macular degeneration have been known to share common genetic factors, its clinical characteristics including the different responses to photodynamic therapy suggest that polypoidal choroidal vasculopathy is a separate clinical entity from age-related macular degeneration. The results of photodynamic therapy for polypoidal choroidal vasculopathy are encouraging; however, recurrence may affect vision over time. Therapeutic modalities to inhibit development of the exudative choroidal vasculature of polypoidal choroidal vasculopathy are desirable.

Photodynamic therapy for polypoidal choroidal vasculopathy: Vaso-occlusive effect on the branching vascular network and origin of recurrence

To determine whether photodynamic therapy (PDT) has a vaso-occlusive effect on the branching vascular network in polypoidal choroidal vasculopathy (PCV) and whether PDT can prevent future recurrence. We analyzed pre-and post-PDT indocyanine green angiography (ICGA) results of 27 patients (27 eyes) who were diagnosed with PCV and who had shown clinical improvement accompanied by occlusion of polypoidal lesions after PDT. We also investigated the recurrent events in these patients and the origin of the recurrences. The branching vascular network persisted, at least in part, in 20 (87%) of 23 eyes undergoing one PDT session and in two (50%) of four eyes undergoing two PDT sessions. In the remaining five eyes, we could not determine definitively whether the branching vessels were occluded completely. Recurrent serous changes occurred in nine eyes (33%) 14-48 months after the last PDT. ICGA revealed that these changes were caused by new polypoidal lesions that originated from further-grown branches of the persistent branching vascular network. Diffuse leakage from undetermined sources seemed to coexist in two eyes. PDT cannot induce complete occlusion of the branching vascular network. PDT does not prevent future recurrence, because new active polypoidal lesions may develop from the persistent branching vessels in the network.

Chorioretinal anastomosis after photodynamic therapy for polypoidal choroidal vasculopathy

An 80-year-old woman was treated with photodynamic therapy (PDT) to the left eye for polypoidal choroidal vasculopathy (PCV). About 3 months after PDT, her left eye developed a chorioretinal anastomosis with severe atrophy of the retinal pigment epithelium in the macula; visual acuity in this eye was 20/1000. She received a second session of PDT, plus an intravitreal injection of triamcinolone acetonide. About 3 months after the second treatment, the chorioretinal anastomosis was enlarged and the retinal vessels involved in the anastomosis were more dilated. About 1 year after the first PDT, visual acuity in the left eye had stabilized at 20/400. Development of a chorioretinal anastomosis is a distinct possibility following PDT in eyes with PCV, and can lead to poor visual recovery.

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

To determine the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV). PDT was performed in 35 patients (35 eyes) with PCV. We evaluated the number of treatments and compared visual acuity (VA), ophthalmological findings, and changes in polypoidal lesions and branching vascular networks by measuring lesion diameters using Heidelberg retina angiography before PDT, and then every 3 months for 1 year after PDT. The mean annual number of treatment sessions was 2.2. VA was improved or maintained in 80% of the patients. Retinal pigment epithelium detachment, retinal detachment, hemorrhage, and/or exudates disappeared in 69%, and leakage resolved in 74% of the patients. Polypoidal lesions disappeared completely on indocyanine green angiography in 83% of the patients. All branching vascular networks persisted. Polypoidal lesions had recurred at the termini of the remaining branching vascular networks at 9 months after the first PDT in two eyes and at 12 months in one eye. PDT with verteporfin for PCV appears to improve or maintain VA for the first posttreatment year. Approximately 70% of PCV cases showed improved ophthalmoscopic findings. However, as polypoidal lesions recur after PDT in some cases, further study is needed to confirm the long-term efficacy of PDT for PCV.

One-Year Outcomes of Photodynamic Therapy in Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy in Japanese Patients

To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in Japanese patients presumed to have age-related macular degeneration (AMD) and compare 1-year outcomes after photodynamic therapy between PCV and choroidal neovascularization secondary to AMD. Prospective interventional study. Ninety-three consecutive patients (93 eyes) met the inclusion criteria: at least 50 years old, best-corrected visual acuity (VA) of 34 to 73 on the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart, a subfoveal lesion 5400 mum or smaller in greatest linear dimension (GLD) on fluorescein angiography (FA), and eligibility for photodynamic therapy. Indocyanine green angiography was performed in all participants, and PCV and AMD were differentiated, treated with photodynamic therapy, and the patients observed for 1 year. The GLD was determined by FA for AMD and by indocyanine green angiography for PCV, and the diameter of the laser spot size was chosen, with an extra 1000 microm added to the GLD. Photodynamic therapy was repeated if leakage occurred on FA at 3-month follow-up visits. Prevalence of PCV at baseline and visual and angiographic changes 1 year after photodynamic therapy in PCV and AMD. Using indocyanine green angiography, 36 eyes (39%) were diagnosed with PCV and 54 eyes (58%) with choroidal neovascularization secondary to AMD. The median change in VA using the ETDRS letter score from baseline to 1 year was -7.0 in AMD eyes and +8.0 in PCV eyes (Mann-Whitney rank sum test; P<0.001). The VA improved (> or =15 letters) in AMD and PCV by 6% and 25%, respectively, and decreased (> or =15 letters) by 31% and 8%, respectively. Fluorescein leakage stopped at 1 year in 86% of PCV and 61% of AMD eyes (P = 0.031). Polypoidal choroidal vasculopathy recurred in 2 PCV eyes (5.6%), and a new PCV lesion developed in 1 PCV eye (2.8%) and 2 AMD eyes (3.7%) on indocyanine green angiography at 1 year. The prevalence of PCV meeting the treatment criteria for photodynamic therapy for presumed AMD is high in Japanese patients. Photodynamic therapy is more efficacious for PCV than for AMD, which may explain the good results in Japanese patients. Further study should assess the long-term clinical results.

Indocyanine Green Angiography: Guided Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To report the 12-month follow-up results of subfoveal polypoidal choroidal vasculopathy (PCV) patients treated with indocyanine green angiography (ICGA)-guided photodynamic therapy (PDT). Interventional, noncomparative cases series. A retrospective analysis of the clinical and angiographic data related to 47 PCV eyes that were followed up for 12 months was carried out. The greatest linear dimension (GLD) for PDT was determined based on the ICGA findings. Optical coherence tomography (OCT) also was used to evaluate the therapeutic effects. The mean logarithm of the minimum angle of resolution visual acuity (VA; 0.58 +/- 0.37) significantly improved to 0.53 +/- 0.38 at three months (P = .04) and to 0.46 +/- 0.40 at 12 months (P = .02). The average ICGA GLD (2682.3 +/- 1026.9 mm) was significantly (P = .0001) smaller than the presumed fluorescein angiography (FA) GLD (4043.6 +/- 1914.8 mm). In more than 80% of cases, complete resolution of retinal exudative changes was observed. Although polypoidal vascular lesions disappeared in 82.2% of eyes, the branched vascular networks showed little change. The initial VA and GLD had little correlation with the VA outcome. ICGA-guided PDT reduces the size of laser exposure and is an effective treatment for PCV. Because PCV may appear as occult choroidal neovascularization (CNV) on FA, PCV should be diagnosed using ICGA before treatment because PCV may respond differently than CNV to appropriate treatment.

Central Retinal Sensitivity Measured with the Micro Perimeter 1 After Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To evaluate central retinal sensitivity and its relation to the symptomatic change noted in central visual disturbance shortly after photodynamic therapy (PDT) in eyes with polypoidal choroidal vasculopathy (PCV). Retrospective interventional case series. We reviewed retrospectively 20 eyes of 20 patients who underwent PDT for the treatment of subfoveal PCV. Microperimetry in the macular area was performed with Micro Perimeter 1 (MP1) [Nidek, Vigonza, Italy] before and at one, three, and six months after PDT. Forty measurement points were located within the central 10 degree of the macula. After PDT, although most eyes showed a reduction in exudation, the mean posttreatment visual acuity did not change significantly. At one month after PDT, however, retinal sensitivities within the central 2 degree, 6 degree, and 10 degree fields, which were 3.6 +/- 3.1, 5.1 +/- 3.4, and 6.2 +/- 3.6 dB [decibels] at baseline, improved to 5.9 +/- 3.8 (P = .003), 7.1 +/- 3.6 (P = .003), and 8.1 +/- 3.5 dB (P = .004). At one month after treatment, 14 patients (70%) noted subjective improvement of the central visual disturbance and mean retinal sensitivity within the central 2 degree, 6 degree, and 10 degree fields had improved more than 2 dB in 11, 10, and eight eyes, respectively. At three and six months after PDT, however, postoperative improvement of the retinal sensitivities was diminished. Retinal sensitivity in the macular area of eyes with subfoveal PCV improved shortly after PDT, and may account, at least in part, for the immediate subjective improvement in central vision after PDT.

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.