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Storp JJ, Diener R, Eter N, Bormann E, Treder M. Submacular Hemorrhages Show No Significant Seasonal Variations in a European Cohort. J Clin Med 2023; 12:jcm12113622. [PMID: 37297819 DOI: 10.3390/jcm12113622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/29/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of the article is to investigate the seasonality of acute submacular hemorrhages (SMHs) in a European population and analyze the influence of the seasons, arterial hypertension, and intake of anticoagulatory/antiplatelet (AC/AP) medication on hemorrhage size. This retrospective, monocentric study included 164 eyes of 164 patients treated for acute SMH at the University Hospital Münster, Germany, between 1 January 2016 and 31 December 2021. Data on the day of occurrence, hemorrhage size, and general patient characteristics were recorded. "Test for cyclic trends in incidence data" and the Chi-Square Test were applied to investigate seasonal variations in SMH incidence. Fisher's exact test was used to investigate the influence of the seasons, arterial hypertension, and intake of AC/AP medication on hemorrhage size. A statistical analysis did not reveal significant seasonal variations in the occurrence of SMHs (p = 0.81). While the seasons and the presence of systemic arterial hypertension did not exert a significant influence, the intake of AC/AP medication significantly affected the size of SMH (p = 0.03). In this European cohort, no significant seasonal variations of SMHs were observed. However, in patients with risk factors, such as neovascular age-related macular degeneration (nAMD), the chance of an increase in hemorrhage size should be considered when initiating AC/AP therapy.
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Affiliation(s)
- Jens Julian Storp
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Raphael Diener
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Eike Bormann
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Maximilian Treder
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
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Wongchaisuwat P, Thamphithak R, Jitpukdee P, Wongchaisuwat N. Application of Deep Learning for Automated Detection of Polypoidal Choroidal Vasculopathy in Spectral Domain Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:16. [PMID: 36219163 PMCID: PMC9580222 DOI: 10.1167/tvst.11.10.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To develop an automated polypoidal choroidal vasculopathy (PCV) screening model to distinguish PCV from wet age-related macular degeneration (wet AMD). Methods A retrospective review of spectral domain optical coherence tomography (SD-OCT) images was undertaken. The included SD-OCT images were classified into two distinct categories (PCV or wet AMD) prior to the development of the PCV screening model. The automated detection of PCV using the developed model was compared with the results of gold-standard fundus fluorescein angiography and indocyanine green (FFA + ICG) angiography. A framework of SHapley Additive exPlanations was used to interpret the results from the model. Results A total of 2334 SD-OCT images were enrolled for training purposes, and an additional 1171 SD-OCT images were used for external validation. The ResNet attention model yielded superior performance with average area under the curve values of 0.8 and 0.81 for the training and external validation data sets, respectively. The sensitivity/specificity calculated at a patient level was 100%/60% and 85%/71% for the training and external validation data sets, respectively. Conclusions A conventional FFA + ICG investigation to differentiate PCV from wet AMD requires intense health care resources and adversely affects patients. A deep learning algorithm is proposed to automatically distinguish PCV from wet AMD. The developed algorithm exhibited promising performance for further development into an alternative PCV screening tool. Enhancement of the model's performance with additional data is needed prior to implementation of this diagnostic tool in real-world clinical practice. The invisibility of disease signs within SD-OCT images is the main limitation of the proposed model. Translational Relevance Basic research of deep learning algorithms was applied to differentiate PCV from wet AMD based on OCT images, benefiting a diagnosis process and minimizing a risk of ICG angiogram.
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Affiliation(s)
- Papis Wongchaisuwat
- Department of Industrial Engineering, Faculty of Engineering, Kasetsart University, Bangkok, Thailand
| | - Ranida Thamphithak
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerakarn Jitpukdee
- Department of Industrial Engineering, Faculty of Engineering, Kasetsart University, Bangkok, Thailand
| | - Nida Wongchaisuwat
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mathis T, Holz FG, Sivaprasad S, Yoon YH, Eter N, Chen LJ, Koh A, Cunha de Souza E, Staurenghi G. Characterisation of macular neovascularisation subtypes in age-related macular degeneration to optimise treatment outcomes. Eye (Lond) 2022:10.1038/s41433-022-02231-y. [DOI: 10.1038/s41433-022-02231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/24/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.
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Montero Hernández J, Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Cervera Taulet E. Optical coherence tomography angiography analysis of aneurismal type 1 neovascularization in a cohort of white patients. Eur J Ophthalmol 2021; 32:2338-2346. [PMID: 34628950 DOI: 10.1177/11206721211048801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To evaluate the detection rate of aneurysmal type 1 neovascularization (AT1) in Caucasian patients using optical coherence tomography angiography (OCTA) and to describe OCTA characteristics of AT1 in a cohort of white patients. METHODS We conducted an observational retrospective study in 44 eyes of 43 patients with AT1. All patients underwent a complete ophthalmologic examination, including fundus imaging, indocyanine green angiography, optical coherence tomography, and OCTA. Branching vascular network (BVN) and polyp detection rates by OCTA were evaluated. Furthermore, we described BVN and polyp morphologies on en face OCTA and flow of polyps on B-scan OCTA. RESULTS En face OCTA revealed BVN in 84.09% of cases and polypoidal lesions in 86.36% of cases. B-scan OCTA showed BVN and polyps in 95.45% and 93.18% of the patients, respectively. "Trunk" BVNs (51.35%) and "ring" polyps (47.37%) were the most frequent morphologies observed in our cohort, and "patchy hyperflow" (80.49%) signal was the most common visualized in our patients. Regarding OCT parameters, CT under polyps was higher in patients with positive detection of polyps on B-scan OCTA. CONCLUSION OCTA is a possible diagnosis tool in Caucasian patients with AT1. To the best of our knowledge, this is the largest study performed in Caucasian patients regarding OCTA diagnostic abilities and features.
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Affiliation(s)
- Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Choe S, Kang HG, Park KH, Lee CS, Woo SJ. Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy. Int J Ophthalmol 2021; 14:1402-1407. [PMID: 34540617 DOI: 10.18240/ijo.2021.09.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy (PCV). METHODS Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2y after focal laser photocoagulation treatment. The patients were diagnosed with PCV using indocyanine green angiography, and eyes with other comorbid ocular diseases were excluded. The measurement outcomes of the study were the post-treatment regression and recurrence of polyps, complications, and changes in visual acuities. Paired t-test was performed to compare visual outcome before and after the treatment. RESULTS The mean age of the 13 patients was 70.2±5.5y, and the follow-up period was 72.3±31.0 (range, 25-118)mo. Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps. Of the 13 eyes, 9 eyes (69.2%) had regression of polyps 1.7±1.2 (range, 0.9-4)mo after focal laser photocoagulation. Five eyes (55.6%) showed recurrence of polyps during the follow-up periods, and the recurrence period was 12.8±18.9 (range, 1.9-48)mo. Mild subretinal hemorrhage occurred in two eyes (15.4%) 27 and 72d after laser treatment, respectively. There were no statistically significant differences in visual acuities at baseline; 1, 2, 3y post-treatment (all P>0.05); and last follow-up (0.63±0.5, 0.73±0.70, 0.67±0.57, 0.75±0.7, and 0.95±0.8 logMAR, respectively). CONCLUSION Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up. Furthermore, it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.
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Affiliation(s)
- Sooyeon Choe
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
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Sánchez-Vicente JL, Martínez-Borrego AC, Molina-Socola FE, Franco-Ruedas C, Espiñeira Periñán MA, López-Herrero F. Peripapillary pachychoroidopathy. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:157-161. [PMID: 32593603 DOI: 10.1016/j.oftal.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
A study was made on 8 eyes of 5 patients between 47 and 65 years of age with peripapillary pachychoroidopathy. They all presented with a serous detachment of the neuroepithelium or retinal pigment epithelium in the nasal macular region that extended to the optic disc, with an increase in choroidal thickness at that level. An analysis was made of the choroidal thickness using high penetration optical coherence tomography, as well as their outcome in a period between 12 and 48 months. Peripapillary pachychoroidopathy is a distinct variant of the pachychoroid disease spectrum. It must be distinguished from other disorders, such as inflammatory or neuro-ophthalmological conditions, that may manifest in the vicinity of the optic disc. When faced with a patient with suspected pachychoroidopathy, a specific study of the papillary area should be considered using high penetration optical coherence tomography.
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Affiliation(s)
| | | | - F E Molina-Socola
- Oftalmología, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - C Franco-Ruedas
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - F López-Herrero
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Kabedi NN, Kayembe DL, Mwanza JC. Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa, the Democratic Republic of Congo. Int J Ophthalmol 2020; 13:1652-1659. [PMID: 33078118 DOI: 10.18240/ijo.2020.10.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
AIM To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa, Democratic Republic of Congo. METHODS Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa, the University Hospital of Kinshasa (UHK) and Saint Joseph Hospital (SJH), from January 2012 to December 2014. Demographics and diagnoses were retrieved and analyzed. Outcome measures were frequency and prevalence of retinal diseases, blindness and low vision. RESULTS A total of 40 965 patients aged 40y or older were examined during this period in both clinics. Of these, 1208 had retinal disease, giving a 3-year and an annual prevalence of 3% and 1%, respectively. Mean age was 61.7±10.7y, and 55.8% of the patients were males. Arterial hypertension (68.1%) and diabetes (43.3%) were the most common systemic comorbidities. Hypertensive retinopathy (41.8%), diabetic retinopathy (37.9%), age-related macular degeneration (AMD; 14.6%), and chorioretinitis and retinal vein occlusion (7.3% each) were the most common retinal diseases, with 3-year prevalence rates of 1.3%, 1.0%, 0.43%, and 0.21% respectively. Bilateral low vision and blindness were present in 26.8% and 8.4% of the patients at presentation. Major causes of low vision and blindness were diabetic retinopathy (14.8%), AMD (4.9%), retinal detachment (2.8%), and retinal vein occlusion (2.5%). The prevalence was significantly higher among males than females, and at the UHK than SJH. CONCLUSION Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa. They cause a significant proportion of low vision and blindness.
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Affiliation(s)
- Nelly N Kabedi
- Departmemt of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa XI, Democratic Republic of Congo
| | - David L Kayembe
- Departmemt of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa XI, Democratic Republic of Congo
| | - Jean-Claude Mwanza
- Departmemt of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa XI, Democratic Republic of Congo.,Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, USA
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8
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Kabedi NN, Kayembe DL, Mwanza JC. Vision-Related Quality of Life, Anxiety and Depression in Congolese Patients with Polypoidal Choroidal Vasculopathy. Semin Ophthalmol 2020; 35:156-163. [PMID: 32507004 DOI: 10.1080/08820538.2020.1774623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the impact of polypoidal choroidal vasculopathy (PCV) on quality of life (QoL) and mental health in a cohort of Congolese patients. METHODS Fifteen PCV patients and 26 age-matched controls completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Outcome measures were QoL and HADS scores, frequency of anxiety and depression, correlations between best-corrected distance visual acuity (BCDVA) and QoL and HADS scores. Risk factors for anxiety and depression were also determined. RESULTS The QoL composite score was (54.9 ± 24.2) in patients and (94.5 ± 4.5) in controls, p <.001. Patients scored higher on HADS-A (9.5 ± 3.4) and HADS-D (6.7 ± 4.7) than controls (3.0 ± 2.7 and 1.5 ± 2.6), all p <.001. Anxiety and depression were present in 73.3% and 46.7% of patients, respectively, versus 1% each of controls (p <.001). Every unit improvement in best eye's BCDVA increased QoL composite score by 24.3, but decreased HADS-D by 5.9. Macular lesions decreased QoL by 34.5 while increasing HADS-A and HADS-D scores by 4.2 and 4.4, respectively. A history of stroke also increased the HADS-A score by 5.9. CONCLUSIONS PCV impairs the QoL and induces both anxiety and depression in Congolese PCV patients. Screening for QoL, anxiety and depression in PCV patients at first presentation will help detect those in need of psychological support.
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Affiliation(s)
- Nelly N Kabedi
- Department of Ophthalmology, School of Medicine, University of Kinshasa , Kinshasa, Democratic Republic of the Congo
| | - David L Kayembe
- Department of Ophthalmology, School of Medicine, University of Kinshasa , Kinshasa, Democratic Republic of the Congo
| | - Jean-Claude Mwanza
- Department of Ophthalmology, School of Medicine, University of Kinshasa , Kinshasa, Democratic Republic of the Congo.,Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
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Polypoidal Choroidal Vasculopathy in Congolese Patients. J Ophthalmol 2020; 2020:4103871. [PMID: 32051763 PMCID: PMC6995324 DOI: 10.1155/2020/4103871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/21/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients. Methods A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs. Results Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients (n = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively. Conclusions PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV.
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Heinrich D, Ulbig M, Feucht N, Maier M. [Stressed country doctor with acute visual loss : Clear diagnosis?]. Ophthalmologe 2019; 115:773-777. [PMID: 29242983 DOI: 10.1007/s00347-017-0635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Heinrich
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - M Ulbig
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - N Feucht
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Maier
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Palkar AH, Khetan V. Polypoidal choroidal vasculopathy: An update on current management and review of literature. Taiwan J Ophthalmol 2019; 9:72-92. [PMID: 31198666 PMCID: PMC6557071 DOI: 10.4103/tjo.tjo_35_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.
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Affiliation(s)
- Amit Harishchandra Palkar
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vikas Khetan
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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