Intravitreal aflibercept for active polypoidal choroidal vasculopathy without active polyps

RISK OF EXUDATION IN EYES WITH NONEXUDATIVE POLYPOIDAL CHOROIDAL VASCULOPATHY

PURPOSE

To investigate the characteristics and natural history of treatment-naive nonexudative polypoidal choroidal vasculopathy (PCV) and to determine biomarkers predicting exudative conversion.

METHODS

Patients diagnosed with nonexudative PCV based on indocyanine green angiography and optical coherence tomography were included. Incidence of exudative conversion in nonexudative PCV patients and cumulative estimates for overall risk were assessed. Indocyanine green angiography and optical coherence tomography imaging-based features were analyzed to identify risk factors for exudative conversion.

RESULTS

The study included 42 eyes of 40 patients with nonexudative PCV. The mean follow-up duration was 54.3 ± 35.5 months. Of the 42 eyes with nonexudative PCV, exudative conversion developed in 23 eyes (54.8%) after 42.2 ± 28.3 months (range, 8-103 months). Kaplan-Meier analysis showed that the exudation-free survival at 5 years after baseline was estimated to be 53.6%. Multivariate regression analysis showed that sequentially increased protrusion of retinal pigment epithelium in the polyp area was a significant risk factor for exudation in nonexudative PCV (odds ratio = 10.16; 95% CI 1.78-57.81; P = 0.01).

CONCLUSION

Exudative conversion has been noted in nearly half of the nonexudative PCV cases in 5 years. The progressive protrusion of polypoidal lesions on optical coherence tomography examination may be a significant biomarker for predicting the near-term onset of exudation.

Seven-year outcomes of combined treatment of anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy; according to polypoidal lesion regression

PURPOSE

To evaluate the long-term prognosis of polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (anti-VEGF) combined with verteporfin photodynamic therapy (PDT), according to polypoidal lesion regression.

METHODS

This study retrospectively reviewed the data of 33 naïve eyes with PCV treated with anti-VEGF combined with verteporfin PDT and followed-up for at least 7 years. The collected data included demographic profile, best-corrected visual acuity (BCVA), central foveal thickness (CFT), PED volume, and presence of submacular hemorrhage. Regression of polypoidal lesion was determined using indocyanine green angiography and optical coherence tomography. All eyes were divided into regression or persistent groups, based on the polypoidal lesion regression one year after the initial combined treatment.

RESULTS

BCVA improvement was maintained for 3 years in the regression (p = 0.001) and 1 year in the persistent (p = 0.006) groups, respectively. The mean BCVA of the regression group was better than that of the persistent group over 7 years, but the difference was significant only at 1 year (p = 0.037). The number of eyes which maintained BCVA less than or equal to 0.3 logMAR at 7 years was 11 eyes (64.7%) in regression group and 4 eyes (25.0%) in persistent group (p = 0.022).

CONCLUSIONS

Regression of the polypoidal lesion at 1 year after the initial combination treatment was associated with favorable long-term visual prognosis, particularly in terms of maintaining good visual acuity.

Updated guidelines for the management of polypoidal choroidal vasculopathy: Recommendations from the Indian Polypoidal Choroidal Vasculopathy Panel and the Vitreoretinal Society of India

In Asians, polypoidal choroidal vasculopathy (PCV) is becoming more widely recognized as a significant cause of exudative maculopathy. The previous set of Indian guidelines on the management of PCV were published in 2018, with a literature search updated up to November 2015. As the treatment of PCV evolves, retinal physicians must constantly modify their current practice. The current guidelines are based on the most up-to-date information on PCV and are an update to the previous set of guidelines. These guidelines were developed by a panel of Indian retinal experts under the aegis of the Vitreoretinal Society of India (VRSI), based on a comprehensive search and assessment of literature up to September 2021. The final guidelines i) provide the updated nomenclature in PCV; ii) discusses the newer diagnostic imaging features of PCV, especially in the absence of indocyanine green angiography (ICGA); and iii) recommends the best possible therapeutic approach in the management of PCV, including the choice of anti-vascular endothelial growth factor (anti-VEGF) agents, treatment regimen, and the role of switching between the anti-VEGF agents. In the face of non-availability of photodynamic therapy (PDT) in India, we constructed practical recommendations on anti-VEGF monotherapy in PCV. The current updated recommendations would provide a broader framework to the treating retinal physician for the diagnosis and management of PCV for optimal therapeutic outcomes.

Regression in polypoidal choroidal vasculopathy treated with ziv-aflibercept monotherapy – short term study

PURPOSE:

The aim of this study was to evaluate the effectiveness of intravitreal ziv-aflibercept (IVZ) in the treatment of polypoidal choroidal vasculopathy (PCV) and its efficacy in regard to polyp regression using optical coherence tomography (OCT) and indocyanine green angiography (ICGA).

METHODS:

This was a retrospective study of eight eyes of eight patients with treatment-naïve PCV. Patients received IVZ on pro re nata protocol. OCT and ICGA parameters were assessed at baseline and subsequent visits with a minimum follow-up of 6 months. ICGA was repeated at 3–6 months to determine the disease activity and quantify the changes in branching vascular network (BVN) polyps. Quantifiable OCT parameters included central macular thickness, pigment epithelial detachment (PED) height, and subfoveal choroidal thickness.

RESULTS:

The mean age of the study cohort was 62.3 ± 7.7 years, with a mean follow-up of 7.1 ± 1.2 months. The baseline best-corrected visual acuity improved from 0.70 ± 0.36 logarithm of the minimum angle of resolution (Snellen's equivalent 20/100) to 0.63 ± 0.34 (20/80) at last follow-up which was statistically insignificant (P = 0.5). Post IVZ injections (mean ± standard deviation: 2.6 ± 0.7), the total number of polyps reduced significantly from 3 ± 3.5 to 1 ± 1.7 (P = 0.03) along with a reduction in BVN size (3.9 ± 4.8 to 2.7 ± 3.8mm²; P = 0.07). OCT analysis revealed a significant reduction in PED height from 462.5 ± 353.8 μ to 169.9 ± 127.2 μ (P = 0.02).

CONCLUSION:

IVZ leads to significant morphological changes on ICGA and OCT in terms of polyp regression and reduction of PED height, respectively, with a limited change in visual acuity. IVZ may serve as a cost-effective alternative to treat eyes with PCV.