Polypoidal Choroidal Vasculopathy
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Transcript of Polypoidal Choroidal Vasculopathy
VA
Conference
May 19, 2009
Michele Todman
Sharper peaks than PED and peripapillary location
Multiple PED’s
Polypoidal Choroidal Vasculopathy• Choroidal vascular network ending in an
anuerysmal bulge • Visual loss 2ndary to serosanguinous
detachment of RPE and neurosensory retina
• Pathogenesis not fully understood but PCV and CNV both have increase in VEGF found in aqueous humor
• PCV mainly affects Asians and Pigmented individuals
• Common for PCV lesions to grow near optic nerve
Treatment• Long-Term Results of Photodynamic Therapy of
Polypoidal Choroidal Vasculopathy Akaza, Mori et al. Retina 28:717-722, 2008– 24 month post-PDT follow-up of 47 eyes of 47
patients. 1-6 PDT sessions performed– Improvement of fundus findings in 20 eyes (42%) at 3
months, 34 eyes (74%) at 12 months, and 37 eyes (79%) at the final visit. Ie. Free of bleeding and exudation.
– 39 of 47 eyes (83%) had disappearance of FA leakage at final visit.
– Recurrences noted 12 months after PDT in 6 eyes, and later (29 months after PDT) in 24 eyes.
– At 24 months 9% had improved visual acuity, 70% had preserved visual acuity and 11% had decreased visual acuity.
– Abnormal vascular network continues to expand despite PDT
Treatment• Short-Term Safety and Efficacy of a Single Intravitreal
Bevacizumab Injection for the Management of Polypoidal Choroidal Vasculopathy Song, Byeon et al.Ophthalmologica 2009;223:85-92
• 19 eyes of 18 patients Retrospective review– Of the 19 eyes, (13) 68% of eyes had received some prior therapy.
(PDT, or combo of PDT, intravitreal triamcinolone, and thermal laser). Remaining 6 eyes (32%) got Bevacizumab as primary therapy.
– After three months both visual acuity mean (20/80->20/63) and CRT mean improved (267 to 204 microns) over baseline significantly
– Angiographic findings at 3 months showed reduced leakage and at least partial regression of polyps in more than half of patients but ICG showed no definite change in choroidal branching
– Pathologic vascular structures in PCV do not regress– Two types of polyps in PCV – Alternate treatment for patients who can’t get PDT
Treatment• The Therapuetic Effects of Bevacizumab in patients with
polypoidal choroidal vasculopathy Korean Journal of Ophthalmology 22:(2)92-99; 2008– 12 eyes of 11 patients with active PCV were treated with
intravitreal bevacizumab alone or in combo with PDT. – Intravitreal bevacizumab was repeated every 6 weeks until FA,
OCT or ICG picked up regression of active lesions.– Bevacizumab alone in 8 eyes (Group 1) mean 2.2 inj– Bevacizumab with PDT on same day in 4 eyes (Group 2) mean
2.5 inj– BCVA improved by >/= 2 lines in 58 % eyes and resolution on
OCT/FA confirmed in 83% of eyes– Partial or complete regression of polypoidal vessels and
interconnecting vessels was reported for most cases at last follow-up
– Mean BCVA improved in both groups• 20/63->20/40 in Group 1• 20/63->20/32 in Group 2