Polypoidal Choroidal Vasculopathy: Definition, Pathogenesis, Diagnosis, and Management.

Published

Journal Article (Review)

Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. Previous studies have suggested disparity in response to intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents between PCV and typical AMD, and thus, the preferred treatment for PCV has remained unclear. Recent research has provided novel insights into the pathogenesis of PCV, and imaging studies based on OCT suggest that PCV belongs to a spectrum of conditions characterized by pachychoroid, in which disturbance in the choroidal circulation seems to be central to its pathogenesis. Advances in imaging, including enhanced depth imaging, swept-source OCT, en face OCT, and OCT angiography, have facilitated the diagnosis of PCV. Importantly, 2 large, multicenter randomized clinical trials evaluating the safety and efficacy of anti-VEGF monotherapy and combination with photodynamic therapy (PDT) recently reported initial first-year outcomes, providing level I evidence to guide clinicians in choosing the most appropriate therapy for PCV. In this review, we summarize the latest updates in the epidemiologic features, pathogenesis, and advances in imaging and treatment trials, with a focus on the most recent key clinical trials. Finally, we propose current management guidelines and recommendations to help clinicians manage patients with PCV. Remaining gaps in current understanding of PCV, such as significance of polyp closure, high recurrence rate, and heterogeneity within PCV, are highlighted where further research is needed.

Full Text

Duke Authors

Cited Authors

  • Cheung, CMG; Lai, TYY; Ruamviboonsuk, P; Chen, S-J; Chen, Y; Freund, KB; Gomi, F; Koh, AH; Lee, W-K; Wong, TY

Published Date

  • May 2018

Published In

Volume / Issue

  • 125 / 5

Start / End Page

  • 708 - 724

PubMed ID

  • 29331556

Pubmed Central ID

  • 29331556

Electronic International Standard Serial Number (EISSN)

  • 1549-4713

Digital Object Identifier (DOI)

  • 10.1016/j.ophtha.2017.11.019

Language

  • eng

Conference Location

  • United States