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Sayanagi K, Fujimoto S, Hara C, Fukushima Y, Maruyama K, Kawasaki R, Sato S, Nishida K. Effect of polyp regression and reduction on treatment efficacy in polypoidal choroidal vasculopathy treated with aflibercept. Sci Rep 2024; 14:1833. [PMID: 38246960 PMCID: PMC10800340 DOI: 10.1038/s41598-024-52448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Intravitreal injection of aflibercept (IVA) has successfully treated polypoidal choroidal vasculopathy (PCV), and polyp morphology is an important indicator of treatment efficacy. However, many studies have not reported the presence or absence of polyp regression and treatment outcomes, and few studies have reported polyp reduction and treatment outcomes in cases with residual polyps. We retrospectively measured the polyp area on indocyanine green angiography images before and after the IVA loading phase and investigated the regression and reduction of polyps and treatment outcomes of 81 eyes with PCV treated with IVA. We investigated the relationship between the presence or absence of complete regression of polyps and the percentage change in the polyp area and treatment outcomes. Eyes with complete polyp regression had significantly better visual acuity improvements compared with baseline at 12 months (P = 0.0108), fewer treatments (P = 0.0024), fewer recurrences during 12-months follow-up (P = 0.0010), and more "dry maculas" at 3 months (P = 0.0048) than eyes in which polyp regression did not occur. A significant correlation was seen only between the percentage of polyp regression and visual acuity at 3 months (P = 0.0395). Regarding IVA therapy for PCV, the presence or absence of complete polyp regression at the end of the loading phase affected the treatment outcome, whereas the degree of polyp reduction in cases of residual polyps had no effect.
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Affiliation(s)
- Kaori Sayanagi
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
| | - Satoko Fujimoto
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Chikako Hara
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yoko Fukushima
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shigeru Sato
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Kohji Nishida
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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Hang A, Feldman S, Amin AP, Ochoa JAR, Park SS. Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Retinal Disorders. Pharmaceuticals (Basel) 2023; 16:1140. [PMID: 37631054 PMCID: PMC10458692 DOI: 10.3390/ph16081140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Vascular endothelial growth factors (VEGFs) are key mediator of retinal and choroidal neovascularization as well as retinal vascular leakage leading to macular edema. As such, VEGF plays an important role in mediating visually significant complications associated with common retinal disorders such as diabetic retinopathy, retinal vein occlusion, and age-related macular degeneration. Various drugs that inhibit vascular endothelial growth factors (anti-VEGF therapies) have been developed to minimize vision loss associated with these disorders. These drugs are injected into the vitreous cavity in a clinic setting at regular intervals. This article provides an overview of the various anti-VEGF drugs used in ophthalmology and the common retinal conditions that benefit from this therapy.
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Affiliation(s)
- Abraham Hang
- Department of Ophthalmology & Vision Science, Ernest E. Tschannen Eye Institute, University of California Davis Eye Center, 4860 Y Street, Sacramento, CA 95817, USA; (A.H.); (S.F.)
| | - Samuel Feldman
- Department of Ophthalmology & Vision Science, Ernest E. Tschannen Eye Institute, University of California Davis Eye Center, 4860 Y Street, Sacramento, CA 95817, USA; (A.H.); (S.F.)
| | - Aana P. Amin
- School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (A.P.A.); (J.A.R.O.)
| | - Jorge A. Rivas Ochoa
- School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (A.P.A.); (J.A.R.O.)
| | - Susanna S. Park
- Department of Ophthalmology & Vision Science, Ernest E. Tschannen Eye Institute, University of California Davis Eye Center, 4860 Y Street, Sacramento, CA 95817, USA; (A.H.); (S.F.)
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Liu S, Chhabra R. Comparison of 3-year outcomes of photodynamic therapy combined with intravitreal ranibizumab or aflibercept for polypoidal choroidal vasculopathy in a European cohort. Graefes Arch Clin Exp Ophthalmol 2022; 260:3533-3542. [PMID: 35678837 PMCID: PMC9581849 DOI: 10.1007/s00417-022-05724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Combined use of photodynamic therapy (PDT) with intravitreal anti-vascular endothelial growth factors (anti-VEGF) agents, such as ranibizumab (IVR) or aflibercept (IVA), has been shown to be effective for treating polypoidal choroidal vasculopathy (PCV). However, it is currently not well established which anti-VEGF agent provides superior outcomes for performing combination therapy. The present study compares the visual outcomes and re-treatment burden of combination therapy of PDT with either IVR or IVA in a European cohort of patients with PCV. METHODS A retrospective analysis was done on PCV patients who had received combination therapy of PDT with either IVR or IVA. The demographic characteristics, visual outcome, and anti-VEGF re-treatment exposures were analysed and compared. RESULTS A total of forty-four eyes (n = 11 male, 25%) were included in the analysis: 7 patients received IVR, 19 started with IVR but switched to IVA (IVS), and 18 received IVA, in combination with PDT. The BCVA improved in all three groups at 6-, 12-, 18-, 24-, 30-, and 36-month follow-ups after PDT, although the improvement was not statistically significant in the IVR group. The number of intravitreal anti-VEGF injections required/year after PDT was significantly fewer than before PDT. Significantly less eyes in the IVS group attained a good visual acuity of more than 70 ETDRS letters at the final visit. CONCLUSION Both IVR and IVA combined with PDT were effective treatments for the European cohort of patients with PCV. In eyes refractory to IVR, performing PDT promptly may be more beneficial than switching to IVA.
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Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK. .,School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
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Liu S, Chhabra R. Real-world outcomes of combined therapy of photodynamic therapy with anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy. Eye (Lond) 2022; 36:1934-1939. [PMID: 34584234 PMCID: PMC9500056 DOI: 10.1038/s41433-021-01773-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/10/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To describe the real-world outcomes of photodynamic therapy (PDT) as a rescue therapy in eyes with polypoidal choroidal vasculopathy (PCV) refractory to anti-vascular endothelial growth factor (VEGF) monotherapy in a British cohort of patients. METHODS This is a retrospective chart review of 53 eyes with PCV. Based on the timing of PDT, the eyes were stratified into two groups (9 in the Initial-PDT group, 44 in the Deferred group). The number of anti-VEGF injections/year and the best corrected visual acuity (BCVA) before and after PDT were analysed. Multivariate regression model was created to identify factors predictive of visual outcome and treatment burden after PDT. RESULTS The Deferred group received a mean of 9.4 injections/year but significantly reduced to 7.2 after PDT (p < 0.001). The Initial-PDT group required significantly fewer injections after PDT compared to the Deferred group (p = 0.004). The Deferred group experienced improvement in BCVA from 58.7 letters at baseline to 63.8 at 18-months follow-up (p < 0.001), but no significant increase was observed in the Initial-PDT group (p = 0.310). Better baseline BCVA is associated with higher likelihood of achieving good BCVA ≥ 70 letters after PDT (Odd Ratio=1.12, 95% CI: 1.03-1.21, p = 0.006), while increased number of anti-VEGF injections/year before PDT reduces the likelihood of easing treatment burden to ≥12 weeks apart between each injection after PDT (Odd Ratio=0.724, 95% CI: 0.58-0.91, p = 0.006). CONCLUSIONS PDT as a rescue therapy is beneficial in the long-term management of PCV, particularly in eyes that had experienced a significant period of prior exposure to anti-VEGF monotherapy.
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Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK. .,School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
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Sumnicht AJ, Chalam KV, Sierpina DI. Photodynamic Therapy-Induced Acute Exudative Maculopathy (PAEM): Prevalence, Impact and Management Strategies. Clin Ophthalmol 2022; 16:3145-3154. [PMID: 36193512 PMCID: PMC9526441 DOI: 10.2147/opth.s359302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Photodynamic therapy (PDT) has a niche role in treating various choroidal pathologies. PDT-induced acute exudative maculopathy (PAEM) is an uncommon complication of PDT that results in exudative retinal detachment and mild to severe decrease in vision. Successful management strategies include observation, local or systemic corticosteroids, and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Most cases return to visual acuity near baseline. This review summarizes what is known about PAEM to date including etiology, prevalence, management strategies, and outcomes. We conclude that management of PAEM must take into consideration various patient-specific factors. Treatment with corticosteroids or anti-VEGF agents may expedite time to recovery, though lack of randomized controlled trials preclude firm conclusions regarding a standardized approach to managing this complication of PDT.
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Affiliation(s)
- Andrew J Sumnicht
- Loma Linda University Eye Institute, Loma Linda University, Loma Linda, CA, USA
| | - Kakarla V Chalam
- Loma Linda University Eye Institute, Loma Linda University, Loma Linda, CA, USA
| | - David I Sierpina
- Loma Linda University Eye Institute, Loma Linda University, Loma Linda, CA, USA
- Correspondence: David I Sierpina, 11370 Anderson St., Suite #2900, Loma Linda, CA, 92354, USA, Tel +1 909-558-2182, Fax +1 909-558-2506, Email
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Sheth JU, Narayanan R, Anantharaman G, Bhende M, Agarwal A, Chawla S, Rajendran A. Updated guidelines for the management of polypoidal choroidal vasculopathy: Recommendations from the Indian Polypoidal Choroidal Vasculopathy Panel and the Vitreoretinal Society of India. Indian J Ophthalmol 2022; 70:3102-3111. [PMID: 35918981 DOI: 10.4103/ijo.ijo_2985_21] [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: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Jay U Sheth
- Department of Clinical Research, Chaithanya Eye Hospital, Trivandrum, Kerala, India
| | - Raja Narayanan
- Vitreoretinal Society of India (VRSI) General Secretary, Vitreoretinal Society of India, Kochi, Kerala, India
| | | | - Muna Bhende
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Aniruddha Agarwal
- Department of Vitreoretina, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Shobhit Chawla
- Vitreoretinal Society of India (VRSI) President, Vitreoretinal Society of India, India
| | - Anand Rajendran
- Vitreoretinal Society of India (VRSI) Convenor Scientific Committee, Vitreoretinal Society of India, India
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Fukuyama H, Komuku Y, Araki T, Gomi F. ASSOCIATION OF FLOW SIGNALS WITHIN POLYPS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH TREATMENT RESPONSES AFTER COMBINATION THERAPY FOR POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2022; 42:942-948. [PMID: 34954774 DOI: 10.1097/iae.0000000000003395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the changes of blood circulation within the polypoidal lesions by OCT angiography in eyes with polypoidal choroidal vasculopathy after combination therapy with aflibercept and photodynamic therapy. METHODS A total of 46 eyes from 46 patients who underwent the combination therapy for polypoidal choroidal vasculopathy were followed for more than 6 months. OCT angiography, covering an area 6 mm2 × 6 mm2 including the macula, were performed at baseline, 2 weeks, and 3 months and 6 months post-treatment. RESULTS The subretinal fluid resolved within 3 months after treatment in 44 eyes (95.7%), and 27 eyes (58.7%) showed no recurrence, with no additional treatment. Seventeen eyes (37.0%) showed recurrence, and two eyes (4.3%) showed poor response. On OCT angiography at 2 weeks after treatment, flow signals were detected in 3 of 27 eyes (11.1%) without recurrence and in 8 of 19 eyes (42.1%) with recurrence or poor responses. A detectable flow signal at 2 weeks was significantly associated with recurrence or poor response (P = 0.032). CONCLUSION Persistent flow signals within polyps on OCT angiography at 2 weeks after combination therapy suggest less effectiveness of the initial treatment.
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Affiliation(s)
- Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
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Wang Y, Xie M, Zhang M, Zhao X, Zhu X, Wang Y, Chen Y, Chen J, Sun X. Publication Trends of Research on Polypoidal Choroidal Vasculopathy During 2001–2020: A 20-Year Bibliometric Study. Front Med (Lausanne) 2022; 8:785126. [PMID: 35174182 PMCID: PMC8841421 DOI: 10.3389/fmed.2021.785126] [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] [Received: 09/28/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionPolypoidal choroidal vasculopathy (PCV) is a special subtype of AMD, which is one of the leading threats to vision health worldwide. At this time, many aspects of PCV, from how it works to potential treatments, remain a mystery. In this study, we explored the frontier researches and revealed the study trends within the study of PCV.MethodsWe collected all the publications in this field from 2001 to 2020, analyzed trends within them, and defined the contributions of various countries/regions, institutions, authors, and journals. Additionally, VOSviewer software was used to define the hot keywords in this field.ResultsA total of 1,190 publications were ultimately examined; We found that PCV is becoming an increasingly relevant topic of research, and that Japan has contributed the most publications (428), the most citations (14,504 in total), and the highest H-index value (62) to the field. Our keywords analysis was classified into four clusters to show the hotspots within the study of PCV, namely mechanism-related, imaging-related, prognosis-related, and therapy-related topics. The average years in which the keywords appeared the most were also calculated, and we identified anti-VEGF therapy, anti-complement therapy and angiography as having been the main focus in recent years.ConclusionsThese results helped clarify the comprehensive research progress that has been made as well as the future trends in the study of PCV, which can assist and guide future research.
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Affiliation(s)
- Yimin Wang
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Minyue Xie
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Min Zhang
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaohuan Zhao
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xinyue Zhu
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yuwei Wang
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yuhong Chen
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jieqiong Chen
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- *Correspondence: Jieqiong Chen
| | - Xiaodong Sun
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept. Int Ophthalmol 2022; 42:601-610. [PMID: 35034223 DOI: 10.1007/s10792-021-02032-4] [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: 01/09/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV). METHODS Patients with PPCV were treated with PDT combined with 3 IVA injections on a monthly basis, followed by pro re nata criteria. The 12-month follow-up consisted of multiple revaluations of visual acuity and SS-OCT parameters of clinical activity. RESULTS Nineteen eyes were included in the study; mean age was 65.5 years. Visual acuity improved after 12 months (0.35 ± 0.25 to 0.2 ± 0.20 logMAR, p = 0.005). Percentage of eyes with intraretinal and subretinal fluid reduced from baseline to the 12-month follow-up (from 52.6 to 10.5%, p = 0.12, and from 89.5 to 5.3% p = 0.0009, respectively). Central retinal and mean macular thicknesses reduced (258 ± 39.6 to 204.8 ± 38.8 μm p = 0.04 and 293.8 ± 32.1 to 248.1 ± 29.6 μm p = 0.017, respectively). Central choroidal and mean choroidal thicknesses also displayed a reduction (328.6 ± 54.9 to 289.8 ± 44.6 μm p = 0.001 and 314.5 ± 55.3 to 287.9 ± 47.6 μm p = 0.015, respectively). The mean number of injections was 4.6/year. CONCLUSION The results support the use of a combined therapy with Aflibercept and PDT in PPCV. This treatment would act in synergy, with anti-VEGF controlling exudation and PDT closing the aneurysmal vessel and reducing choroidal congestion.
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Borooah S, Sim PY, Phatak S, Moraes G, Wu CY, Cheung CMG, Pal B, Bujarborua D. Pachychoroid spectrum disease. Acta Ophthalmol 2021; 99:e806-e822. [PMID: 33258304 DOI: 10.1111/aos.14683] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/11/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023]
Abstract
Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The number of conditions linked to this phenotype has continued to widen with specific endophenotypes found within the pachychoroid spectrum. The spectrum includes choroidal features such as focal or diffuse choroidal thickening and thinning of the overlying inner choroid, and choroidal hyperpermeability as demonstrated by indocyanine green angiography. In addition, these diseases are associated with overlying retinal pigmentary changes and retinal pigment epithelial dysfunction and may also be associated with choroidal neovascularization. This article provides a comprehensive review of the literature looking at diseases currently described within the pachychoroid spectrum including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid disease and focal choroidal excavation. We particularly focus on clinical imaging, genetics and pathological findings in these conditions with the aim of updating evidence suggesting a common aetiology between diseases within the pachychoroid spectrum.
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Affiliation(s)
- Shyamanga Borooah
- Shiley Eye Institute University of California San Diego La Jolla CA USA
- Moorfields Eye Hospital NHS Foundation Trust London UK
- Centre for Clinical Brain Sciences School of Clinical Sciences University of Edinburgh Edinburgh UK
| | - Peng Yong Sim
- Moorfields Eye Hospital NHS Foundation Trust London UK
- Royal Free Hospital London UK
| | - Sumita Phatak
- Moorfields Eye Hospital NHS Foundation Trust London UK
| | | | - Chris Yang Wu
- Shiley Eye Institute University of California San Diego La Jolla CA USA
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Montero Hernández J, Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Cervera Taulet E. Two-year results of a treat and extend regimen with aflibercept in Caucasian patients with aneurysmal type 1 neovascularization. Eur J Ophthalmol 2021; 32:377-384. [PMID: 33706554 DOI: 10.1177/11206721211001313] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There are a few reports investigating the treatment of aneurysmal type 1 neovascularization (AT1) in Caucasian patients. The aim of this study is to evaluate the 2-year results of a treat and extend regimen with aflibercept in Caucasian patients with AT1. METHODS We conducted an observational retrospective study in 28 eyes of 26 patients with naïve AT1 treated with a treat an extend regimen of intravitreal aflibercept. Best corrected visual acuity (BCVA), central macular thickness (CMT), pigment epithelium detachment (PED) height, presence of dry macula, and regression rate of polypoidal lesions were assessed at baseline and at 12 and 24 months. RESULTS BCVA was significantly increased by 9.03 ± 16 letters (p < 0.01) and 9.2 ± 16.87 letters (p < 0.01) after the 12 and 24 months follow-up. A significant decrease of CMT was found at 12 and 24 months (p < 0.01). Nevertheless, significant changes in PED height were not observed (0.1 < p > 0.05). At 12 and 24 months of follow-up, dry macula was achieved in a total of 10 eyes (35.71%) and 15 eyes (53.57%). The regression rate of polypoidal lesions was 25% (7 eyes) and 35.71% (10 eyes) after 12 and 24 months. The mean number of intravitreal injections was 7.81 ± 3.20 the first year and 6.11 ± 3.49 the second year. CONCLUSION To the best of our knowledge, treat and extend regimen with intravitreal aflibercept in Caucasian patients may be effective for improving BCVA, CMT, wet macula, and regression rate of polypoidal lesions.
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Affiliation(s)
- Javier Montero Hernández
- Servicio de Oftalmología, Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Lidia Remolí Sargues
- Servicio de Oftalmología, Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Servicio de Oftalmología, Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Servicio de Oftalmología, Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Servicio de Oftalmología, Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Servicio de Oftalmología, Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
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The Efficacy of Conbercept in Polypoidal Choroidal Vasculopathy: A Systematic Review. J Ophthalmol 2020; 2020:4924053. [PMID: 32855818 PMCID: PMC7442996 DOI: 10.1155/2020/4924053] [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: 04/25/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022] Open
Abstract
Methods Thirty studies with 1308 eyes were identified and included in this study. The primary outcome measures were best-corrected visual acuity (BCVA), and secondary outcomes were optical coherence tomography characteristics and polyp regression rates. The pooled results were calculated by the random-effect or fixed-effect model according to the heterogeneity of the data. Results Despite a large standard deviation in means (SMD) improvement for BCVA and central retinal thickness (CRT) in the conbercept group, there was no statistically significant difference in the other outcomes compared to ranibizumab and aflibercept. However, there was a greater polyp regression rate in the conbercept group at 12 months. Conclusions This systematic review indicates that conbercept may achieve similar BCVA and CRT improvements as ranibizumab and aflibercept, with a superior rate of polyp regression at 12 months.
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Abstract
PURPOSE To compare the 6-month efficacy of the intravitreal injection of conbercept or ranibizumab for patients with polypoidal choroidal vasculopathy (PCV). METHODS This is a retrospective case-control study involved 79 PCV eyes of 77 patients. The PCV eyes were treated with an intravitreal injection of either ranibizumab (n = 44) or conbercept (n = 35). Three monthly loading doses were injected and followed by retreatment as needed. The best-corrected visual acuity and angiographic characteristics were evaluated after 6 months. RESULTS The mean logarithm of the minimum angle of resolution best-corrected visual acuity had improved from 0.86 (Snellen equivalent, 20/145) at baseline to 0.70 (Snellen equivalent, 20/100) at 6 months in the conbercept group (P < 0.001), and from 0.74 (Snellen equivalent, 20/110) at baseline to 0.63 (Snellen equivalent, 20/85) at 6 months in the ranibizumab group (P = 0.032), respectively. The central foveal thickness was decreased from 407 ± 146 μm to 230 ± 71 μm in the conbercept group (P < 0.001), and from 394 ± 93 μm to 208 ± 56 μm in the ranibizumab group (P < 0.001). Polyps were completely regressed and in 21 (47.7%) eyes in the conbercept group at 6 months, significant higher than in 10 (28.6%) eyes in the ranibizumab group (P = 0.029). CONCLUSION Both conbercept and ranibizumab effectively increased the visual acuity and regressed the polyps of PCV eyes. No significant difference was found in the visual acuity improvement of the patients with PCV between the conbercept group and ranibizumab group at 6 months. However, conbercept was superior to ranibizumab monotherapy in the regression of polyps.
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Chen LJ, Cheng CK, Yeung L, Yang CH, Chen SJ, Chen JT, Chen LJ, Chen SN, Chen WL, Cheng CK, Hsu SM, Hwang DK, Lai CC, Lai CH, Lee FL, Yang CH, Yang CM, Yeung L, Wu TT, Chen SJ. Management of polypoidal choroidal vasculopathy: Experts consensus in Taiwan. J Formos Med Assoc 2020; 119:569-576. [DOI: 10.1016/j.jfma.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
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El Chehab H, Kodjikian L, Lagenaite-Desmaizère C, Agard E, De Bats F, Mathis T, Dot C. Idiopathic polypoidal choroidal vasculopathy in Caucasians: The POLYON real-life study in 50 naive patients. Eur J Ophthalmol 2019; 30:948-955. [DOI: 10.1177/1120672119874674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Polypoidal choroidal vasculopathy is a common disease in Asia, but it has been less described in the Caucasian population. The aim of this real-life observational study was to describe the diagnostic and therapeutic practices as well as the prognosis in this population. Method: Fifty Caucasian patients with polypoidal choroidal vasculopathy were included in this study. All patients underwent angiography to confirm the diagnosis. Patients were divided into two treatment groups: patients of group 1 only received anti–vascular endothelial growth factor injections and those of group 2 required photodynamic therapy rescue in addition to intravitreal injections in case of suboptimal (anatomically or functionally) response. Clinical (visual acuity, fundus examination), paraclinical (retinal pigment epithelium detachment height and central retinal thickness on optical coherence tomography), and therapeutic (number of intravitreal injections) criteria were analyzed after 24 months. Results: Patient mean age was 73.9 ± 9.1 years, and half of the patients had age-related macular degeneration. In the whole cohort, the initial visual acuity was equivalent to the final visual acuity (59.9 ± 24.0 letters vs 62.5 ± 21.1 letters, p = 0.259). In group 1, the final visual acuity was significantly increased (from 56.9 ± 24.7 letters to 63.4 ± 21.6 letters, p = 0.016), while in group 2, it remained stable (from 61.7 ± 23.4 letters to 61.0 ± 21.4 letters, p = 0.249). The number of intravitreal injections was similar between both groups. Conclusion: In a Caucasian population, polypoidal choroidal vasculopathy seems to have a later onset. A non-standardized management allows stabilizing the functional prognosis. Patients requiring photodynamic therapy rescue have a poorer prognosis.
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Affiliation(s)
- Hussam El Chehab
- Service d’ophtalmologie, Hôpital d’Instruction des Armées DESGENETTES, Lyon, France
| | - Laurent Kodjikian
- Service d’ophtalmologie, Centre Hospitalo-Universitaire de la Croix-Rousse, Lyon, France
| | | | - Emilie Agard
- Service d’ophtalmologie, Hôpital d’Instruction des Armées DESGENETTES, Lyon, France
| | - Flore De Bats
- Clinique du Val d’Ouest, Pôle Vision, Ecully, France
| | - Thibaud Mathis
- Service d’ophtalmologie, Centre Hospitalo-Universitaire de la Croix-Rousse, Lyon, France
| | - Corinne Dot
- Service d’ophtalmologie, Hôpital d’Instruction des Armées DESGENETTES, Lyon, France
- École du Val-de-Grâce, Paris, France
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Srour M, Sayag D, Nghiem-Buffet S, Arndt C, Creuzot-Garcher C, Souied E, Mauget-Faÿsse M. Approche diagnostique et thérapeutique de la vasculopathie polypoïdale choroïdienne. Recommandations de la Fédération France Macula. J Fr Ophtalmol 2019; 42:762-777. [DOI: 10.1016/j.jfo.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/25/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Hata M, Tagawa M, Oishi A, Kawashima Y, Nakata I, Akagi-Kurashige Y, Yamashiro K, Ooto S, Tamura H, Miyata M, Miyake M, Ueda-Arakawa N, Takahashi A, Tsujikawa A. Efficacy of Photodynamic Therapy for Polypoidal Choroidal Vasculopathy Associated with and without Pachychoroid Phenotypes. Ophthalmol Retina 2019; 3:1016-1025. [PMID: 31606329 DOI: 10.1016/j.oret.2019.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/28/2019] [Accepted: 06/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the efficacy of photodynamic therapy (PDT) in eyes with polypoidal choroidal vasculopathy (PCV) associated with and without pachychoroid phenotypes (pachychoroid PCV and nonpachychoroid PCV, respectively). DESIGN Retrospective chart review. PARTICIPANTS Patients previously diagnosed with PCV and initially treated with PDT. METHODS Patients were classified as having pachychoroid- or nonpachychoroid-driven conditions. The long-term visual outcome and its associated factors were investigated. MAIN OUTCOME MEASURES Visual acuity (VA) outcomes at 1, 2, 3, 4, and 5 years after initial PDT in pachychoroid and nonpachychoroid PCV. RESULTS Of the 158 eyes, 88 (55.7%) met the criteria for pachychoroid PCV; 70 (44.3%) did not (nonpachychoroid PCV). In cases of pachychoroid PCV, VA improved significantly at 1 year (P = 0.042) and maintained baseline level at 5 years (P = 0.38). By contrast, VA continued to deteriorate in the nonpachychoroid PCV group during the follow-up period and had already declined significantly by the second year (P = 0.022, compared with baseline). Despite no difference in baseline VA between pachychoroid and nonpachychoroid PCV groups (P = 0.11), the VA at 5 years was significantly better in the pachychoroid PCV group compared with the nonpachychoroid PCV group (0.54±0.47 vs. 0.93±0.63, respectively; P = 0.23 × 10-3). The incidence of massive submacular hemorrhage (SMH) or vitreous hemorrhage (VH) was not different between groups at 5 years (P = 0.67), and their occurrence was associated with decreased VA in both the nonpachychoroid and pachychoroid PCV groups (coefficient β, 0.361 and 0.481; P = 0.59 × 10-3 and P < 1.0 × 10-5, respectively). CONCLUSIONS Five years after PDT treatment, VA was maintained at the baseline level in the pachychoroid PCV group but not in the nonpachychoroid PCV group. Massive SMH or VH during the follow-up period affected the final visual outcomes in both conditions.
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Affiliation(s)
- Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Miho Tagawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yu Kawashima
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isao Nakata
- Department of Ophthalmology, Otsu Red Cross Hospital, Otsu, Japan
| | | | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Ophthalmology, Otsu Red Cross Hospital, Otsu, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kumar A, Kumawat D, Sundar M D, Gagrani M, Gupta B, Roop P, Hasan N, Sharma A, Chawla R. Polypoidal choroidal vasculopathy: a comprehensive clinical update. Ther Adv Ophthalmol 2019; 11:2515841419831152. [PMID: 30834360 PMCID: PMC6393826 DOI: 10.1177/2515841419831152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022] Open
Abstract
Polypoidal choroidal vasculopathy as a disease is yet to be comprehended completely. The clinical features consisting of huge serosanguineous retinal pigment epithelial and neurosensory layer detachments, although unique may closely mimick neovascular age-related macular degeneration and other counterparts. The investigative modalities starting from indocyanine angiography to optical coherence tomography angiography provide diagnostic challenges. The management strategies based on the available therapies are plenty and not vivid. A detailed review with clarifying images has been compiled with an aim to help the readers in getting a better understanding of the disease.
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Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dheepak Sundar M
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Barkha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prakhyat Roop
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Polypoidal choroidal vasculopathy (PCV) is a retinal disorder commonly found in Asians presenting as neovascular age-related macular degeneration and is characterized by serous macular detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage, and occasionally visible orange-red subretinal nodular lesions. PCV is diagnosed using indocyanine green angiography (ICGA), and the lesions appear as polypoidal aneurysmal vascular lesions with or without abnormal branching vascular network. Although ICGA remains the gold standard for the diagnosis of PCV, various imaging modalities have also facilitated the diagnosis and monitoring of PCV. Recent advances in imaging technology including the use of high resolution spectral domain optical coherence tomography (OCT) and OCT angiography have provided new insights on the pathogenesis of PCV, suggesting a link between PCV and pachychoroid spectrum of macular disorders. With the evolving understanding on the pathogenesis and clinical characteristics of PCV, different therapeutic options have been proposed. These include intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy, combination therapy with anti-VEGF and verteporfin photodynamic therapy, and thermal laser photocoagulation. In recent years, major multi-center randomized clinical trials such as EVEREST, EVEREST II, and PLANET studies have been conducted to compare the efficacy and safety of various treatment options for PCV. This review aims to summarize the results of recent literature, clinical trials and studies to provide an update on the management options of PCV. An overall management strategy for PCV will also be proposed.
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Affiliation(s)
- Christine P S Ho
- Faculty of Medicine, The University of Hong Kong; 2010 Retina and Macula Centre, Kowloon, Hong Kong SAR
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong; 2010 Retina and Macula Centre, Kowloon, Hong Kong SAR
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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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Chen SN, Cheng CK, Yeung L, Chen JT, Chan WC, Liu JH, Sheu SJ, Wu WC, Lai CC. One-year real-world outcomes of ranibizumab 0.5 mg treatment in Taiwanese patients with polypoidal choroidal vasculopathy: a subgroup analysis of the REAL study. Int J Ophthalmol 2018; 11:1802-1808. [PMID: 30450311 DOI: 10.18240/ijo.2018.11.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/01/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To assess the effectiveness and safety of ranibizumab 0.5 mg in Taiwanese patients with polypoidal choroidal vasculopathy (PCV) by performing a retrospective exploratory subgroup analysis of the REAL study. METHODS REAL was a 12-month, observational, prospective, non-interventional phase IV post-marketing surveillance study conducted at 9 centers in Taiwan. The study collected data as part of the routine patient visits from the medical records of patients with neovascular age-related macular degeneration treated with ranibizumab 0.5 mg according to local standard medical practice and local label and/or reimbursement guidelines. The presence of PCV at baseline was determined using indocyanine green angiography. RESULTS At baseline, PCV was diagnosed in 64 of the 303 enrolled patients (21.1%). Of these, 41 patients (64.1%) had received prior treatment; 15 (23.4%) patients had received ranibizumab. The intent-to-treat population included 58 patients; 47 (80%) who received ranibizumab and 11 (20%) who received ranibizumab plus photodynamic therapy (PDT; 9 patients received once, 2 patients received twice). Bevacizumab was used as a concomitant medication in a similar percentage of patients who received ranibizumab (43%, n=20) or ranibizumab plus PDT (45%, n=5). In patients who received ranibizumab, visual acuity (VA) at baseline was 50.1±12.9 Early Treatment Diabetic Retinopathy Study letters, and the gain at month 12 was 1.1±17.8 letters. In patients who received ranibizumab plus PDT, VA at baseline was 51.4±15.9 letters, and there was a marked gain in VA at month 12 (14.0±9.2 letters, P=0.0009). In the intent-to-treat population, the reduction in central retinal subfield thickness from baseline at month 12 was 69.6±122.6 µm (baseline: 310.8±109.8 µm, P=0.0004). The safety results were consistent with the well-characterized safety profile of ranibizumab. CONCLUSION In real-world settings, ranibizumab 0.5 mg treatment for 12mo results in maintenance of VA and reduction in central retinal subfield thickness in Taiwanese patients with PCV. Improvements in VA are observed in patients who received ranibizumab plus PDT. There are no new safety findings.
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Affiliation(s)
- San-Ni Chen
- Changhua Christian Hospital, Changhua, Taiwan 50094, China.,College of Medicine, Chung Shan Medical University, Taichung City, Taiwan 40246, China
| | - Cheng-Kuo Cheng
- Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei City, Taiwan 11101, China
| | - Ling Yeung
- Chang Gung Memorial Hospital-Keelung, Anle District, Keelung City, Taiwan 204, China
| | - Jiann-Torng Chen
- Tri-Service General Hospital, Chenggong Road, Taipei City, Taiwan 11490, China
| | - Wei-Chun Chan
- Mackay Memorial Hospital, Zhongshan District, Taipei City, Taiwan 813, China
| | - Jorn-Hon Liu
- Cheng Hsin General Hospital, Beitou District, Taipei City, Taiwan 112, China
| | - Shwu-Jiuan Sheu
- Kaohsiung Veterans General Hospital, Zuoying District, Kaohsiung City, Taiwan 81362, China
| | - Wen-Chuan Wu
- Kaohsiung Medical University Chung-Ho Memorial Hospital, Sanmin District, Kaohsiung City, Taiwan 807, China
| | - Chi-Chun Lai
- Chang Gung Memorial Hospital-Linkou, Guishan District, Taoyuan City, Taiwan 333, China
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Teo KYC, Gillies M, Fraser-Bell S. The Use of Vascular Endothelial Growth Factor Inhibitors and Complementary Treatment Options in Polypoidal Choroidal Vasculopathy: A Subtype of Neovascular Age-Related Macular Degeneration. Int J Mol Sci 2018; 19:ijms19092611. [PMID: 30177632 PMCID: PMC6165414 DOI: 10.3390/ijms19092611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/04/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (AMD; nAMD) which occurs more commonly in Asian populations as compared to Caucasians. PCV and nAMD share pathological mechanisms, including pathological expression of vascular endothelial growth factor (VEGF). The advent of anti-vascular endothelial growth factor (VEGF) revolutionized the treatment of nAMD. Despite being a subtype of nAMD, PCV responds less well to VEGF inhibitors; thus, photodynamic therapy (PDT) in combination with anti-VEGF treatment may be considered. This review aims to summarize the current evidence for the treatment of PCV, especially whether VEGF inhibitors should be used alone or in combination with PDT.
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Affiliation(s)
- Kelvin Yi Chong Teo
- Singapore National Eye Centre, Singapore 168751, Singapore.
- Singapore Eye Research Institute, Singapore 169856, Singapore.
- Sydney Eye Hospital Foundation, Sydney Eye Hospital, Sydney 2000, Australia.
| | - Mark Gillies
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney 2000, Australia.
| | - Samantha Fraser-Bell
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney 2000, Australia.
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Azuma K, Asaoka R, Matsuda A, Lee J, Shimizu K, Inui H, Murata H, Ogawa A, Yamamoto M, Inoue T, Obata R. Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients. Clin Ophthalmol 2018; 12:1589-1597. [PMID: 30214143 PMCID: PMC6120579 DOI: 10.2147/opth.s172115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of the study was to evaluate the 2-year outcome and predictive factors of treat-and-extend aflibercept in patients with eyes affected by typical neovascular age-related macula degenelation (t-AMD) or polypoidal choroidal vasculopathy (PCV), who were switched from ranibizumab. Patients and methods The patients underwent three monthly aflibercept injections and subsequent administration following the treat-and-extend protocol. Sixty-two eyes of 62 patients were reviewed retrospectively. R statistical software was used for statistical analysis. Results Twenty-two eyes were t-AMD and the remaining 40 eyes were PCV. There was no significant difference in the logarithm of the minimal angle of resolution visual acuity (VA) between baseline and 2 years after switching to aflibercept (0.40 vs 0.40; P=0.99). Multivariate analyses suggested that the following factors were significantly correlated with better VA at 2 years after switching to aflibercept: patients with PCV, the absence of intraretinal fluid at baseline, and better VA at baseline. Conclusion In conclusion, VA was maintained and there was an anatomical improvement at 2 years in patients with t-AMD and PCV who were switched from ranibizumab to treat-and-extend aflibercept. PCV patients showed more favorable visual outcomes and less injections at 2 years compared to t-AMD patients. Intraretinal fluid and VA at baseline were predictors of VA at 2 years.
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Affiliation(s)
- Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Aya Matsuda
- Department of Ophthalmology, Toranomon Byoin, Tokyo, Japan
| | - Jihee Lee
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, Japan
| | - Kimiko Shimizu
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Hiroko Inui
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Asako Ogawa
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Motoshi Yamamoto
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan,
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A Multinational Comparison of Anti-Vascular Endothelial Growth Factor Use: The United States, the United Kingdom, and Asia-Pacific. Ophthalmol Retina 2018; 3:16-26. [PMID: 30935655 DOI: 10.1016/j.oret.2018.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE A comparison of anti-vascular endothelial growth factor (anti-VEGF) medication use across multiple countries. CLINICAL RELEVANCE Anti-VEGF medication use is now considered first-line treatment for numerous retinal diseases globally. Exploring medication choices, costs within each healthcare system, policy challenges, emerging treatments, and patient access all provide insight into a newly recognized and major public health issue. METHODS All data presented in this review are available through the published English literature in PubMed, non-peer-reviewed trade publications, and reported surveys. The following search terms were used: anti-VEGF OR bevacizumab OR ranibizumab OR aflibercept OR pegaptanib OR conbercept AND trends OR survey OR cost OR patterns OR preference. Countries with large populations and available data included the United States, United Kingdom, China, India, Korea, Singapore, and Australia. Population and economic statistics were obtained from published reports from the World Bank, World Health Organization, and Commonwealth Fund. RESULTS Anti-VEGF medication use and costs are significant aspects of patient and healthcare system expenditures in each nation and may have an especially large potential economic burden in India and China. Bevacizumab use comprises the majority of anti-VEGF medication use in the United States and Singapore, although aflibercept use is growing rapidly. Paradoxically, data demonstrate that there is a significant trend in medication choice toward ranibizumab and aflibercept among practice settings outside of the United States, such as the United Kingdom, China, South Korea, and Australia. The price of anti-VEGF medications ranged from US $30 (ziv-aflibercept) to US $1950 (ranibizumab and aflibercept). Ranibizumab's price ranged from US $240 in India to US $1950 in the United States. Conbercept in China costs approximately US $1150 per dose. CONCLUSIONS Outside of the United States, many nations are using a majority of more expensive anti-VEGF medications, which may lead to increased costs and decreased access. Increasing the availability of safely compounded anti-VEGF medications will likely improve access, create patient/provider choice, and decrease relative healthcare costs for the growing burden of retinal diseases globally.
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Miyamoto N, Mandai M, Oishi A, Nakai S, Honda S, Hirashima T, Oh H, Matsumoto Y, Uenishi M, Kurimoto Y. Long-term results of photodynamic therapy or ranibizumab for polypoidal choroidal vasculopathy in LAPTOP study. Br J Ophthalmol 2018; 103:844-848. [PMID: 30077969 DOI: 10.1136/bjophthalmol-2018-312419] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/25/2018] [Accepted: 07/07/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIM We previously reported that ranibizumab performed better on visual prognosis than photodynamic therapy (PDT) in a Ranibizumab (Lucentis) And Photodynamic Therapy On Polypoidal choroidal vasculopathy (LAPTOP) study. To determine if the first-choice treatment, either PDT or intravitreal ranibizumab, has a long-term effect in patients with polypoidal choroidal vasculopathy (PCV). METHODS We reviewed medical records of patientsrandomised to either PDT (29 eyes) or ranibizumab (27 eyes) from July 2009 to June 2011 in LAPTOP study. Retreatment or switching to other treatments were at the investigator's discretion after release from the 2-year LAPTOP study up to 5years. We evaluated visual acuity (VA), continuity of initial treatment, percentage of dry macula achievement and macular atrophy at 5 years. RESULTS The logarithm of minimal angle of resolution VA was 0.56 in the PDT and 0.44 in the ranibizumab groups at baseline (p=0.101) and was 0.55 and 0.28 at 5years, respectively (p<0.05). More than 70% of the patients converted to aflibercept in following years. Achievement percentages of dry macula were 74% (PDT) and 63% (ranibizumab) at 5years, and macular atrophy was detected in 78% (PDT) and 60% (ranibizumab) with a mean area of 7.7 and 3.5 mm2, respectively (p=0.155). CONCLUSIONS The better VA in the initial ranibizumab group compared with the PDT group at 2 years was retained at the 5-year follow-up.
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Affiliation(s)
- Noriko Miyamoto
- Department of Ophthalmology, Kobe City Eye Hospital, Kobe, Japan .,Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michiko Mandai
- Department of Ophthalmology, Kobe City Eye Hospital, Kobe, Japan.,Laboratory for Retinal Regeneration, RIKEN Center for Developmental Biology, Kobe, Japan
| | - Akio Oishi
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shunichiro Nakai
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shigeru Honda
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takafumi Hirashima
- Department of Ophthalmology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hideyasu Oh
- Department of Ophthalmology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Mamoru Uenishi
- Department of Ophthalmology, Mitsubishi Kobe Hospital, Kobe, Japan
| | - Yasuo Kurimoto
- Department of Ophthalmology, Kobe City Eye Hospital, Kobe, Japan.,Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
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Anantharaman G, Sheth J, Bhende M, Narayanan R, Natarajan S, Rajendran A, Manayath G, Sen P, Biswas R, Banker A, Gupta C. Polypoidal choroidal vasculopathy: Pearls in diagnosis and management. Indian J Ophthalmol 2018; 66:896-908. [PMID: 29941728 PMCID: PMC6032720 DOI: 10.4103/ijo.ijo_1136_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.
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Affiliation(s)
| | - Jay Sheth
- Department of Vitreoretina, Giridhar Eye Institute, Kochi, Kerala, India
| | - Muna Bhende
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sundaram Natarajan
- Department of Vitreoretina, Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India
| | - Anand Rajendran
- Retina-Vitreous Service, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - George Manayath
- Department of Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Parveen Sen
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Rupak Biswas
- Department of Vitreoretina, B. B. Eye Foundation, Kolkata, West Bengal, India
| | - Alay Banker
- Bankers Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
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Cheung CMG, Lai TY, Ruamviboonsuk P, Chen SJ, Chen Y, Freund KB, Gomi F, Koh AH, Lee WK, Wong TY. Polypoidal Choroidal Vasculopathy. Ophthalmology 2018; 125:708-724. [DOI: 10.1016/j.ophtha.2017.11.019] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
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Peng Y, Zhang X, Li M, Liu B, Mi L, Zuo C, Wen F. Short-term efficacy of intravitreal conbercept in treatment-naive patients with polypoidal choroidal vasculopathy. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:339-345. [PMID: 29497280 PMCID: PMC5823069 DOI: 10.2147/dddt.s158368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction To evaluate the functional and morphological outcomes of intravitreal conbercept monotherapy in patients with polypoidal choroidal vasculopathy (PCV). Materials and methods In this retrospective, observational case series study, we reviewed medical records of 48 eyes (48 patients) with naive PCV that were treated with a series of 3 monthly intravitreal injections of 0.5 mg of conbercept followed by as-needed injections (3+pro re nata). All patients completed at least 6 months of monthly follow-up. Changes in the best-corrected visual acuity, optical coherence tomography, and indocyanine green angiography were retrospectively evaluated. Results At 6 months, the mean best-corrected visual acuity significantly improved from 0.89±0.35 (20/160 in Snellen equivalent) at baseline to 0.58±0.26 (Snellen equivalent of 20/80; P<0.001), and 60.42% (29/48) of eyes had an improvement of three lines of vision; the mean central retinal thickness significantly decreased from 333.56±171.04 μm at baseline to 187.65±54.46 μm (P<0.001), and 93.75% (45/48) achieved a dry macula. At 3 months, 6 of 32 eyes (18.75%) showed partial regression of branching vascular network, 14 of 32 (43.75%) patients showed complete resolution of polyps. The mean number of injections was 3.4±0.9 through 6 months. No conbercept-related systemic or ocular adverse effects were observed. Conclusion Intravitreal injection of conbercept using "3+pro re nata" regimen significantly improved visual acuity and anatomical outcomes in treatment-naive patients with PCV.
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Affiliation(s)
- Yuting Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Management of recalcitrant polypoidal choroidal vasculopathy by feeder vessel laser photocoagulation. Am J Ophthalmol Case Rep 2018; 9:112-115. [PMID: 29577101 PMCID: PMC5861743 DOI: 10.1016/j.ajoc.2018.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 10/27/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe management of residual branch vascular network (BVN) in polypoidal choroidal vasculopathy (PCV) by thermal laser photocoagulation of feeder vessel. Observations Case report of sixty-four year old female with polypoidal choroidal vaculopathy (PCV) with moderate response to seven doses of intravitreal ranibizumab, six doses of intravitreal bevacizumab and one session of photodynamic therapy (PDT). The patient has resolved polyps but persistence of disease activity due to residual BVN and large pigment epithelial detachment (PED). Patient underwent thermal laser photocoagulation of feeder vessel of BVN identified on indocyanine green angiography (ICGA). There was complete resolution of residual BVN and large PED, which was confirmed on ICGA. Conclusions and Importance Recalcitrant cases of PCV without polyps but having BVN with feeder vessel can be managed by ICGA guided thermal laser photocoagulation. The case report illustrates the importance of utilizing multimodal imaging such as video indocyanine green angiography (ICGA) for identification of feeder vessel and its deployment for optimal management of refractory PCV.
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Baek J, Lee JH, Lee WK. CLINICAL RELEVANCE OF AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS IN POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2017; 37:943-950. [PMID: 27617539 DOI: 10.1097/iae.0000000000001284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate vascular endothelial growth factor (VEGF) level according to the clinical and imaging features, and to explore its relationship with the responsiveness to anti-VEGF treatment in eyes with polypoidal choroidal vasculopathy. METHODS Aqueous samples were collected from 62 eyes of 62 patients with treatment-naïve polypoidal choroidal vasculopathy. Vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Baseline best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, greatest linear dimension of the lesion, and the presence of hemorrhage were included in the analysis. The effects of 3 monthly intravitreal ranibizumab injections on best-corrected visual acuity and central macular thickness were assessed. RESULTS Baseline VEGF level was negatively correlated with subfoveal choroidal thickness (r = -0.33, P = 0.01). Other variables had no correlation with VEGF level. The mean change in central macular thickness after anti-VEGF treatment was -51 ± 64 μm, which is positively correlated with VEGF concentration (r = 0.30, P = 0.04) and negatively correlated with subfoveal choroidal thickness (r = -0.35, P = 0.02). CONCLUSION Vascular endothelial growth factor level demonstrated a negative correlation with baseline subfoveal choroidal thickness and was associated with response to anti-VEGF treatment. These findings suggest that VEGF has a variable contribution to the pathogenesis of polypoidal choroidal vasculopathy depending on choroid thickness.
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Affiliation(s)
- Jiwon Baek
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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31
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Marques JP, Farinha C, Costa MÂ, Ferrão Â, Nunes S, Silva R. Protocol for a randomised, double-masked, sham-controlled phase 4 study on the efficacy, safety and tolerability of intravitreal aflibercept monotherapy compared with aflibercept with adjunctive photodynamic therapy in polypoidal choroidal vasculopathy: the ATLANTIC study. BMJ Open 2017; 7:e015785. [PMID: 28851779 PMCID: PMC5629716 DOI: 10.1136/bmjopen-2016-015785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the efficacy and safety of intravitreal aflibercept (IVA) with sham photodynamic therapy (sPDT) versus IVA with verteporfin PDT (vPDT) in a Caucasian population with treatment-naive polypoidal choroidal vasculopathy (PCV), enrolling into a treat and extend (T&E) regimen. METHODS AND ANALYSIS Randomised, double-masked, sham-controlled, multicentre phase 4 investigator-driven clinical trial. The primary outcomes are (1) change in best-corrected visual acuity (BCVA) from baseline and (2) polyp regression at week 52, assessed by indocyanine green angiography (ICGA). Fifty patients with treatment-naive PCV will be recruited from Portuguese and Spanish clinical sites. Eligible patients will receive monthly IVA for 3 months (week 0, week 4 and week 8). At week 16, all patients will repeat ICGA and undergo central randomisation (1:1 ratio) into one of the following groups: Group 1-IVA T&E + vPDT; Group 2-IVA T&E + sPDT. PDT will be performed at week 16, week 28 and week 40 in the presence of active polyps. After week 16, the presence of macular fluid on optical coherence tomography will determine the schedule of observations. When present, the interval between visits/injections will decrease 2 weeks (minimum 6 weeks). When not, the interval between visits/injections will increase 2 weeks (maximum 12 weeks). Efficacy will be evaluated based on BCVA, central retinal thickness and polyp regression. Safety parameters will include assessment of intraocular pressure, adverse events and serious adverse events. ETHICS AND DISSEMINATION This study was designed and shall be implemented and reported in accordance with the International Conference on Harmonisation (ICH) Harmonised Tripartite Guidelines for Good Clinical Practice, with applicable local regulations and with the ethical principles laid down in the Declaration of Helsinki. The study received approval from Comissão de Ética para a Investigação Clínica and Comité Ético de investigación Clínica del Hospital Universitari de Bellvitge. TRIAL REGISTRATION NUMBER This study is registered under the EudraCT number: 2015-001368-20 and the ClinicalTrials.gov Identifier: NCT02495181.
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Affiliation(s)
- João Pedro Marques
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Cláudia Farinha
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Miguel Ângelo Costa
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Ângela Ferrão
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Sandrina Nunes
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Rufino Silva
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
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Tuuminen R, Uusitalo-Järvinen H, Aaltonen V, Hautala N, Kaipiainen S, Laitamäki N, Ollila M, Rantanen J, Välimäki S, Sipilä R, Laukkala T, Komulainen J, Tommila P, Immonen I, Tuulonen A, Kaarniranta K. The Finnish national guideline for diagnosis, treatment and follow-up of patients with wet age-related macular degeneration. Acta Ophthalmol 2017; 95:1-9. [PMID: 28686003 DOI: 10.1111/aos.13501] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Age-related macular degeneration (AMD) is the main cause of visual impairment in developed countries. Several improvements in the visualization of posterior segment of the eye together with the introduction of intravitreal anti-VEGF treatment have revolutionized the prognosis of the wet form of AMD (wAMD). Increasing incidence of wAMD together with the limited resources of society and of the healthcare system poses challenges for the provision and development of care. In context of these current aspects, we aimed to set evidence-based medical guidelines for diagnosis, treatment and follow-up of patients with wAMD.
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Affiliation(s)
- Raimo Tuuminen
- Department of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Patient Insurance Centre; Helsinki Finland
| | | | - Vesa Aaltonen
- Department of Ophthalmology; Turku University Hospital; Turku Finland
| | - Nina Hautala
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu; Oulu Finland
| | - Sulevi Kaipiainen
- Department of Ophthalmology; North Karelian Central Hospital; Joensuu Finland
| | - Nina Laitamäki
- Department of Ophthalmology; Kanta-Häme Central Hospital; Hämeenlinna Finland
| | - Marko Ollila
- Department of Ophthalmology; Lapland Central Hospital; Rovaniemi Finland
| | - Jari Rantanen
- Department of Ophthalmology; Satakunta Central Hospital; Pori Finland
| | - Satu Välimäki
- Department of Ophthalmology; Päijät-Häme Central Hospital; Lahti Finland
| | - Raija Sipilä
- The Finnish Medical Society Duodecim; Helsinki Finland
| | | | | | - Petri Tommila
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Ilkka Immonen
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Anja Tuulonen
- Tays Eye Centre; Tampere University Hospital; Tampere Finland
| | - Kai Kaarniranta
- Department of Ophthalmology; Kuopio University Hospital; Kuopio Finland
- Department of Ophthalmology; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
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Abstract
PURPOSE OF REVIEW The goal of this paper is to review the recent literature of polypoidal choroidal vasculopathy (PCV) and provide an update on the epidemiology, pathophysiology, clinical findings, and management. RECENT FINDINGS Although indocyanine-green angiography (ICGA) is still the gold standard for diagnosis of PCV, the use of en face optical coherence tomography (OCT) and OCT angiography are useful tools in the diagnosis of PCV. Studies demonstrate superior treatment outcomes with combination photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) therapy. SUMMARY PCV is a disease most commonly in Asians and African-Americans and presents with an orange-red nodule in the macula or the peripapillary region. While ICGA remains the most accurate method to diagnose PCV, newer non-invasive imaging modalities (eg. OCT-A and en face OCT) can be used to identify PCV lesions. The combination of PDT and anti-VEGF therapy is superior to either monotherapy. Future studies of OCT modalities and other anti-VEGF agents will be important in guiding PCV diagnosis and management, respectively.
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Affiliation(s)
- Joon-Bom Kim
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajinder S Nirwan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Ajay E Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
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Chan EW, Eldeeb M, Lingam G, Thomas D, Bhargava M, Chee CK. Quantitative Changes in Pigment Epithelial Detachment Area and Volume Predict Retreatment in Polypoidal Choroidal Vasculopathy. Am J Ophthalmol 2017; 177:195-205. [PMID: 28007451 DOI: 10.1016/j.ajo.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine if changes in pigment epithelial detachment (PED) area and volume predict retreatment in polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective case-control study. METHODS PCV patients on pro re nata (PRN) anti-vascular endothelial growth factor (VEGF) therapy with >1 year follow-up at an academic retina service were included. Monthly anti-VEGF injections were given until a dry macula was achieved, and treatment deferred. Retreatment indication was recurrence of intraretinal or subretinal fluid or new hemorrhage. PED area and volume changes between visits with a dry macula ("D") and immediate preceding visits ("D-1") were analyzed with an automated optical coherence tomography-based software. Univariate and multivariate analyses were conducted to determine associations between changes in PED parameters and retreatment need at immediate subsequent visits ("D+1"). RESULTS Twenty-two PCV patients (mean age 69.6 years) were included. Of 46 visits D, 11 (23.9%) were followed by retreatment at D+1. An increase in PED area (>0.43 mm2) and volume (>0.0245 mm3) from D-1 to D was associated with 18.2 (95% CI, 3.7-125.6; P < .001) and 101.9 (95% CI, 9.5-14 308.0; P < .001) higher retreatment odds at D+1, respectively. These associations remained significant after multivariate analyses adjusting for baseline PED area or volume, greatest linear dimension, and type of anti-VEGF agent. CONCLUSION In PCV on PRN anti-VEGF therapy, increases in PED area and volume at one visit, despite achievement of a dry macula, are associated with retreatment at the next visit. Retreatment criteria relying on intraretinal or subretinal fluid or new hemorrhages may be expanded to include PED changes. Studies are needed to determine if using PED parameters in treatment decisions reduces recurrences.
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Arakawa A, Inoue M, Sato S, Yamane S, Kadonosono K. Efficacy of intravitreal aflibercept injections for Japanese patients with polypoidal choroidal vasculopathy. Clin Ophthalmol 2017; 11:797-802. [PMID: 28490861 PMCID: PMC5415008 DOI: 10.2147/opth.s129164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal aflibercept therapy in treatment-naïve Japanese patients with polypoidal choroidal vasculopathy (PCV) using Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores. SUBJECTS AND METHODS This study was a prospective, nonrandomized, interventional exploratory clinical trial performed in an institutional setting. Patients with PCV were treated with intravitreal aflibercept 2 mg/0.05 mL every 2 months after 3 initial monthly doses, for 1 year. Visual acuity test using the ETDRS chart and indocyanine green angiography was performed at baseline and at 6 and 12 months after initiating the treatment, in addition to routine examinations performed at each visit. The main outcome measure was the proportion of patients who achieved <15 ETDRS letter score loss. RESULTS Twenty-two patients were enrolled in this study. Nineteen (86%) patients were eligible for analysis. All the patients maintained their visual acuity (<15 ETDRS letter score loss) at 12 months. The ETDRS letter scores were 64.1 at baseline and 69.8 at 12 months (P<0.039). The polyps regressed completely in 14 (74%) patients at 12 months. Cataract progressed in 1 eye, but this progression was considered to be a senile change. CONCLUSIONS Japanese patients with treatment-naïve PCV, who were treated with intravitreal aflibercept every 2 months after 3 initial monthly doses, exhibited a significant increase in ETDRS letter scores and a high rate of polyp resolution at 12 months.
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Affiliation(s)
- Akira Arakawa
- Department of Ophthalmology, St Marianna University School of Medicine, Yokohama City Seibu Hospital.,Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Maiko Inoue
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shimpei Sato
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Yamane
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
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Hosokawa M, Morizane Y, Hirano M, Kimura S, Kumase F, Shiode Y, Doi S, Toshima S, Hosogi M, Fujiwara A, Mitsuhashi T, Shiraga F. One-year outcomes of a treat-and-extend regimen of intravitreal aflibercept for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2016; 61:150-158. [PMID: 27928695 DOI: 10.1007/s10384-016-0492-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/09/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the 1-year treatment outcomes of intravitreal aflibercept injections (IVA) using a treat-and-extend regimen for polypoidal choroidal vasculopathy (PCV). METHODS Thirty-seven eyes with treatment-naive PCV treated with IVA using a treat-and-extend regimen for 1 year were reviewed retrospectively. The main outcome measures were changes in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT), and the treatment interval at 1 year. The predictive factors for patients who could not continue to extend the treatment interval because of poor response to IVA or recurrence were analyzed. RESULTS The mean logarithm of the minimum angle of resolution BCVA improved from 0.37 at baseline to 0.21 at 1 year (P < 0.001). The mean CRT decreased from 342.3 μm at baseline to 196.6 μm at 1 year (P < 0.001). The mean treatment interval was 9.7 weeks at 1 year (4 weeks in 11 eyes [29.7%], 6 weeks in 1 eye [2.7%], 8 weeks in 2 eyes [5.4%], 10 weeks in 1 eye [2.7%], and 12 weeks in 22 eyes [59.5%]). A larger number of polypoidal lesions at baseline was predictive for patients who could not continue to extend the treatment interval. CONCLUSIONS IVA using a treat-and-extend regimen is effective for improving BCVA and CRT in eyes with PCV.
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Affiliation(s)
- Mio Hosokawa
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Masayuki Hirano
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Fumiaki Kumase
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Shinichiro Doi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Shinji Toshima
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Mika Hosogi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan
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Agarwal A, Aggarwal K, Gupta V. Management of Neovascular Age-related Macular Degeneration: A Review on Landmark Randomized Controlled Trials. Middle East Afr J Ophthalmol 2016; 23:27-37. [PMID: 26957836 PMCID: PMC4759900 DOI: 10.4103/0974-9233.173133] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In the last decade, a number of prospective clinical trials with carefully designed study protocols have been conducted for the treatment of neovascular age-related macular degeneration (AMD). These landmark clinical trials such as ANCHOR and MARINA and, more recently, the Comparison of AMD Treatment Trials and VIEW studies have revolutionized the management of neovascular AMD. While AMD continues to remain a leading cause of severe visual loss worldwide, advances in pharmacotherapeutics have led to substantial improvements in the outcome of these patients. The introduction of anti-vascular endothelial growth factor agents has resulted in improvement of visual outcomes and has had a positive impact on the quality of life among elderly population. While the contemporary management of neovascular AMD has been successful in tremendously reducing the visual morbidity, the financial burden of therapy has increased exponentially. To overcome these challenges, newer pharmacologic agents are evaluated for their efficacy and safety in AMD. Ground-breaking advances in bench to bedside research have led to discovery of new pathways that appear to be viable targets for preventing visual loss in AMD. In this review, study designs and results of landmark clinical trials in AMD from the past decade have been summarized.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Suzuki M, Nagai N, Shinoda H, Uchida A, Kurihara T, Tomita Y, Kamoshita M, Iyama C, Tsubota K, Ozawa Y. Distinct Responsiveness to Intravitreal Ranibizumab Therapy in Polypoidal Choroidal Vasculopathy With Single or Multiple Polyps. Am J Ophthalmol 2016; 166:52-59. [PMID: 27017997 DOI: 10.1016/j.ajo.2016.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To understand the prognosis of polypoidal choroidal vasculopathy (PCV) by evaluating the responsiveness to intravitreal ranibizumab (IVR) monotherapy according to the presence of a single or multiple polyps. DESIGN Retrospective case series. METHODS We included 48 treatment-naïve eyes of 48 patients who received IVR monotherapy at the Medical Retina Division Clinic, Keio University Hospital between March 2009 and January 2013 and attended the clinic for at least 12 months. All patients received 3 monthly IVR injections followed by pro re nata injections and were divided into single polyp and multiple polyps groups according to indocyanine green angiography and optical coherence tomography (OCT) findings. The outcome measures included changes in best-corrected visual acuity (BCVA) and OCT findings over 2 years after initial IVR. RESULTS At baseline, the multiple polyps group exhibited a poorer BCVA, larger greatest linear dimension, and higher prevalence of fibrovascular pigment epithelial detachment compared with the single polyp group. Over 2 years, the multiple polyps group showed no improvement in BCVA, although the central retinal thickness (CRT) decreased in both groups. The multiple polyps group exhibited a significantly greater CRT at 1 year and required more injections in the first year compared with the single polyp group; furthermore, it included a higher number of nonresponders judged either by BCVA or fundus findings at 1 year and fundus findings at 2 years. CONCLUSIONS We propose that the stratification of PCV lesions according to the presence of single or multiple polyps may be valuable to understand the prognosis.
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Affiliation(s)
- Misa Suzuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiro Nagai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Shinoda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Tomita
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Kamoshita
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Chigusa Iyama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
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Tan CS, Ngo WK, Lim LW, Tan NW, Lim TH. EVEREST study report 3: diagnostic challenges of polypoidal choroidal vasculopathy. Lessons learnt from screening failures in the EVEREST study. Graefes Arch Clin Exp Ophthalmol 2016; 254:1923-1930. [PMID: 27142805 PMCID: PMC5045476 DOI: 10.1007/s00417-016-3333-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/26/2016] [Accepted: 03/28/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe screening failures in the EVEREST study by examining the imaging characteristics that enabled differentiation of polypoidal choroidal vasculopathy (PCV) from cases that were subsequently diagnosed not to be PCV. Methods Post-hoc analysis of 34 patients with PCV reported as screening failures from EVEREST study. Standardised confocal scanning laser indocyanine green angiography (ICGA) images were graded by the Central Reading Centre to confirm PCV diagnosis based on the presence of early focal sub-retinal hyperfluorescence on ICGA and at least one of the following six diagnostic criteria: (1) nodular appearance of polyp(s) on stereoscopic examination, (2) hypofluorescent halo around nodule(s), (3) presence of a branching vascular network, (4) pulsation of polyp(s) on dynamic ICGA, (5) orange sub-retinal nodules on colour fundus photography, or (6) massive sub-macular haemorrhage (≥4 disc areas in size). Additional detailed image grading was performed with stereo-imaging and dynamic early-phase ICGA. Results Of the 95 screened PCV cases, 34 were excluded: (1) cases not suitable for recruitment as per the study protocol (n = 14), (2) equivocal lesions on ICGA characterised by small hyperfluorescent dots (n = 9), and (3) cases that were definitely not PCV (non-PCV, n = 11), identified by definitive diagnoses which included one case each of micro-aneurysm, retinal angiomatous proliferation, retino-choroidal anastomosis, small type-2 choroidal neovascularisation, retinal pigment epithelial (RPE) window defect and disciform scar; two cases of lesions where the choroidal vessel changed its course; and three cases of late-onset RPE staining. Conclusions Standardised image grading techniques used in EVEREST study enabled effective differentiation of non-PCV from actual PCV. Electronic supplementary material The online version of this article (doi:10.1007/s00417-016-3333-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nikolle W Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CMG. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res 2016; 53:107-139. [PMID: 27094371 DOI: 10.1016/j.preteyeres.2016.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly people globally. It is estimated that there will be more Asians with AMD than the rest of the world combined by 2050. In Asian populations, polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative AMD, while choroidal neovascularization secondary to AMD (CNV-AMD) is the typical subtype in Western populations. The two subtypes share many common clinical features and risk factors, but also have different epidemiological and clinical characteristics, natural history and treatment outcomes that point to distinct pathophysiological processes. Recent research in the fields of genetics, proteomics and imaging has provided further clarification of differences between PCV and CNV-AMD. Importantly, these differences have manifested as disparity in response to intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) treatment between PCV and CNV-AMD, emphasizing the need for accurate diagnosis of PCV and in distinguishing PCV from CNV-AMD, particularly in Asian patients. Current clinical trials of intravitreal anti-VEGF therapy and photodynamic therapy will provide clearer perspectives of evidence-based management of PCV and may lead to paradigm shifts in therapeutic strategies away from those currently employed in the treatment of CNV-AMD. Further research is needed to clarify the relative contribution of specific pathways in inflammation, complement activation, extracellular matrix dysregulation, lipid metabolism and angiogenesis to the pathogenesis of PCV. Findings from this research, together with improved diagnostic technology and new therapeutics, will facilitate more optimal management of Asian AMD.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yasuo Yanagi
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Won-Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University, Nagoya, Japan
| | - Ian Yeo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
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THREE-YEAR RESULTS OF POLYPOIDAL CHOROIDAL VASCULOPATHY TREATED WITH PHOTODYNAMIC THERAPY: Retrospective Study and Systematic Review. Retina 2016; 35:1577-93. [PMID: 25719986 DOI: 10.1097/iae.0000000000000499] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the 3-year outcome in eyes with polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy with verteporfin. METHODS Retrospective study and review of the literature. We performed a retrospective study of patients with PCV who were treated with photodynamic therapy between January 2007 and December 2008. Patients were excluded if they had received photodynamic therapy before the study period, but those who received previous treatment with other modalities (thermal laser or intravitreal therapies) were allowed. The main outcome measures were best-corrected visual acuity, repeat photodynamic therapy, and recurrence of PCV at the end of Years 1, 2, and 3. We further conducted a systematic review of the literature using the terms "polypoidal choroidal vasculopathy" and "photodynamic therapy" and compared the visual outcome of studies over 3 years using meta-analytical methods. RESULTS The retrospective study included 68 eyes. The mean best-corrected visual acuity was 0.73 ± 0.56 logMAR (20/107, Snellen equivalent) at baseline, 0.73 ± 0.70 logMAR (20/107, Snellen equivalent) at 1 year, 0.96 ± 0.76 logMAR (20/182, Snellen equivalent) at 2 years, and 1.07 ± 0.81 logMAR (20/235, Snellen equivalent) at 3 years. The cumulative recurrence rates of PCV were 16.1% (1 year), 34.9% (2 years), and 52.7% (3 years) and eyes with recurrence were more likely to suffer ≥3 lines loss compared with eyes without recurrence (63.2 vs. 17.6%, P = 0.006). The systematic review summarized results from 48 published studies and our retrospective study. The pooled analysis from 29 studies (316 eyes reporting the 3-year visual outcome) reported mean best-corrected visual acuity improvement of 0.115 logMAR at 1 year (n = 1,669), 0.066 logMAR at 2 years (n = 701), and 0.027 logMAR at 3 years (n = 316). Reported recurrence rates were 5.9% to 50.0% after 1 year, 9.1% to 83.3% after 2 years, and 40.0% to 78.6% after 3 years or longer of follow-up. CONCLUSION The visual outcome in eyes with PCV was stable until 2 years, but the outcome at 3 years worsened, particularly in eyes that experienced recurrence.
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INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2015; 35:1569-76. [PMID: 25830698 DOI: 10.1097/iae.0000000000000526] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lee JH, Lee WK. Anti-vascular endothelial growth factor monotherapy for polypoidal choroidal vasculopathy with polyps resembling grape clusters. Graefes Arch Clin Exp Ophthalmol 2015; 254:645-51. [DOI: 10.1007/s00417-015-3092-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022] Open
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Agarwal A, Rhoades WR, Hanout M, Soliman MK, Sarwar S, Sadiq MA, Sepah YJ, Do DV, Nguyen QD. Management of neovascular age-related macular degeneration: current state-of-the-art care for optimizing visual outcomes and therapies in development. Clin Ophthalmol 2015; 9:1001-15. [PMID: 26089632 PMCID: PMC4467654 DOI: 10.2147/opth.s74959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Contemporary management of neovascular age-related macular degeneration (AMD) has evolved significantly over the last few years. The goal of treatment is shifting from merely salvaging vision to maintaining a high quality of life. There have been significant breakthroughs in the identification of viable drug targets and gene therapies. Imaging tools with near-histological precision have enhanced our knowledge about pathophysiological mechanisms that play a role in vision loss due to AMD. Visual, social, and vocational rehabilitation are all important treatment goals. In this review, evidence from landmark clinical trials is summarized to elucidate the optimum modern-day management of neovascular AMD. Therapeutic strategies currently under development, such as gene therapy and personalized medicine, are also described.
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Affiliation(s)
- Aniruddha Agarwal
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - William R Rhoades
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mostafa Hanout
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Kamel Soliman
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Salman Sarwar
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohammad Ali Sadiq
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yasir Jamal Sepah
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diana V Do
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Quan Dong Nguyen
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
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One-year result of aflibercept treatment on age-related macular degeneration and predictive factors for visual outcome. Am J Ophthalmol 2015; 159:853-60.e1. [PMID: 25634529 DOI: 10.1016/j.ajo.2015.01.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the efficacy of periodic injection of aflibercept in each subtype of age-related macular degeneration (AMD) and to explore the predictive factors for visual outcome in clinical settings. DESIGN Prospective nonrandomized interventional case series. METHODS Patients with AMD were recruited and were administered aflibercept injections once a month for 3 months followed by once every 2 months for 8 months. The logarithm of the minimal angle of resolution (logMAR) at 12 months and improvement of vision from baseline were compared among polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. Regression rate of polypoidal lesions was assessed. We also performed regression analysis with logMAR at 12 months as the dependent variable. RESULTS The study sample consisted of 98 patients: 46 had typical AMD, 42 had PCV, and 10 had RAP. Mean logMAR improved from 0.36 to 0.21 in 12 months. While there was no difference in visual improvement between typical AMD and PCV, final logMAR was better in PCV (0.32 ± 0.09 vs 0.08 ± 0.04, P = .016). Thirty-nine PCV patients underwent follow-up angiography, and regression of polyps was observed in 27 cases (69.2%). Multiple regression analysis showed that the presence of external limiting membrane (ELM), smaller greatest linear dimension, and the presence of polypoidal lesion were associated with better visual outcome (R(2) = 0.53, P = 2.73 × 10(-14)). CONCLUSIONS Periodic injection of aflibercept is effective for PCV as well as for typical AMD. The statuses of ELM, greatest linear dimension, and polypoidal lesion are predictive for visual outcome.
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Wong CW, Wong TY, Cheung CMG. Polypoidal Choroidal Vasculopathy in Asians. J Clin Med 2015; 4:782-821. [PMID: 26239448 PMCID: PMC4470199 DOI: 10.3390/jcm4050782] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/13/2015] [Indexed: 01/16/2023] Open
Abstract
Age related macular degeneration (AMD) in Asians has been suggested to differ from their Western counterparts in terms of epidemiology, pathogenesis, clinical presentation and treatment. In particular, polypoidal choroidal vasculopathy (PCV) appears to be the predominant subtype of exudative AMD in Asian populations, in contrast to choroidal neovascularization secondary to AMD (CNV-AMD) in Western populations. Epidemiological data on PCV has been largely limited to hospital-based studies and there are currently no data on the incidence of PCV. Similarities and differences in risk factor profile between PCV and CNV-AMD point to some shared pathogenic mechanisms but also differential underlying mechanisms leading to the development of each phenotype. Serum biomarkers such as CRP, homocysteine and matrix metalloproteinases suggest underlying inflammation, atherosclerosis and deranged extracellular matrix metabolism as possible pathogenic mechanisms. In addition, recent advances in genome sequencing have revealed differences in genetic determinants of each subtype. While the standard of care for CNV-AMD is anti-vascular endothelial growth factor (VEGF) therapy, photodynamic therapy (PDT) has been the mainstay of treatment for PCV, although long-term visual prognosis remains unsatisfactory. The optimal treatment for PCV requires further clarification, particularly with different types of anti-VEGF agents and possible benefits of reduced fluence PDT.
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Affiliation(s)
- Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
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Tan CS, Ngo WK, Lim LW. Re: Oishi et al.: LAPTOP study: a 24-month trial of verteporfin versus ranibizumab for polypoidal choroidal vasculopathy (Ophthalmology 2014;121:1151-2). Ophthalmology 2015; 122:e5-6. [PMID: 25542543 DOI: 10.1016/j.ophtha.2014.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/03/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore.
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
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Oishi A, Oh H, Mandai M, Honda S, Miyamoto N. Author reply. Ophthalmology 2015; 122:e6-7. [DOI: 10.1016/j.ophtha.2014.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022] Open
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Hikichi T, Kitamei H, Shioya S. Prognostic factors of 2-year outcomes of ranibizumab therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol 2014; 99:817-22. [PMID: 25480464 DOI: 10.1136/bjophthalmol-2014-305606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/19/2014] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine predictors of 2-year outcomes after three, monthly, intravitreal ranibizumab (IVR) injections followed by as-needed injections for treatment-naive polypoidal choroidal vasculopathy (PCV). METHODS This trial included 85 Japanese patients with symptomatic treatment-naive PCV who received one 0.5 mg IVR injection monthly for 3 months followed by as-needed retreatments. PCV with subfoveal leakage on fluorescein angiography with or without actual choroidal neovascularisation were included. Analyses evaluated independent baseline predictors of better and improved visual acuity (VA) and need for fewer reinjections 2 years after the first injection. RESULTS After the three monthly injections, 1.3±1.4 and 1.5±2.0 (mean±SD) as-needed injections were administered during years 1 and 2, respectively. The baseline logarithm of the minimum angle of resolution, VA (0.60±0.49) improved significantly (p=0.001) (0.41±0.47) 2 years after the first injection. Younger patients' eyes with a better baseline VA and no cluster of grape-like polypoidal lesions were significant independent predictors of better VA 2 years after treatment. No baseline factors predicted fewer ranibizumab reinjections during 2 years. At 2 years, resolution of polypoidal lesions 1 month after the three monthly injections did not affect VA and number of reinjections during 2 years. CONCLUSIONS Patient age, baseline VA and clusters of grape-like polypoidal lesions predicted VA outcomes 2 years after treatment with IVR for PCV.
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Affiliation(s)
- Taiichi Hikichi
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| | - Hirokuni Kitamei
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| | - Shoko Shioya
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
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