Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal ...Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.展开更多
AIM:To classify polypoidal choroidal vasculopathy(PCV)into 2 subtypes based on the subfoveal choroidal thickness(SFCT)and to further evaluate their multimodal image features.METHODS:A retrospective observational case ...AIM:To classify polypoidal choroidal vasculopathy(PCV)into 2 subtypes based on the subfoveal choroidal thickness(SFCT)and to further evaluate their multimodal image features.METHODS:A retrospective observational case series study.Sixty-four eyes of 64 patients with PCV were enrolled and classified into 2 groups based on SFCT(thick-choroid group/thin-choroid group).Then further analyze the spectrum domain optical coherence tomography(SD-OCT)and indocyanine green angiography(ICGA)differences of the two subtypes.Imaging analysis included measurement of SFCT,maximum vascular diameter ratio(MVDR),choroidal vascularity index(CVI),central macular thickness(CMT),and the presence of pigment epithelial detachment(PED)on SD-OCT.Polypoidal lesions(polyps)number,branching vascular network(BVN)area,greatest linear dimension(GLD),and the choroidal vascular hyperpermeability(CVH)were analyzed by ICGA.RESULTS:The distribution of SFCT was bimodal with two peaks at 195 and 285μm,and a trough at 225μm.The 225μm was taken as the cutoff point for the following classification of thick/thin choroid groups.The PCV eyes in the thick-choroid group presented with greater MVDR,CVI within 3 and 6 mm of the fovea,but lower CMT,less PED,small PED diameters on SD-OCT scans,and fewer polyps,smaller BVN and GLD,but more frequency of CVH on ICGA.CONCLUSION:The SFCT at 225μm can be used as a readily available indicator for the classification of PCV subtypes.The thick-choroid group presents much apparent enlargement of the choroidal layer and vasculature expansion,which indicates different pathogenesis of the two subtypes.展开更多
AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage(SRH) management for massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV). METHODS: This is a retros...AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage(SRH) management for massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV). METHODS: This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy(PDT) as needed. The main outcome measures were best-corrected visual acuity(BCVA), postoperative adverse events and the recurrence of VH. RESULTS: The average follow-up period was 25.5±9.2 mo(range 12-35 mo). Mean BCVA at baseline(2.16±0.39 logM AR)had improved significantly, both 3 mo after surgery(1.42±0.66 log MAR, P<0.001) and by the last visit(1.23±0.74 logM AR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes(16.3%) and ciliary body detachment in 4 eyes(4.7%).Nineteen eyes(22.1%) received following treatment with ranibizumab injections without/with PDT, and 15(17.4%)were resolved. Four eyes(4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis,thicker SRH(beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis(beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION: Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.展开更多
AIM: To assess the effectiveness and safety of ranibizumab 0.5 mg in Taiwan Residents patients with polypoidal choroidal vasculopathy(PCV) by performing a retrospective exploratory subgroup analysis of the REAL study....AIM: To assess the effectiveness and safety of ranibizumab 0.5 mg in Taiwan Residents 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 agerelated 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-totreat 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 12 mo results in maintenance of VA and reduction in central retinal subfield thickness in Taiwan Residents patients with PCV. Improvements in VA are observed in patients who received ranibizumab plus PDT. There are no new safety findings.展开更多
AIM: To evaluate the efficacy and safety of anti-vascular endothelial growth factor(VEGF) combined with photodynamic therapy(PDT) versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy(PCV).METHODS: We con...AIM: To evaluate the efficacy and safety of anti-vascular endothelial growth factor(VEGF) combined with photodynamic therapy(PDT) versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy(PCV).METHODS: We conducted a Meta-analysis of 9 studies to compare the efficacy and safety between combined therapy and anti-VEGF monotherapy for PCV. The programs of RevM an 5.3 and Stata 12.0 were used to analyze data.RESULTS: The best corrected visual acuity(BCVA) in combined therapy group were significantly better than those of anti-VEGF monotherapy group at 6,24 and 36 mo,with pooled weighted means differences(WMDs) of 0.12(0.06,0.18),0.25(0.12,0.38) and 0.28(0.13,0.43),respectively. The central retinal thickness(CRT) reductions in combined therapy group were higher than that in antiVEGF monotherapy group at 1,3,6 and 9mo,with pooled WMDs of 63.90(20.41,107.38),33.47(4.69,62.24),30.57(0.12,60.01) and 28.00(2.51,53.49),respectively. The regression rate of polyps in combined therapy group was much higher than that in anti-VEGF monotherapy group [RD: 0.47(0.26,0.68); P<0.0001]. The adverse event retinal hemorrhage did not differ significantly between the two groups.CONCLUSION: Our findings clearly document that antiVEGF combined with PDT is a more effective therapy for PCV compared with anti-VEGF monotherapy. Furthermore,combined therapy does not increase the incidence of retinal hemorrhage.展开更多
Dear Editor,Chorodial osteoma(CO) is a rare choroidal tumor characterized by the presence of mature bone tissue predominantly in the juxtapapillary or macularregion.CO mostly affects young healthy females in the secon...Dear Editor,Chorodial osteoma(CO) is a rare choroidal tumor characterized by the presence of mature bone tissue predominantly in the juxtapapillary or macularregion.CO mostly affects young healthy females in the second or third decades of life.It is unilateral in approximately 80%of cases[1],as patients have no obvious visual symptoms during the early stage of CO,and the growth of CO is slow.CO patients usually visit the eye clinic during the later stages of CO and have poor vision.Gradual decline in vision in CO patients is related to changes in retinal pigment epithelium(RPE)and photoreceptor atrophy.Choroidal neovascularization(CNV)and the resultant subretinal fluid and hemorrhage are the most frequent causes of sudden vision loss in CO[2].We report a rare case of bilateral CO with unilateral polypoidal choroidal vasculopathy(PCV)in a middle-aged male.展开更多
Dear Editor,Polypoidal choroidal vasculopathy(PCV)was first described by Yannuzzi et al^([1]) in the 1980s as a distinct choroidal abnormality.Clinically,PCV is seen as orange-red subretinal nodules^([2]) frequently p...Dear Editor,Polypoidal choroidal vasculopathy(PCV)was first described by Yannuzzi et al^([1]) in the 1980s as a distinct choroidal abnormality.Clinically,PCV is seen as orange-red subretinal nodules^([2]) frequently presenting with submacular haemorrhage or serosanguinous pigment epithelial detachments(PED)^([3]).Indocyanine green展开更多
AIM:To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy(PCV).METHODS:Medical records of 13 eyes of 13 patients with PCV were followed-up...AIM:To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy(PCV).METHODS:Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2 y after focal laser photocoagulation treatment.The patients were diagnosed with PCV using indocyanine green angiography,and eyes with other comorbid ocular diseases were excluded.The measurement outcomes of the study were the post-treatment regression and recurrence of polyps,complications,and changes in visual acuities.Paired t-test was performed to compare visual outcome before and after the treatment.RESULTS:The mean age of the 13 patients was 70.2±5.5 y,and the follow-up period was 72.3±31.0(range,25-118)mo.Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps.Of the 13 eyes,9 eyes(69.2%)had regression of polyps 1.7±1.2(range,0.9-4)mo after focal laser photocoagulation.Five eyes(55.6%)showed recurrence of polyps during the follow-up periods,and the recurrence period was 12.8±18.9(range,1.9-48)mo.Mild subretinal hemorrhage occurred in two eyes(15.4%)27 and 72 d after laser treatment,respectively.There were no statistically significant differences in visual acuities at baseline;1,2,3 y post-treatment(all P>0.05);and last follow-up(0.63±0.5,0.73±0.70,0.67±0.57,0.75±0.7,and 0.95±0.8 log MAR,respectively).CONCLUSION:Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up.Furthermore,it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.展开更多
AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interven...AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections(0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity(VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy(PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity(BCVA), central foveal thickness(CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes(56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters(P<0.001) at 12 mo, while CFT decreased significantly from 457.41±207.86 μm to 247.98±127.08 μm(P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12 mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.展开更多
AIM: To compare the efficacy of intravitreal ranibizumab(IVR) alone or in combination with photodynamic therapy(PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy(PCV).·METHODS: A systemat...AIM: To compare the efficacy of intravitreal ranibizumab(IVR) alone or in combination with photodynamic therapy(PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy(PCV).·METHODS: A systematic search of a wide range of databases(including Pub Med, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials(RCTs) and non-RCT studies were included.Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale.Rev Man 5.2.7 software was used to do the Meta-analysis.·RESULTS: Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12(All P ≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs.The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity(BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6and 24(All P <0.05), respectively. In the mean time, this comparison result was also significant at month 12(P <0.01) after removal of a heterogeneous study.·CONCLUSION: IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.展开更多
AIM: To evaluate the efficacy and safety of three consecutive monthly injections of intravitreal ranibizumab for the treatment of polypoidal choroidal vasculopathy(PCV) in Korea.METHODS: A retrospective chart review o...AIM: To evaluate the efficacy and safety of three consecutive monthly injections of intravitreal ranibizumab for the treatment of polypoidal choroidal vasculopathy(PCV) in Korea.METHODS: A retrospective chart review of 25 patients(27 eyes) with PCV was conducted. Patients received three initial monthly intravitreal injections(0.5 mg) of ranibizumab and were monitored monthly for 12 mo from January 2010 to October 2011. Reinjection of ranibizumab after three initial monthly loading was administered on an as-needed basis, guided by the optical coherence tomography(OCT), fluorescein angiography(FA) and indocyanine green angiography(ICGA). The main outcomes were the changes of the mean best corrected Snellen visual acuity(VA), central macular thickness(CMT) by OCT, the changes of polyps and branching vascular network by FA and ICGA, and total number of injections received by patients during the 12 mo.RESULTS: The mean best corrected Snellen visual acuities at baseline, 1, 3, 6 and 12 mo after primary injection were 0.77 ±0.59, 0.76 ±0.53, 0.70 ±0.47, 0.63 ±0.43,0.61 ±0.43, 0.62 ±0.42 log MAR, respectively, and showed significant improvement at 3, 6, 12mo(P =0.003, P =0.002,P =0.018, Wilcoxon signed-rank test). The mean CMT at baseline, 1, 2, 3, 6, and 12 mo was 312.41 ±66.38 μm,244.59 ±71.47 μm, 232.32 ±69.41 μm, 226.69 ±69.03 μm,228.62 ±37.07 μm, 227.59 ±51.01 μm respectively, and showed significant reduction(all P <0.001, Wilcoxon signed-rank test). Polypoidal lesions resolved on ICGA in 3 eyes(11.1%) and a branching vascular network remained in all 24 eyes(88.9%). A total of 106 injections were given in the 12-month period, which equaled to a mean of 3.92(range, 3-6) times. Sixteen of the 27 treatedeyes had additional 1.56 ±0.91 injections. The others(11eyes) had just 3 consecutive injections.CONCLUSION: An initial loading dose of three monthly ranibizumab injections is a safe and effective method in treating PCV, with visual and anatomical improvement over one year follow-up.展开更多
AIM:To report a cohort of patients with polypoidal choroidal vasculopathy(PCV)treated with photodynamic therapy(PDT)followed by intravitreal ranibizumab injection 24-48 h later,and to compare the results between eyes ...AIM:To report a cohort of patients with polypoidal choroidal vasculopathy(PCV)treated with photodynamic therapy(PDT)followed by intravitreal ranibizumab injection 24-48 h later,and to compare the results between eyes with PCV treated by PDT followed by intravitreal anti-vascular endothelial growth factor(VEGF)injection and intravitreal anti-VEGF injection followed by PDT by Meta-analysis.METHODS:Retrospective study and systematic literature review. Medical records of patients with PCV who were initially treated using PDT followed by intravitreal ranibizumab injection 24-48 h after PDT and had completed at least 2y follow-up were reviewed and analyzed. Clinical data,including age,sex,best-corrected visual acuity(BCVA),fundus photograph,fluorescein angiography,indocyanine green angiography and optical coherence tomography were investigated. A systematic literature review was also conducted,and a visual outcome of studies over 1y was compared using Meta-analysis. RESULTS:A total of 52 patients were included in the study. Mean BCVA at baseline and follow-up at 1 or 2y were 0.71± 0.61,0.51±0.36 and 0.68±0.51 log MAR,respectively. The cumulative hazard rate for recurrence at 1 and 2y followup was 15.4% and 30.3% respectively. The percentage of eyes with polyps regression at 3,12 and 24 mo follow-up was 88.5%,84.6% and 67.3% respectively. A Meta-analysis based on 22 independent studies showed the overall vision improvements at 1,2 and 3y follow-up were 0.13±0.04(P<0.001),0.12±0.03(P<0.001),0.16±0.06(P<0.001),respectively. The proportion of polyps regression at 1y follow-up was 64.6%(95%CI:51.5%,77.7%,P<0.001)in 434 eyes treated by intravitreal anti-VEGF agents beforePDT and 76.0%(95%CI:64.8%,87.3%,P=0.001)in 199 eyes treated by intravitreal anti-VEGF agents after PDT. CONCLUSION:Intravitreal ranibizumab injection 24-48 h following PDT effectively stabilizes visual acuity in the eye with PCV. PDT followed by intravitreal anti-VEGF agents may contribute to a relatively higher proportion of polyps' regression as compared to that of intravitreal anti-VEGF before PDT.展开更多
Purpose: This study was designed to measure the changes in the subfoveal choroidal thickness(SFCT) and choroidal maximal vessel diameter(MVD) of the affected and unaffected fellow eyes in patients with polypoidal chor...Purpose: This study was designed to measure the changes in the subfoveal choroidal thickness(SFCT) and choroidal maximal vessel diameter(MVD) of the affected and unaffected fellow eyes in patients with polypoidal choroidal vasculopathy(PCV) and compare them to healthy controls.Methods: In this cross-sectional observational clinical study,SFCT and MVD were measured in both eyes of 53 patients with unilateral PCV. PCV eyes were subgrouped into group A and unaffected fellow eyes into group B. All patients were diagnosed with PCV by fundus fluorescein angiography.(FFA)and indocyanine green angiography.(ICGA). Sixty age- and gender-matched healthy subjects were enrolled in the control group(group C).Results: No statistical difference was observed among groups in age and gender. Overall, SFCT was correlated with MVD in all subjects(P <0.001; correlation coefficient: 0.759). P values were < 0.001 with a correlation coefficient of 0.686,0.801, and 0.808 in groups A, B, and C, respectively. No statistical significance was noted in SFCT among groups A(266.45±99.51 μm),B(269.57 ± 105.10 μm),and C(243.83±99.68 μm)(P =0.335). However, the MVD in group A was(202.55±72.45 μm), significantly larger than that in group C(166.45 ±56.18 μm,P =0.008), while the MVD in group B(194.75±85.27 μm) was equally significantly greater than that in group C(166.45 ± 56.18 μm)(P=0.038).Conclusion: For both PCV patients and healthy subjects,SFCT was positively correlated with MVD. No statistical significance was noted in SFCT between PCV eyes and unaffected fellow / normal eyes. However, MVD was significantly larger in the PCV affected eyes than in unaffected fellow or normal control eyes, suggesting that MVD could be considered as a sensitive indicator to evaluate choroidal perfusion in PCV patients.展开更多
Background:Neovascular age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV)are sight-threatening maculopathies with both environmental and genetic risk factors.We have previously shown relat...Background:Neovascular age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV)are sight-threatening maculopathies with both environmental and genetic risk factors.We have previously shown relative risks posed by genes of the complement pathways to neovascular AMD and PCV.Methods:In this study,we investigated the haplotype-tagging single nucleotide polymorphisms(SNPs)in the complement component 5(C5)gene in 708 unrelated Chinese individuals:200 neovascular AMD patients,233 PCV patients and 275 controls.Six tagging SNPs in C5 were genotyped.Univariate single SNP association analysis,haplotype-based association analysis and gene-gene interaction analysis between C5 and other AMD-associated genes were performed.Results:The results revealed none of the six tagging SNPs of the C5 gene had a significant association with neovascular AMD or PCV(P>0.05).We also found insignificant haplotype-based association,and no significant SNPSNP interaction between C5 and other genes(including C2-CFB-RDBP-SKIV2L,SERPING1,CETP,ABCG1,PGF,ANGPT2,CFH and HTRA1)for neovascular AMD and PCV.Conclusions:This study showed no statistical significance in the genetic association of C5 with neovascular AMD or PCV in a Hong Kong Chinese population.Further studies in large samples from different populations are warranted to elucidate the role of C5 in the genetic susceptibility of AMD and PCV.展开更多
文摘Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.
基金Supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2018PT32029)。
文摘AIM:To classify polypoidal choroidal vasculopathy(PCV)into 2 subtypes based on the subfoveal choroidal thickness(SFCT)and to further evaluate their multimodal image features.METHODS:A retrospective observational case series study.Sixty-four eyes of 64 patients with PCV were enrolled and classified into 2 groups based on SFCT(thick-choroid group/thin-choroid group).Then further analyze the spectrum domain optical coherence tomography(SD-OCT)and indocyanine green angiography(ICGA)differences of the two subtypes.Imaging analysis included measurement of SFCT,maximum vascular diameter ratio(MVDR),choroidal vascularity index(CVI),central macular thickness(CMT),and the presence of pigment epithelial detachment(PED)on SD-OCT.Polypoidal lesions(polyps)number,branching vascular network(BVN)area,greatest linear dimension(GLD),and the choroidal vascular hyperpermeability(CVH)were analyzed by ICGA.RESULTS:The distribution of SFCT was bimodal with two peaks at 195 and 285μm,and a trough at 225μm.The 225μm was taken as the cutoff point for the following classification of thick/thin choroid groups.The PCV eyes in the thick-choroid group presented with greater MVDR,CVI within 3 and 6 mm of the fovea,but lower CMT,less PED,small PED diameters on SD-OCT scans,and fewer polyps,smaller BVN and GLD,but more frequency of CVH on ICGA.CONCLUSION:The SFCT at 225μm can be used as a readily available indicator for the classification of PCV subtypes.The thick-choroid group presents much apparent enlargement of the choroidal layer and vasculature expansion,which indicates different pathogenesis of the two subtypes.
基金Supported by the National Natural Science Foundation of China (No.81271009)the Science and Technology Planning Project of Guangdong Province, China (No.2017A030303016)
文摘AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage(SRH) management for massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV). METHODS: This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy(PDT) as needed. The main outcome measures were best-corrected visual acuity(BCVA), postoperative adverse events and the recurrence of VH. RESULTS: The average follow-up period was 25.5±9.2 mo(range 12-35 mo). Mean BCVA at baseline(2.16±0.39 logM AR)had improved significantly, both 3 mo after surgery(1.42±0.66 log MAR, P<0.001) and by the last visit(1.23±0.74 logM AR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes(16.3%) and ciliary body detachment in 4 eyes(4.7%).Nineteen eyes(22.1%) received following treatment with ranibizumab injections without/with PDT, and 15(17.4%)were resolved. Four eyes(4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis,thicker SRH(beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis(beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION: Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.
文摘AIM: To assess the effectiveness and safety of ranibizumab 0.5 mg in Taiwan Residents 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 agerelated 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-totreat 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 12 mo results in maintenance of VA and reduction in central retinal subfield thickness in Taiwan Residents patients with PCV. Improvements in VA are observed in patients who received ranibizumab plus PDT. There are no new safety findings.
文摘AIM: To evaluate the efficacy and safety of anti-vascular endothelial growth factor(VEGF) combined with photodynamic therapy(PDT) versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy(PCV).METHODS: We conducted a Meta-analysis of 9 studies to compare the efficacy and safety between combined therapy and anti-VEGF monotherapy for PCV. The programs of RevM an 5.3 and Stata 12.0 were used to analyze data.RESULTS: The best corrected visual acuity(BCVA) in combined therapy group were significantly better than those of anti-VEGF monotherapy group at 6,24 and 36 mo,with pooled weighted means differences(WMDs) of 0.12(0.06,0.18),0.25(0.12,0.38) and 0.28(0.13,0.43),respectively. The central retinal thickness(CRT) reductions in combined therapy group were higher than that in antiVEGF monotherapy group at 1,3,6 and 9mo,with pooled WMDs of 63.90(20.41,107.38),33.47(4.69,62.24),30.57(0.12,60.01) and 28.00(2.51,53.49),respectively. The regression rate of polyps in combined therapy group was much higher than that in anti-VEGF monotherapy group [RD: 0.47(0.26,0.68); P<0.0001]. The adverse event retinal hemorrhage did not differ significantly between the two groups.CONCLUSION: Our findings clearly document that antiVEGF combined with PDT is a more effective therapy for PCV compared with anti-VEGF monotherapy. Furthermore,combined therapy does not increase the incidence of retinal hemorrhage.
基金Supported by the National Basic Research of China(No.81600758)。
文摘Dear Editor,Chorodial osteoma(CO) is a rare choroidal tumor characterized by the presence of mature bone tissue predominantly in the juxtapapillary or macularregion.CO mostly affects young healthy females in the second or third decades of life.It is unilateral in approximately 80%of cases[1],as patients have no obvious visual symptoms during the early stage of CO,and the growth of CO is slow.CO patients usually visit the eye clinic during the later stages of CO and have poor vision.Gradual decline in vision in CO patients is related to changes in retinal pigment epithelium(RPE)and photoreceptor atrophy.Choroidal neovascularization(CNV)and the resultant subretinal fluid and hemorrhage are the most frequent causes of sudden vision loss in CO[2].We report a rare case of bilateral CO with unilateral polypoidal choroidal vasculopathy(PCV)in a middle-aged male.
文摘Dear Editor,Polypoidal choroidal vasculopathy(PCV)was first described by Yannuzzi et al^([1]) in the 1980s as a distinct choroidal abnormality.Clinically,PCV is seen as orange-red subretinal nodules^([2]) frequently presenting with submacular haemorrhage or serosanguinous pigment epithelial detachments(PED)^([3]).Indocyanine green
基金the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSITNo.2020R1F1A1072795)。
文摘AIM:To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy(PCV).METHODS:Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2 y after focal laser photocoagulation treatment.The patients were diagnosed with PCV using indocyanine green angiography,and eyes with other comorbid ocular diseases were excluded.The measurement outcomes of the study were the post-treatment regression and recurrence of polyps,complications,and changes in visual acuities.Paired t-test was performed to compare visual outcome before and after the treatment.RESULTS:The mean age of the 13 patients was 70.2±5.5 y,and the follow-up period was 72.3±31.0(range,25-118)mo.Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps.Of the 13 eyes,9 eyes(69.2%)had regression of polyps 1.7±1.2(range,0.9-4)mo after focal laser photocoagulation.Five eyes(55.6%)showed recurrence of polyps during the follow-up periods,and the recurrence period was 12.8±18.9(range,1.9-48)mo.Mild subretinal hemorrhage occurred in two eyes(15.4%)27 and 72 d after laser treatment,respectively.There were no statistically significant differences in visual acuities at baseline;1,2,3 y post-treatment(all P>0.05);and last follow-up(0.63±0.5,0.73±0.70,0.67±0.57,0.75±0.7,and 0.95±0.8 log MAR,respectively).CONCLUSION:Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up.Furthermore,it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.
文摘AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy(PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections(0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity(VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy(PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity(BCVA), central foveal thickness(CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes(56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters(P<0.001) at 12 mo, while CFT decreased significantly from 457.41±207.86 μm to 247.98±127.08 μm(P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12 mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.
基金Supported by the National Natural Science Foundation of China(No.81373826,No.81100658)Development Project of Science and Technology of Traditional Chinese Medicine of Shandong Province(No.2013ZDZK-083)Development Project of Medicine and Health Science Technology of Shandong Province(No.2013WS0251)
文摘AIM: To compare the efficacy of intravitreal ranibizumab(IVR) alone or in combination with photodynamic therapy(PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy(PCV).·METHODS: A systematic search of a wide range of databases(including Pub Med, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials(RCTs) and non-RCT studies were included.Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale.Rev Man 5.2.7 software was used to do the Meta-analysis.·RESULTS: Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12(All P ≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs.The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity(BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6and 24(All P <0.05), respectively. In the mean time, this comparison result was also significant at month 12(P <0.01) after removal of a heterogeneous study.·CONCLUSION: IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.
文摘AIM: To evaluate the efficacy and safety of three consecutive monthly injections of intravitreal ranibizumab for the treatment of polypoidal choroidal vasculopathy(PCV) in Korea.METHODS: A retrospective chart review of 25 patients(27 eyes) with PCV was conducted. Patients received three initial monthly intravitreal injections(0.5 mg) of ranibizumab and were monitored monthly for 12 mo from January 2010 to October 2011. Reinjection of ranibizumab after three initial monthly loading was administered on an as-needed basis, guided by the optical coherence tomography(OCT), fluorescein angiography(FA) and indocyanine green angiography(ICGA). The main outcomes were the changes of the mean best corrected Snellen visual acuity(VA), central macular thickness(CMT) by OCT, the changes of polyps and branching vascular network by FA and ICGA, and total number of injections received by patients during the 12 mo.RESULTS: The mean best corrected Snellen visual acuities at baseline, 1, 3, 6 and 12 mo after primary injection were 0.77 ±0.59, 0.76 ±0.53, 0.70 ±0.47, 0.63 ±0.43,0.61 ±0.43, 0.62 ±0.42 log MAR, respectively, and showed significant improvement at 3, 6, 12mo(P =0.003, P =0.002,P =0.018, Wilcoxon signed-rank test). The mean CMT at baseline, 1, 2, 3, 6, and 12 mo was 312.41 ±66.38 μm,244.59 ±71.47 μm, 232.32 ±69.41 μm, 226.69 ±69.03 μm,228.62 ±37.07 μm, 227.59 ±51.01 μm respectively, and showed significant reduction(all P <0.001, Wilcoxon signed-rank test). Polypoidal lesions resolved on ICGA in 3 eyes(11.1%) and a branching vascular network remained in all 24 eyes(88.9%). A total of 106 injections were given in the 12-month period, which equaled to a mean of 3.92(range, 3-6) times. Sixteen of the 27 treatedeyes had additional 1.56 ±0.91 injections. The others(11eyes) had just 3 consecutive injections.CONCLUSION: An initial loading dose of three monthly ranibizumab injections is a safe and effective method in treating PCV, with visual and anatomical improvement over one year follow-up.
文摘AIM:To report a cohort of patients with polypoidal choroidal vasculopathy(PCV)treated with photodynamic therapy(PDT)followed by intravitreal ranibizumab injection 24-48 h later,and to compare the results between eyes with PCV treated by PDT followed by intravitreal anti-vascular endothelial growth factor(VEGF)injection and intravitreal anti-VEGF injection followed by PDT by Meta-analysis.METHODS:Retrospective study and systematic literature review. Medical records of patients with PCV who were initially treated using PDT followed by intravitreal ranibizumab injection 24-48 h after PDT and had completed at least 2y follow-up were reviewed and analyzed. Clinical data,including age,sex,best-corrected visual acuity(BCVA),fundus photograph,fluorescein angiography,indocyanine green angiography and optical coherence tomography were investigated. A systematic literature review was also conducted,and a visual outcome of studies over 1y was compared using Meta-analysis. RESULTS:A total of 52 patients were included in the study. Mean BCVA at baseline and follow-up at 1 or 2y were 0.71± 0.61,0.51±0.36 and 0.68±0.51 log MAR,respectively. The cumulative hazard rate for recurrence at 1 and 2y followup was 15.4% and 30.3% respectively. The percentage of eyes with polyps regression at 3,12 and 24 mo follow-up was 88.5%,84.6% and 67.3% respectively. A Meta-analysis based on 22 independent studies showed the overall vision improvements at 1,2 and 3y follow-up were 0.13±0.04(P<0.001),0.12±0.03(P<0.001),0.16±0.06(P<0.001),respectively. The proportion of polyps regression at 1y follow-up was 64.6%(95%CI:51.5%,77.7%,P<0.001)in 434 eyes treated by intravitreal anti-VEGF agents beforePDT and 76.0%(95%CI:64.8%,87.3%,P=0.001)in 199 eyes treated by intravitreal anti-VEGF agents after PDT. CONCLUSION:Intravitreal ranibizumab injection 24-48 h following PDT effectively stabilizes visual acuity in the eye with PCV. PDT followed by intravitreal anti-VEGF agents may contribute to a relatively higher proportion of polyps' regression as compared to that of intravitreal anti-VEGF before PDT.
基金National Natural Science Fund for Young Scholars of China(grant No.81100685)
文摘Purpose: This study was designed to measure the changes in the subfoveal choroidal thickness(SFCT) and choroidal maximal vessel diameter(MVD) of the affected and unaffected fellow eyes in patients with polypoidal choroidal vasculopathy(PCV) and compare them to healthy controls.Methods: In this cross-sectional observational clinical study,SFCT and MVD were measured in both eyes of 53 patients with unilateral PCV. PCV eyes were subgrouped into group A and unaffected fellow eyes into group B. All patients were diagnosed with PCV by fundus fluorescein angiography.(FFA)and indocyanine green angiography.(ICGA). Sixty age- and gender-matched healthy subjects were enrolled in the control group(group C).Results: No statistical difference was observed among groups in age and gender. Overall, SFCT was correlated with MVD in all subjects(P <0.001; correlation coefficient: 0.759). P values were < 0.001 with a correlation coefficient of 0.686,0.801, and 0.808 in groups A, B, and C, respectively. No statistical significance was noted in SFCT among groups A(266.45±99.51 μm),B(269.57 ± 105.10 μm),and C(243.83±99.68 μm)(P =0.335). However, the MVD in group A was(202.55±72.45 μm), significantly larger than that in group C(166.45 ±56.18 μm,P =0.008), while the MVD in group B(194.75±85.27 μm) was equally significantly greater than that in group C(166.45 ± 56.18 μm)(P=0.038).Conclusion: For both PCV patients and healthy subjects,SFCT was positively correlated with MVD. No statistical significance was noted in SFCT between PCV eyes and unaffected fellow / normal eyes. However, MVD was significantly larger in the PCV affected eyes than in unaffected fellow or normal control eyes, suggesting that MVD could be considered as a sensitive indicator to evaluate choroidal perfusion in PCV patients.
基金supported in part by the General Research Fund,Hong Kong(14120516[LJC])the Direct Grant of Chinese University of Hong Kong Medical Panel,Hong Kong(4054281[LJC])the Endowment Fund for Lim Por-Yen Eye Genetics Research Centre,Hong Kong.
文摘Background:Neovascular age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV)are sight-threatening maculopathies with both environmental and genetic risk factors.We have previously shown relative risks posed by genes of the complement pathways to neovascular AMD and PCV.Methods:In this study,we investigated the haplotype-tagging single nucleotide polymorphisms(SNPs)in the complement component 5(C5)gene in 708 unrelated Chinese individuals:200 neovascular AMD patients,233 PCV patients and 275 controls.Six tagging SNPs in C5 were genotyped.Univariate single SNP association analysis,haplotype-based association analysis and gene-gene interaction analysis between C5 and other AMD-associated genes were performed.Results:The results revealed none of the six tagging SNPs of the C5 gene had a significant association with neovascular AMD or PCV(P>0.05).We also found insignificant haplotype-based association,and no significant SNPSNP interaction between C5 and other genes(including C2-CFB-RDBP-SKIV2L,SERPING1,CETP,ABCG1,PGF,ANGPT2,CFH and HTRA1)for neovascular AMD and PCV.Conclusions:This study showed no statistical significance in the genetic association of C5 with neovascular AMD or PCV in a Hong Kong Chinese population.Further studies in large samples from different populations are warranted to elucidate the role of C5 in the genetic susceptibility of AMD and PCV.
