Refractory neovascular age-related macular degeneration secondary to polypoidal choroidal vasculopathy

Am J Ophthalmol. 2009 Jul;148(1):70-8.e1. doi: 10.1016/j.ajo.2009.02.012. Epub 2009 Apr 29.


Purpose: To describe a neovascular pattern associated with treatment-refractory neovascular age-related macular degeneration (AMD).

Design: A retrospective observational case series.

Setting: Clinical practice.

Patient population: Twelve eyes of 12 patients with neovascular AMD in which a poor anatomic response to anti-vascular endothelial growth factor (VEGF) therapy was related to polypoidal choroidal vasculopathy (PCV).

Observation procedure: Slit-lamp biomicroscopy, optical coherence tomography, fluorescein and indocyanine green angiography.

Main outcome measures: Snellen visual acuity (VA), anatomic response to therapy including presence or absence of retinal edema, hemorrhage, and lipid exudates.

Results: New or persistent PCV was identified in a cohort of patients demonstrating increasing macular exudation despite regular intravitreal ranibizumab (Lucentis; Genentech Inc, South San Francisco, California, USA) or bevacizumab (Avastin; Genentech Inc) injections for a minimum of 6 months. Treatment with verteporfin photodynamic therapy (PDT), PDT/anti-VEGF combination therapy, or continued anti-VEGF monotherapy resulted in complete resolution of exudation in 9 of 12 patients and partial resolution of exudation in the remaining 3 patients.

Conclusion: Treatment-refractory neovascular AMD may harbor vascular abnormalities such as PCV. Modifications in therapeutic protocols may be indicated in order to improve visual and anatomic outcomes in this population.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use
  • Choroid / blood supply*
  • Choroidal Neovascularization / diagnosis
  • Choroidal Neovascularization / drug therapy
  • Choroidal Neovascularization / etiology*
  • Coloring Agents
  • Combined Modality Therapy
  • Drug Resistance
  • Female
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green
  • Macular Degeneration / diagnosis
  • Macular Degeneration / drug therapy
  • Macular Degeneration / etiology*
  • Male
  • Middle Aged
  • Peripheral Vascular Diseases / complications*
  • Peripheral Vascular Diseases / diagnosis
  • Peripheral Vascular Diseases / drug therapy
  • Photochemotherapy
  • Photosensitizing Agents / therapeutic use
  • Porphyrins / therapeutic use
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Verteporfin
  • Visual Acuity / physiology


  • Angiogenesis Inhibitors
  • Coloring Agents
  • Photosensitizing Agents
  • Porphyrins
  • Vascular Endothelial Growth Factor A
  • Verteporfin
  • Indocyanine Green