Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment

Retina. 2013 Apr;33(4):686-716. doi: 10.1097/IAE.0b013e3182852446.

Abstract

Background: Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age-related macular degeneration. Currently, no evidence-based guidelines exist for its diagnosis and treatment.

Methods: A panel of experts analyzed a systematic literature search on PCV together with results of the EVEREST trial, the only published randomized controlled clinical trial in PCV. At a subsequent Roundtable meeting, recommendations for the management of PCV were agreed based on this analysis and their own expert opinion.

Results: Diagnosis of PCV should be based on early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography. Recommended initial treatment of juxtafoveal and subfoveal PCV is either indocyanine green angiography-guided verteporfin photodynamic therapy or verteporfin photodynamic therapy plus 3 × 0.5 mg ranibizumab intravitreal injections 1 month apart. If there is incomplete regression of polyps by indocyanine green angiography, eyes should be retreated with verteporfin photodynamic therapy monotherapy or verteporfin photodynamic therapy plus ranibizumab. If there is complete regression of polyps by indocyanine green angiography, but there is leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab.

Conclusion: Practical guidance on the clinical management of PCV is proposed based on expert evaluation of current evidence.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Choroid / blood supply*
  • Choroid Diseases / diagnosis*
  • Choroid Diseases / drug therapy*
  • Coloring Agents*
  • Databases, Factual
  • Evidence-Based Medicine
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use
  • Polyps / diagnosis*
  • Polyps / drug therapy*
  • Porphyrins / therapeutic use
  • Ranibizumab
  • Verteporfin

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Coloring Agents
  • Photosensitizing Agents
  • Porphyrins
  • Verteporfin
  • Indocyanine Green
  • Ranibizumab