Evolving treatment paradigms for PCV

Eye (Lond). 2022 Feb;36(2):257-265. doi: 10.1038/s41433-021-01688-7. Epub 2021 Jul 14.


Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular AMD (nAMD) that accounts for a significant proportion of nAMD cases worldwide, and particularly in Asia. Contemporary PCV treatment strategies have closely followed those used in typical nAMD, though there are significant gaps in knowledge on PCV management and it remains unclear if these strategies are appropriate. Current clinical trial data suggest intravitreal anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy is effective in managing haemorrhage and exudation in PCV, although the optimal treatment interval, including as-needed and treat-and-extend approaches, is unclear. Newer imaging modalities, including OCT angiography and high-resolution spectral domain OCT have enabled characterisation of unique PCV biomarkers that may provide guidance on how and when treatment and re-treatment should be initiated. Treatment burden for PCV is a major focus of future therapeutic research and several newly developed anti-VEGF agents, including brolucizumab, faricimab, and new modes of drug delivery like the port delivery system, offer hope for dramatically reduced treatment burden for PCV patients. Beyond anti-VEGF therapy, recent developments in our understanding of PCV pathophysiology, in particular the role of choroidal anatomy and lipid mediators in PCV pathogenesis, offer new treatment avenues that may become clinically relevant in the future. This article explores the current management of PCV and more recent approaches to PCV treatment based on an improved understanding of this unique disease process.

摘要: 息肉状脉络膜血管病变 (Polypoidal choroidal vasculopathy, PCV)为新生血管性AMD (neovascular AMD, nAMD) 的亚型, 患病人数在全球尤其是亚洲占相当大的比例。目前PCV的治疗策略密切遵循典型nAMD的治疗策略, 尽管在PCV管理方面存在巨大差距, 但仍不清楚这些策略是否适当。目前的临床试验数据表明, 单独行玻璃体内抗血管内皮生长因子 (vascular endothelial growth factor, VEGF) 或联合光动力疗法可有效管理PCV的出血和渗出, 但最佳治疗间隔 (包括按需治疗和延长治疗时间) 尚不清楚。包括OCT血管成像和高分辨率频域OCT在内的新型成像方式已能够表征PCV独特的生物标志物, 这可为如何以及何时开始治疗和再治疗提供指导。PCV的治疗负担是未来治疗研究的主要焦点, 新开发的brolucizumab、faricimab等抗VEGF药物, 以及如缓释给药系统等新的给药模式, 为显著降低PCV患者的治疗负担提供了希望。除抗VEGF治疗外, 我们对PCV病理生理学认识的最新进展, 尤其是脉络膜解剖和脂质介质在PCV发病机制中的作用, 提供了可能在未来具有临床相关性的新治疗途径。本文基于对这一独特疾病过程的深度理解, 探讨了目前PCV的管理和治疗的最新方法。.

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Choroid / blood supply
  • Choroidal Neovascularization* / drug therapy
  • Fluorescein Angiography
  • Humans
  • Polyps*
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / therapeutic use
  • Visual Acuity
  • Wet Macular Degeneration* / drug therapy


  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A