scholarly journals Polypoidal Choroidal Vasculopathy and Treatments

2017 ◽  
pp. 262-267
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Polypoidal Choroidal Vasculopathy ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Combination Therapies ◽  
Age Related ◽  
Choroidal Vasculature ◽  
Endothelial Growth Factor ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV), characterized by aneurysmal polypoidal lesions in the choroidal vasculature, is a subtype of exudative age-related macular degeneration (AMD) which can cause permanent vision loss due to hemorrhage, exudation, macular edema, and disciform scar formation. Besides anti-vascular endothelial growth factor (anti-VEGF) therapy, photodynamic therapy (FDT) and combination therapies are currently being used in the treatment of PCV.

scholarly journals The Use of Vascular Endothelial Growth Factor Inhibitors and Complementary Treatment Options in Polypoidal Choroidal Vasculopathy: A Subtype of Neovascular Age-Related Macular Degeneration

2018 ◽  
Vol 19 (9) ◽  
pp. 2611 ◽  
Author(s):  
Kelvin Teo ◽  
Mark Gillies ◽  
Samantha Fraser-Bell
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Degeneration ◽  
Polypoidal Choroidal Vasculopathy ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Vegf Inhibitors ◽  
Age Related ◽  
Endothelial Growth Factor ◽  
Choroidal Vasculopathy

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.

Polypoidal Choroidal Vasculopathy

2020 ◽  
pp. 118-125
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Imaging Features ◽  
Current Management ◽  
Choroidal Circulation ◽  
Management Guidelines ◽  
Age Related ◽  
Endothelial Growth Factor ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. There is a disparity in response to intravitreal anti-vascular endothelial growth factor (VEGF) treatments between PCV and typical AMD, and the preferred treatment for PCV has remained unclear. Recent researches suggest that PCV belongs to a condition characterized by pachychoroid and disturbance in the choroidal circulation seems to be central to its pathogenesis. In this review, we summarize the clinical and imaging features, diagnostic criteria, and current management guidelines of PCV.

Using optical coherence tomography angiography in assessment of the anti-vascular endothelial growth factor effect for pathological vascular tissue in age-related macular degeneration and polypoidal choroidal vasculopathy

2020 ◽  
pp. 112067212091301
Author(s):  
Yi-Syun Shen ◽  
Cheng-Kuo Cheng
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Polypoidal Choroidal Vasculopathy ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Optical Coherence ◽  
Age Related ◽  
Choroidal Vasculopathy

Purpose: Using optical coherence tomography angiography to assess and compare changes in pathological vascular tissue, including choroidal neovascularization in neovascular age-related macular degeneration and polypoidal complex in polypoidal choroidal vasculopathy, after treatment with anti-vascular endothelial growth factor. Methods: This is a retrospective observational case series study. Clinical data were collected, including that on the best-corrected visual acuity and images of spectrum domain optical coherence tomography and optical coherence tomography angiography of consecutive patients with macula-involved lesions, active pathological vascular tissue in neovascular age-related macular degeneration, and polypoidal complex in polypoidal choroidal vasculopathy who were treated with anti-vascular endothelial growth factor injection. The primary outcome measures were the lesion area, flow density, and flow area of the pathological vascular tissue obtained in optical coherence tomography angiography before treatment, as well as week-1 (W1) and week-5 (W5) after treatment. The secondary outcome measures were the best-corrected visual acuity and the anatomic changes in spectrum domain optical coherence tomography at the same periods. Results: A total of 86 eyes in 79 patients (mean age: 73.10 ± 10.10 (range = 50–91) years, 45 males (57%), of which two eyes were treatment-naïve) underwent one section of intravitreal treatment. Of which 44 eyes (40 patients) were diagnosed as typical neovascular age-related macular degeneration and 42 eyes (39 patients) as polypoidal choroidal vasculopathy. The sensitivity for detecting choroidal neovascularization in neovascular age-related macular degeneration and polypoidal complex in polypoidal choroidal vasculopathy was 75.00% (33/44) and 69.05% (29/42), respectively. There was no significant difference in the detection rate between neovascular age-related macular degeneration and polypoidal choroidal vasculopathy ( p = 0.54). In the detectable group, there were significant decrease in lesion area and flow area in the optical coherence tomography angiography images after anti-vascular endothelial growth factor treatment in both the neovascular age-related macular degeneration group (lesion area: W1 = –26.94 ± 19.50%, W5 = –35.52 ± 30.85%, all ps < 0.001; flow area: W1 = –26.22 ± 25.23%, W5 = –32.24 ± 32.07%, all ps < 0.001) and the polypoidal choroidal vasculopathy group (lesion area: W1 = –25.19 ± 20.27%, W5 = –31.55 ± 27.04%, all ps < 0.001; flow area: W1 = –21.83 ± 26.29%, W5 = –28.31 ± 30.72%, all ps < 0.001). The central subfield retinal thickness in spectrum domain optical coherence tomography also showed similar amelioration in both groups. However, the flow density in optical coherence tomography angiography image and the visual outcome did not reveal any significant difference before or after intravitreal injections, and neither were there significant differences between the neovascular age-related macular degeneration and polypoidal choroidal vasculopathy groups. Concerning the effect on the optical coherence tomography angiography images of pathological vascular tissue, there were no statistical differences among different anti-vascular endothelial growth factor agents (i.e. aflibercept, ranibizumab, and bevacizumab). Conclusion: Our study revealed that optical coherence tomography angiography can be used noninvasively and quantitatively to assess the detailed pathologic vascular structures in both neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Our study also demonstrated that anti-vascular endothelial growth factor could effectively decrease the lesion size and flow area of both the choroidal neovascularization in neovascular age-related macular degeneration cases and the polypoidal complex in polypoidal choroidal vasculopathy cases; the effects were similar in both diseases.

scholarly journals Anti-vascular endothelial growth factor therapy for age-related macular degeneration: a systematic review and network meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Andrea C. Tricco ◽  
Sonia M. Thomas ◽  
Erin Lillie ◽  
Areti Angeliki Veroniki ◽  
Jemila S. Hamid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vascular Endothelial Growth Factor ◽  
Vision Loss ◽  
Meta Analysis ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Safety And Efficacy ◽  
Age Related ◽  
Comparative Safety ◽  
Endothelial Growth Factor

Abstract Background The comparative safety and efficacy between anti-vascular endothelial growth factor agents (anti-VEGFs) and between combined therapies for patients with neovascular age-related macular degeneration (nAMD) is unclear. We conducted a systematic review to examine the comparative safety and efficacy anti-VEGFs for adults with nAMD. Methods Studies were identified through MEDLINE, EMBASE, and Cochrane CENTRAL (inception to June 3, 2019), grey literature, and scanning reference lists. Two reviewers independently screened citations and full-text articles to identify randomized controlled trials (RCTs), extracted data, and appraised risk of bias. Pairwise random-effects meta-analysis and Bayesian network meta-analysis (NMA) were conducted. The primary outcomes were the proportion of patients experiencing moderate vision gain (≥ 15 letters on the Early Treatment Diabetic Retinopathy Study chart) and the proportion of patients experiencing moderate vision loss (≤ 15 letters). Results After screening 3647 citations and 485 potentially relevant full-text articles, 92 RCTs with 24,717 patients were included. NMA (34 RCTs, 8809 patients, 12 treatments) showed small differences among anti-VEGFs in improving the proportion of patients with moderate vision gain, with the largest for conbercept versus broluczumab (OR 0.15, 95% CrI: 0.05–0.56), conbercept versus ranibizumab (OR 0.17, 95% CrI: 0.05–0.59), conbercept versus aflibercept (OR 0.19, 95% CrI: 0.06–0.65), and conbercept versus bevacizumab (OR 0.2, 95% CrI: 0.06–0.69). In NMA (36 RCTs, 9081 patients, 13 treatments) for the proportion of patients with moderate vision loss, small differences were observed among anti-VEGFs, with the largest being for conbercept versus aflibercept (OR 0.24, 95% CrI: 0–4.29), conbercept versus brolucizumab (OR 0.24, 95% CrI: 0–4.71), conbercept versus bevacizumab (OR 0.26, 95% CrI: 0–4.65), and conbercept versus ranibizumab (OR 0.27, 95% CrI: 0–4.67). Conclusion The only observed differences were that ranibizumab, bevacizumab, aflibercept, and brolucizumab were statistically superior to conbercept in terms of the proportion of patients with nAMD who experienced moderate vision gain. However, this finding is based on indirect evidence through one small trial comparing conbercept with placebo. This does not account for drug-specific differences when assessing anatomic and functional treatment efficacy in variable dosing regimens. Systematic review registration PROSPERO registration number CRD42015022041.

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