Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy

Abstract

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 2y 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±5.5y, 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 72d after laser treatment, respectively. There were no statistically significant differences in visual acuities at baseline; 1, 2, 3y 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 logMAR, 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.

Keywords: focal laser photocoagulation; long-term efficacy; polypoidal choroidal vasculopathy.

Figure 1. Images of a 63-year-old man with polypoidal choroidal vasculopathy in his right eye who was successfully treated with focal laser photocoagulation

Top row images show a round orange-colored subretinal nodule with exudates nearby (A), corresponding to the nodular choroidal vascular lesion shown on indocyanine green angiography (B) and dome-like elevation of retinal pigment epithelial detachment on optical coherence tomography (C). Images in the middle (D-F) and bottom (G-I) rows demonstrate successful regression of the polyp at 1 and 12mo after the laser treatment, respectively.

Figure 2. Images of a 76-year-old man with polypoidal choroidal vasculopathy in his right eye who was successfully treated with focal laser photocoagulation

Images in the top row (A-C) show a round orange-colored subretinal nodule surrounded by a subretinal hemorrhage. Images in the middle (D-F) and bottom (G-I) rows demonstrate a decreased in polyp size 1 and 12mo after the laser treatment, respectively.

Figure 3. Images of a 69-year-old man with polypoidal choroidal vasculopathy in his left eye with recurred polyp

Top row images were fundus photograph (A) and optical coherence tomography (B) at 6mo prior to a subretinal hemorrhage. Images in the second row (C, D) show the advent of subretinal hemorrhage as a complication of the polyp. The patient underwent focal laser treatment on the same day. Images in the third row (E, F) show a decrease in polyp size after 1mo. Images in the bottom row (G-J) were taken 1y after the focal laser treatment and show the recurrence of polyp from the branching vascular network.

Figure 4. Scatter plot showing logMAR visual acuity (VA)

There were no statistical differences between baseline VA and the VA at each follow-up period (P>0.05).