Current Trends in Clinical Characteristics, Diagnosis, and Treatment of Polypoidal Choroidal Vasculopathy: A Perspective from Vietnam

Abstract

Polypoidal choroidal vasculopathy (PCV) is a common choroidal disease in the Asian population including Vietnam and is characterized by subretinal red-orange nodules, pigmented epithelium detachment, and massive subretinal hemorrhage. The recent focus on PCV in Vietnam can be attributed to advancements in PCV diagnosis and treatment. However, there is a scarcity of published literature and clinical data on PCV in the Vietnamese population, highlighting a key knowledge gap in this region. In order to address this gap, we gathered the opinions of experienced clinicians and retinal experts in Vietnam and reviewed available medical literature with the aim of: (i) providing an overview of PCV in the Vietnamese population-in terms of epidemiology, clinical characteristics, and management; (ii) tailoring international/national guidelines for the diagnosis and management of PCV, in line with available resources and medical equipment in Vietnam; and (iii) identifying gaps in clinical data in order to guide future PCV research in Vietnam and other countries with similar clinical conditions. The present review will enable healthcare providers and researchers to gain insight into current clinical practices and the limitations of PCV management in Vietnam and provide optimal and effective solutions.

Keywords: Vietnam; anti-VEGF; laser therapy; neovascular age-related macular degeneration; polypoidal choroidal vasculopathy.

Figure 1

Various presentations of PCV on fundus photographs of Vietnamese patients (cases confirmed by ICGA). ((A) Two orange-red nodules, one at fovea and one in perifoveal region; (B) Multiples orange-red nodules at the macula with subfoveal hemorrhage; (C) Orange-red nodules at the upper vessel arcade, hard exudates and subretinal fluid; (D) Subfoveal orange-red nodules with extensive subretinal hemorrhage).

Figure 2

A representation of ICGA in a 56-year-old Vietnamese male patient with PCV in the left eye ((A) shows one large orange-red nodule in upper temporal vessel arcade (arrow); (B) depicts ICGA early phase showing branching vascular network (white arrow); (C) represents ICGA mid-phase showing hot spots (orange arrows) and branching vascular network; (D) shows ICGA late phase showing hot spots).

Figure 3

A 51-year-old Vietnamese male patient with PCV with a typical orange-red nodule, hard exudates, and fluid around the nodule in the left eye.

Figure 4

OCT images in eyes with PCV ((A) sharp-peaked PEDs with ring shaped (white stars), double-layer sign (white arrow), subretinal fluid and thicken choroid; (B) Multiple lobular PED (white arrows), subretinal fluid and hemorrhage [high reflective material]; (C) A sharp peak PED with hyper-reflective material at the top underneath the RPE; (D) En face OCT: retinal elevation (white arrow)).

Figure 5

Proposed treatment algorithm for PCV based on latest evidence tailored for Vietnam.