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Review
. 2023 Jan 5:17:53-70.
doi: 10.2147/OPTH.S385827. eCollection 2023.

Polypoidal Choroidal Vasculopathy: An Update on Diagnosis and Treatment

Parveen Sen  1 , George Manayath  2 , Daraius Shroff  3 , Vineeth Salloju  4 , Priyanka Dhar  4
Affiliations
Review

Polypoidal Choroidal Vasculopathy: An Update on Diagnosis and Treatment

Parveen Sen et al. Clin Ophthalmol. .

Abstract

Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid that leads to hemorrhagic and exudative macular degeneration. It may cause significant vision loss and thus affect the quality-of-life and psychological well-being. Non-invasive, non-ICGA-based OCT criteria have shown reliable results to plan adjunct photodynamic therapy (PDT) treatment, with the complete and consistent coverage of polypoidal lesions (PL) and branching neovascular network (BNN). The safety and efficacy of anti-vascular endothelial growth factor (anti-VEGF) monotherapy and its combination with verteporfin PDT have been established. However, treatment is still challenging due to frequent follow-ups, non-availability of PDT, and need for multiple anti-VEGF injection visits that increase the treatment burden and lead to patients being lost to follow-up. Effective treatments that prolong intervals between injections while maintaining vision and anatomical gains remain a critical unmet need. Longer acting molecules, like brolucizumab, have shown non-inferiority in BCVA gains and superior anatomical outcomes compared to other anti-VEGF agents. Newer therapies in the pipeline to enhance the efficacy and longevity of treatment include Faricimab and a port delivery system (PDS). This review summarizes the most recent diagnostic and treatment approaches in PCV to offer better treatment avenues.

Keywords: anti-vascular endothelial growth factor (anti-VEGF) agents; best-corrected visual acuity; branching neovascular network; brolucizumab; photodynamic therapy; polypoidal lesions.

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Conflict of interest statement

Vineeth Salloju and Priyanka Dhar are employees of Novartis Healthcare Private Limited, India. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
OCT images of PCV.
Figure 2
Figure 2
OCT features of PCV.
Figure 3
Figure 3
SS-OCTA images.
Figure 4
Figure 4
Response to therapy as seen on OCT.
Figure 5
Figure 5
OCT images of anti-VEGF monotherapy for PCV.
Figure 6
Figure 6
FFA/ICGA images at baseline and post-injections showing PL regression.
Figure 7
Figure 7
OCT images of combination therapy for persistent disease activity in PCV.
Figure 8
Figure 8
FFA/ICGA images at baseline and post-injections showing persistent PL on FFA/ ICGA after three aflibercept injections of combination therapy patient.
Figure 9
Figure 9
Optos color photo.
See this image and copyright information in PMC

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