Polypoidal choroidal vasculopathy in Caucasians.
ABSTRACT To study the prevalence of polypoidal choroidal vasculopathy (PCV) in Caucasian patients with occult choroidal neovascularization (CNV); to study the clinical spectrum of PCV in Caucasians and the outcome after laser photocoagulation of such lesions.
(1) A consecutive series of 374 eyes of Caucasian patients at least 58 years old, presenting occult CNV, presumed to have age-related macular degeneration (AMD) on fluorescein angiography (FA) were further characterized by indocyanine green angiography (ICGA) to determine the frequency of PCV. (2) The funduscopic, FA and ICGA findings in a cohort of 36 Caucasian patients with PCV were analyzed. (3) The outcome after laser photocoagulation was studied in 14 PCV eyes with a minimum follow-up of 6 months.
(1) Fourteen of 374 eyes (4%) presenting occult CNV in patients at least 58 years old were diagnosed as PCV by means of ICG-A. (2) A polypoidal lesion was found in the macula in 22 of 45 PCV eyes, in the peripapillary area in 16 of 45, under the temporal vascular arcade in 6 of 45 and in the midperiphery in 6 of 45. Large or soft drusen were observed in 15 of 45 eyes with PCV. (3) Regression of fundus signs without persisting polyps 6 months after laser photocoagulation was obtained in 5 of 5 treated peripapillary lesions but in only 5 of 9 treated macular or arcade lesions.
Polypoidal choroidal vasculopathy is not rare in Caucasian patients presenting with occult choroidal neovascularization. The fundus abnormalities seen in such eyes overlap with the typical manifestations of AMD. Whereas the prognosis after photocoagulation of peripapillary polypoidal lesions appears to be relatively good, it is more guarded for macular or arcade lesions.
[show abstract] [hide abstract]
ABSTRACT: To evaluate the efficacy and safety of intravitreal bevacizumab for polypoidal choroidal vasculopathy (PCV). In this retrospective interventional pilot study, 12 eyes of 11 patients with active PCV were treated with intravitreal bevacizumab (1.25 mg) alone or in combination with photodynamic therapy (PDT) depending on the informed patient's choice. Intravitreal bevacizumab was repeated at 6-week intervals until the regression of active lesion was detected on fluorescein angiography (FA) which was done on a regular basis, Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) analyses. Intravitreal bevacizumab was given alone in 8 eyes (Group 1) and in combination with PDT in 4 eyes (Group 2). Mean follow-up duration was 17 weeks in group 1 and 15 weeks in group 2 after bevacizumab treatment. The mean number of bevacizumab injections was 2.2 in group 1 and 2.5 in group 2. Mean BCVA improved from 20/63 to 20/40 in group 1 and 20/63 to 20/32 in group 2. Of all eyes, the BCVA improved by > or = 2 lines in seven (58%) eyes and resolution of fluid and hemorrhages in clinical examination, an absence of leakage on repeat FAs, or resolved pigment epithelial detachment (PED) and/or subretinal fluid (SRF) on OCT exam was confirmed in 10 (83%) eyes. Partial or complete regression of the polypoidal vessels and interconnecting vessels was reported for most cases at the last follow-up. No significant ocular or systemic side effects were observed in both groups. Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients. Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.Korean Journal of Ophthalmology 06/2008; 22(2):92-9.
Article: Use of fluorescein and indocyanine green angiography in polypoidal choroidal vasculopathy patients following photodynamic therapy.[show abstract] [hide abstract]
ABSTRACT: Exudative age-related macular degeneration (AMD) is a sight-threatening event in many elderly people. Some patients have a much better outcome in visual acuity (VA) than others after treatment with photodynamic therapy (PDT) with verteporfin. The combination of fluorescein angiography (FA) and indocyanine green (ICG) angiography using the Heidelberg Retina Angiograph II (HRA 2) should make a delineation of distinct pattern(s) possible in order to better select and assess therapy. This is a retrospective, case-control, single-centre study. We identified a total of 168 eyes of 168 patients from July 2003 to June 2006, including 30 eyes of 30 patients with better visual outcome, defined in this study as VA < or = 0.48 logMAR (> or =20/60 Snellen chart) at the end of the study. Best-corrected VA, maximal central retinal thickness as measured by optical coherence tomography, and results of the FA/ICG angiography using the HRA 2 were analyzed. In this article, we discuss patients with polypoidal choroidal vasculopathy (PCV) and their characteristics. The average follow-up time was 15.3 months (range 4-28 months). Seventeen (57%) of the 30 patients with better visual outcome had PCV. All patients in the group with better visual outcome needed fewer PDT treatments compared with our control group of patients with an exudative AMD. Simultaneous FA/ICG angiography using the HRA 2 allowed delineation of a subgroup of patients with PCV who showed a better visual outcome compared with those with other types of exudative AMD, after treatment with PDT.Canadian Journal of Ophthalmology 01/2009; 43(6):678-82. · 1.47 Impact Factor
Article: Analysis of candidate genes for age-related macular degeneration subtypes in the Japanese population.[show abstract] [hide abstract]
ABSTRACT: Age-related macular degeneration (AMD) is thought to be a polygenetic disease. It is divided into three subtypes; neovascular AMD (nAMD), polypoidal choroidal vasculopathy, and retinal angiomatous proliferation (RAP). These subtypes are thought to have different pathophysiological and genetic backgrounds. We aimed to investigate the relationships between single nucleotide polymorphisms (SNPs) in candidate genes and subtypes of AMD in the Japanese population. We genotyped 685 AMD patients and 277 controls for four SNPs of the selected candidate genes: rs800292 in complement factor H, rs10490924 in age-related maculopathy susceptibility 2 (ARMS2), rs2301995 in elastin (ELN), and rs1801133 in methylenetetrahydrofolate reductase (MTHFR). Case-control studies were performed using these AMD subtypes. Logistic regression analysis was performed using a history of hypertension, diabetes mellitus, and smoking as cardiovascular risks. The genotype-dominant or recessive distribution of all four SNPs differed significantly between the controls and the AMD patients. In the subtype analysis, there were significant differences between the controls and the AMD patients in genotype distributions. This was true for all AMD subtype analyses of both rs800292 (complement factor H) and rs10490924 (ARMS2). Logistic regression analysis indicated the TT genotype of the ARMS2 gene to be significantly more common in RAP patients (p=1.54×10(-13), odds ratio: 22.18). In contrast, there were significant differences in the genotype distribution between the controls and nAMD patients only for rs2301995 (ELN, p=0.022) and rs1801133 (MTHFR, p=2.50×10(-3)). Our results indicate that SNPs of the ARMS2 gene may serve as strong genetic markers of RAP, and that SNPs of the ELN and MTHFR genes are potential genetic markers for nAMD.Molecular vision 01/2011; 17:2751-8. · 2.20 Impact Factor