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Sayaka Masko, Tsutomu Yasukawa, Shuichiro Hirahara, Shinpei Fujino, Aki Kato, Akiko Nishiwaki, Munenori Yoshida, Yuichiro Ogura; Visual outcomes of polypoidal choroidal vasculopathy with or without prompt treatments. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2651.
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© 2017 Association for Research in Vision and Ophthalmology.
Polypoidal choroidal vasculopathy (PCV) is currently treated with anti-vascular endothelial growth factor (VEGF) therapies and photodynamic therapy (PDT). However, there are many cases, which cannot undergo any treatments due to various reasons practically but preserve good vision over years. The purpose of this study is to compare visual outcomes of eyes with PCV with and without prompt treatments.
Thirty-six treatment-naïve eyes of 34 consecutive patients, who consulted a single ophthalmologist in Nagoya City University Hospital between April 2009 and June 2015 and were diagnosed as PCV, were enrolled in this study. The mean age of patients was 72 years (range: 51-91). The mean follow-up period was 42 months (range: 8-88). All patients were recommended to abstain from smoking and take supplements with lutein and other anti-oxidants. Some patients were followed without any treatments due to patients’ rejection or doctor’s decisions based on older ages and absence of sight-threatening findings (e.g. hard exudate, hemorrhage, and large polyps). BCVAs at baseline and at the last visit were analyzed. The changes of BCVAs with 0.2 or larger in the logarithm of minimal angle of resolution (logMAR) unit were considered as improved or deteriorated.
Seventeen eyes of 16 patients were treated promptly with anti-VEGF therapies, PDT, or both. Serous retinal detachment (RD) completely remitted in 14 eyes (82.4%) but relapsed in 2 eyes, and persistent in 3 eyes (17.6%). BCVAs deteriorated in 3 eyes (17.6%). Nineteen eyes of 18 patients were observed without treatments at least for 3 months. Serous RD completely remitted without treatments in 8 eyes (42.1%) but relapsed in 1 eye, and remitted with rescue treatments in 9 eyes (47.4%) but relapsed in 5 eyes. In the other 2 eyes (10.5%), persisting serous RD was observed without treatments. One eye with rescue treatments (5.3%) deteriorated BCVA. Fourteen of 16 patients with prompt treatments and all patients without prompt treatments took supplements. Smoking status was not different between 2 groups.
For the treatment of PCV, observation and, if any, delayed treatments exhibited equivalent visual outcomes to prompt treatments. Spontaneous remission of sRD was often achieved without treatments. Further studies are needed to determine an optimal treatment regimen of PCV and elucidate possible impacts of supplementation and stopping smoking.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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