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Gisela Velez; De novo and recurrent polypoidal lesions are amenable to anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4964.
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© ARVO (1962-2015); The Authors (2016-present)
Polypoidal choroidal vasculopathy (PCV) can present a treatment challenge. We performed a retrospective review of patients with PCV and describe our experience using anti-VEGF therapies in the management of de novo and recurrent polypoidal lesions. Our goal was to identify lesion characteristics which may predict response to anti-VEF therapy.
Records of all patients with exudative age related macular degeneration were reviewed. Eight patients (9 eyes) with PCV were identified and confirmed by indocyanine green (ICG) angiography (Spectralis, Heidelberg). De novo lesions were defined as those diagnosed at the time of presentation, or new lesions in previously treated patients without evidence of PCV at the time of initial diagnosis. Successful treatment was defined as (1) complete resolution of subretinal fluid (SRF) on SD-OCT (Cirrus 4000, Zeiss) with (2) stabilization (1 line or less loss of vision) or improvement of visual acuity (VA).
Patients ragned in age from 50 to 86 years. Six patients were caucasian, 2 hispanic/latino. Six eyes were treated with bevacizumab (1.25mg) followed by aflibercept (2 mg), 1 eye with ranibizumab (0.5mg) followed by aflibercept, and 2 eyes with aflibercept (2 mg). One patient was treated with aflibercept (2 mg) in combination with photodynamic therapy (PDT). Eight eyes had de novo polypoidal lesions, 6 at the time or presentation and 2 developed after protracted anti-VEGF therapy, possibly representing the result of vascular remodeling. One eye presented with recurrent polypoidal lesions after PDT therapy.All 9 eyes had a partial or complete response to anti-VEGF therapy. Median number of treatments in eyes successfully treated was 15, ranging from 1 to 36. In 3/9 eyes treatment was unsuccessful- one eye had a decrease of 2 lines of vision, two eyes had persistent SRF. Eyes with persistent SRF represented lesions resulting from vascular remodeling. Polypoidal lesions persisted despite SRF resolution in most eyes, and resolved in 2/6 eyes with de novo lesions at the time of initial presentation and 1/1 eyes with recurrent lesions.
Different subtypes of polypoidal lesions have different patterns of response to anti-VEGF therapy. In our study, recurrent lesions had the best response, while lesions that arose from vascular remodeling were most resistant to treatment. Ultimately, however, all subtypes can be successfully managed with anti-VEGF therapy.
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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