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Stephen Davis, Andreas Lauer, Christina Flaxel; Polypoidal choroidal vasculopathy in Caucasian patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4092.
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© ARVO (1962-2015); The Authors (2016-present)
Report on a series of Caucasian patients in the United States with Polypoidal Choroidal Vasculopathy (PCV).
Retrospective chart review of patients at a single center with PCV were identified. 24 patients were identified with an average age of 74.4 (42-89) with 13/24 (54%) being male.
The most common diagnosis prior to PCV being identified was neovascular age-related macular degeneration (NVAMD) in 14/24 (58%) of patients. In only 3/24 (12.5%) was PCV the initial diagnosis. On average it took 18.4 (5-46) months before PCV was diagnosed. During this time, patients received an average of 9.3 anti-VEGF intravitreal injections. The most common reasons for suspecting PCV were the presence of a large pigment epithelial detachment (PED) in 12/24 (50%) or a poor response to anti-VEGF therapy in 12/24 (50%). Polypoidal lesions were in the macula in 19/24 (79%), the periphery in 2/24 (8%), and both the macula and periphery in 3/24 (12%). Of the polypoidal lesions in the macula, 6/19 (32%) were peripapillary and 5/19 (26%) were temporal. Of those with peripheral PCV, there were 3 cases of exudative retinal detachment, 2 of which required vitrectomy, 3 with vitreous hemorrhage, and one choroidal hemorrhage. Once PCV was diagnosed, 18/22 (81.8%) underwent photodynamic therapy (PDT), 2/22 (9%) focal laser therapy and 2/22 (9%) continued anti-VEGF monotherapy. Of those that received PDT or focal laser, the fluid and\or PED decreased in size in 18/20 (90%). An improvement in vision was seen in 7/20 (35%) with 9/20 (45%) maintaining stable vision. The follow up time after PDT or focal was 14.4 (3-46) months and during this time, patients received only an additional 2.95 anti-VEGF injections and\or 1.4 more PDT treatments on average.
This report is one of the larger series of PCV in an entirely Caucasian population. It contains the first report of a patient with Usher’s that developed PCV. This emphasizes the importance of PCV diagnosis in Caucasians especially if there is a poor response to anti-VEGF therapy and\or large PED present as PCV can masquerade as NVAMD. Common findings were a temporal or peripapillary location as well as the presence of lipid. It also emphasizes the importance of a peripheral exam given the risk of pathology here. In these patients, after PDT, anti-VEGF therapy was still required but the injection burden was decreased by 40% (p<0.001) and vision was improved or maintained in 80%.
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