Thermal Laser Monotherapy for Extrafoveal Polypoidal Choroidal Vasculopathy

Abstract

Introduction Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid. Diagnosis is mainly based on polypoidal aneurysm-like lesions seen in indocyanine green (ICG) angiography. Various therapeutic options have been proposed.

Methods Outcomes of 10 cases with extrafoveal PCV and consecutive macular edema treated with thermal laser are reported. Diagnosis of PCV was confirmed by ICG angiography.

Results Upon successful occlusion of the polyps in 10 eyes after thermal laser treatment demonstrated in ICG angiography, a regression of central foveal edema was seen in optical coherence tomography and color fundus photography. Visual acuity improved from logMAR 0.8 to logMAR 0.3. Follow-up ranged from 4 months to 15 years, with a median of 1 year. Two eyes had a recurrence of exudative maculopathy 5 and 7 years after laser treatment, respectively.

Conclusion A careful differentiation between various subforms of exudative maculopathy using fluorescein and ICG angiography can identify certain selected patients with extrafoveal PCV, for whom thermal laser monotherapy can be a therapeutic option.

Zusammenfassung

Einleitung Die polypoidale chorioidale Vaskulopathie (PCV) ist eine Gefäßerkrankung der Chorioidea. Die Diagnose wird durch in der Indocyaningrünangiografie (ICG-Angiografie) sichtbaren polypoidalen aneurysmatischen Veränderungen gestellt. Es gibt verschiedene Therapiemöglichkeiten.

Methoden Die Ergebnisse von 10 Fällen mit extrafoveal gelegener PCV und daraus resultierendem Makulaödem nach Photokoagulation werden demonstriert. Die Diagnose der PCV war durch eine vorherige ICG-Angiografie gesichert worden.

Ergebnisse Nachdem der erfolgreiche Verschluss der Polypen in 10 Augen nach thermischer Laserkoagulation sich in der ICG-Angiografie darstellte, kam es ebenfalls zu einer Verminderung des Makulaödems zentral im OCT und in der Fundusfotografie. Die Sehschärfe stieg von 0,8 logMAR auf 0,3 logMAR.

Schlussfolgerung Eine sorgfältige Differenzierung der unterschiedlichen AMD-Unterformen und die Diagnose einer extrafovealen PCV durch die ICG-Angiografie kann geeignete Patienten identifizieren, die möglicherweise von einer einzigen Behandlung mit dem thermischen Laser profitieren und möglichen Strapazen durch andere Therapieoptionen entgehen können.

Key words

laser treatment - polypoidal choroidal vasculopathy - macula edema - indocyanine green angiography - retina - choroid

Schlüsselwörter

Chorioidea - Retina - Laser - polypoidale chorioidale Vaskulopathie - Makulaödem - Indocyaningrünangiografie

Publication History

Received: 21 July 2021

Accepted: 19 August 2021

Article published online:
29 September 2021

• References

• 1 Cheung CMG, Lai TYY, Ruamviboonsuk P. et al. Polypoidal Choroidal Vasculopathy: Definition, Pathogenesis, Diagnosis, and Management. Ophthalmology 2018; 125: 708-724
• 2 Sahu Y, Chaudhary N, Joshi M. et al. Idiopathic polypoidal choroidal vasculopathy: a review of literature with clinical update on current management practices. Int Ophthalmol 2021; 41: 753-765
• 3 Castro-Navarro V, Behar-Cohen F, Chang W. et al. Pachychoroid: current concepts on clinical features and pathogenesis. Graefes Arch Clin Exp Ophthalmol 2021; 259: 1385-1400
• 4 Lafaut BA, Leys AM, Snyers B. et al. Polypoidal choroidal vasculopathy in Caucasians. Graefes Arch Clin Exp Ophthalmol 2000; 238: 752-759
• 5 Helbig H, Niederberger H, Valmaggia C. et al. Simultaneous fluorescein and indocyanine green angiography for exudative macular degeneration. Klin Monbl Augenheilkd 2005; 222: 202-205
• 6 Jordan-Yu JM, Teo K, Fan Q. et al. Phenotypic and genetic variations between Asian and Caucasian polypoidal choroidal vasculopathy. Br J Ophthalmol 2020;
• 7 Imamura Y, Engelbert M, Iida T. et al. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol 2010; 55: 501-515
• 8 Simão JM, Farinha C, Marques JP. et al. Polypoidal Choroidal Vasculopathy in Caucasians: Morphological Findings from Multimodal Retinal Imaging. Ophthalmologica 2021; 244: 315-325
• 9 Lee MW, Yeo I, Wong D. et al. Argon laser photocoagulation for the treatment of polypoidal choroidal vasculopathy. Eye (Lond) 2009; 23: 145-148
• 10 Yuzawa M, Mori R, Haruyama M. A study of laser photocoagulation for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2003; 47: 379-384
• 11 Gemmy Cheung CM, Yeo I, Li X. et al. Argon laser with and without anti-vascular endothelial growth factor therapy for extrafoveal polypoidal choroidal vasculopathy. Am J Ophthalmol 2013; 155: 295-304.e1
• 12 Macular Photocoagulation Study Group. Recurrent choroidal neovascularization after argon laser photocoagulation for neovascular maculopathy. Macular Photocoagulation Study Group. Arch Ophthalmol 1986; 104: 503-512
• 13 Wong CW, Cheung CMG, Mathur R. et al. Three-year results of polypoidal choroidal vasculopathy treated with photodynamic therapy: Retrospective Study and Systematic Review. Retina 2015; 35: 1577-1593
• 14 Kokame GT, deCarlo TE, Kaneko KN. et al. Anti-Vascular Endothelial Growth Factor Resistance in Exudative Macular Degeneration and Polypoidal Choroidal Vasculopathy. Ophthalmol Retina 2019; 3: 744-752
• 15 Hatz K, Prünte C. Polypoidal choroidal vasculopathy in Caucasian patients with presumed neovascular age-related macular degeneration and poor ranibizumab response. Br J Ophthalmol 2014; 98: 188-194
• 16 Koh A, Lee WK, Chen LJ. et al. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 2012; 32: 1453-1464
• 17 Lim TH, Lai TYY, Takahashi K. et al. Comparison of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: The EVEREST II Randomized Clinical Trial. JAMA Ophthalmol 2020; 138: 935-942
• 18 Lee WK, Iida T, Ogura Y. et al. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in the PLANET Study: A Randomized Clinical Trial. JAMA Ophthalmol 2018; 136: 786-793