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      Photodynamic therapy for polypoidal choroidal vasculopathy secondary to choroidal nevus

      case-report

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          Abstract

          We report a case of a Caucasian female who developed active polypoidal choroidal vasculopathy (PCV) at the edge of a stable choroidal nevus and was successfully treated with verteporfin photodynamic therapy. No active polyp was detectable on indocyanine green angiography 2 years after treatment, and good vision was maintained. Indocyanine green angiography is a useful investigation to diagnose PCV and may be underutilized. Unlike treatment of choroidal neovascularization secondary to choroidal nevus, management of PCV secondary to nevus may not require intravitreal anti-vascular endothelial growth factor therapy. Photodynamic monotherapy may be an effective treatment of secondary PCV.

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          Idiopathic polypoidal choroidal vasculopathy (IPCV).

          L Yannuzzi, J. Sorenson, R Spaide … (1990)
          Eleven patients, 40 to 71 years old, had a choroidal vasculopathy that led to hemorrhagic and exudative macular degeneration. The patients had peculiar polypoidal, subretinal, vascular lesions associated with serious and hemorrhagic detachments of the retinal pigment epithelium. This macular disorder, which we have named idiopathic polypoidal choroidal vasculopathy (IPCV), appears to represent a distinct entity that differs clinically and demographically from age-related macular degeneration (AMD) and other macular diseases associated with subretinal neovascularization. Recognition of this condition is important because it may have specific risk factors, natural course, and management considerations that differ from those of age-related macular degeneration.
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            One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients.

            Masahito Ohji, Yasuo Tano, Fumi Gomi … (2007)
            To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in Japanese patients presumed to have age-related macular degeneration (AMD) and compare 1-year outcomes after photodynamic therapy between PCV and choroidal neovascularization secondary to AMD. Prospective interventional study. Ninety-three consecutive patients (93 eyes) met the inclusion criteria: at least 50 years old, best-corrected visual acuity (VA) of 34 to 73 on the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart, a subfoveal lesion 5400 mum or smaller in greatest linear dimension (GLD) on fluorescein angiography (FA), and eligibility for photodynamic therapy. Indocyanine green angiography was performed in all participants, and PCV and AMD were differentiated, treated with photodynamic therapy, and the patients observed for 1 year. The GLD was determined by FA for AMD and by indocyanine green angiography for PCV, and the diameter of the laser spot size was chosen, with an extra 1000 microm added to the GLD. Photodynamic therapy was repeated if leakage occurred on FA at 3-month follow-up visits. Prevalence of PCV at baseline and visual and angiographic changes 1 year after photodynamic therapy in PCV and AMD. Using indocyanine green angiography, 36 eyes (39%) were diagnosed with PCV and 54 eyes (58%) with choroidal neovascularization secondary to AMD. The median change in VA using the ETDRS letter score from baseline to 1 year was -7.0 in AMD eyes and +8.0 in PCV eyes (Mann-Whitney rank sum test; P or =15 letters) in AMD and PCV by 6% and 25%, respectively, and decreased (> or =15 letters) by 31% and 8%, respectively. Fluorescein leakage stopped at 1 year in 86% of PCV and 61% of AMD eyes (P = 0.031). Polypoidal choroidal vasculopathy recurred in 2 PCV eyes (5.6%), and a new PCV lesion developed in 1 PCV eye (2.8%) and 2 AMD eyes (3.7%) on indocyanine green angiography at 1 year. The prevalence of PCV meeting the treatment criteria for photodynamic therapy for presumed AMD is high in Japanese patients. Photodynamic therapy is more efficacious for PCV than for AMD, which may explain the good results in Japanese patients. Further study should assess the long-term clinical results.
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              Expression of pigment epithelium derived factor and vascular endothelial growth factor in choroidal neovascular membranes and polypoidal choroidal vasculopathy.

              M Matsumura, N Ogata, M Matsuoka … (2004)
              To determine whether pigment epithelium derived factor (PEDF), a protein that inhibits angiogenesis, is expressed in human choroidal neovascular membranes (CNVMs) and in tissues from an eye with polypoidal choroidal vasculopathy (PCV). In addition, to compare the expression of PEDF with that of vascular endothelial growth factor (VEGF), a known stimulator of angiogenesis, in these tissues. CNVMs, associated with age related macular degeneration (AMD), angioid streaks, and PCV, were obtained during surgery. The expression of PEDF and VEGF in the excised subretinal fibrovascular membranes was determined by immunohistochemistry. PEDF and VEGF were strongly expressed in the vascular endothelial cells and retinal pigment epithelial (RPE) cells in the CNVMs where numerous new vessels were prominent (clinically active CNVMs). On the other hand, immunoreactivity for PEDF and VEGF was weak in the new vessels where fibrosis was prominent (clinically quiescent CNVMs). However, the RPE cells were still positive for PEDF and VEGF. The specimens from the eye with PCV also showed strong expression of PEDF and VEGF in the vascular endothelial cells and the RPE cells. Because PEDF is an inhibitor of ocular angiogenesis and an inhibitor of ocular cell proliferation, our results suggest that PEDF along with VEGF may modulate the formation of subfoveal fibrovascular membranes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int Med Case Rep J
                Journal ID (iso-abbrev): Int Med Case Rep J
                Journal ID (publisher-id): International Medical Case Reports Journal
                Title: International Medical Case Reports Journal
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-142X
                Publication date Collection: 2017
                Publication date (Electronic): 14 February 2017
                Volume: 10
                Pages: 51-54
                Affiliations
                [1 ]Strathfield Retina Clinic, Sydney, NSW, Australia
                [2 ]Medical Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
                [3 ]Save Sight Institute, University of Sydney, Sydney, NSW, Australia
                [4 ]School of Medicine, University of Queensland, Brisbane, QLD, Australia
                [5 ]Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
                [6 ]Ophthalmology Clinic, Children’s Hospital Westmead, Sydney, NSW, Australia
                Author notes
                Correspondence: Xin Jie Lai, Strathfield Retina Clinic, Suite 3A/9 Redmyre Road, Strathfield, Sydney, NSW 2135, Australia, Tel +61 2 9746 3378, Fax +61 2 9746 3396, Email research@ 123456strathfieldretina.com.au
                Article
                Publisher ID: imcrj-10-051
                DOI: 10.2147/IMCRJ.S107648
                PMC ID: 5317340
                SO-VID: 476414af-6324-41fc-ba69-16689531d4f0
                Copyright © © 2017 Wong et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Case Report

                Keywords: chorioretinopathy,indocyanine green angiography,optical coherence tomography,oct,fluorescein angiography,pigment epithelium detachments,peds,subretinal fluid
                Data availability:
                Keywords: chorioretinopathy, indocyanine green angiography, optical coherence tomography, oct, fluorescein angiography, pigment epithelium detachments, peds, subretinal fluid

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