Polypoidal Choroidal Vasculopathy: Evidence-Based Guidelines For Clinical Diagnosis And Treatment

Mitsuko Yuzawa¹ on behalf of the PCV Roundtable Group²

¹Surugadai Hospital, Nihon University, Tokyo, Japan
²Lee-Jen Chen (Taiwan), Shih-Jen Chen (Taiwan), Youxin Chen (China), Anantharam Giridhar (India), Tomohiro Iida (Japan), Hakyoung Kim (South Korea), Adrian Koh (Singapore), Timothy Yuk Yau Lai (Hong Kong), Won Ki Lee (South Korea), Xiaoxin Li (China), Tock Han Lim (Singapore), Paisan Ruamviboonsuk (Thailand), Tarun Sharma (India), Shibo Tang (China), Mitsuko Yuzawa (Japan)

Purpose:
To report on evidence-based practical guidelines for the diagnosis and management of polypoidal choroidal vasculopathy (PCV) which resulted from a systematic examination of published and available evidence on the diagnosis and treatment of PCV.

Methods:
A panel of clinical experts analyzed a systematic literature search on PCV as well as results of the EVEREST trial, the only known randomized controlled clinical trial in PCV. Available evidence was categorized and recommendations for diagnosis and treatment of PCV developed.

Results:
Diagnosis of PCV should be based upon early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography (ICGA). For initial treatment of juxtafoveal and subfoveal PCV the recommendation is either ICGA-guided verteporfin photodynamic therapy (PDT) or verteporfin PDT plus 3×0.5 mg ranibizumab intravitreal injections 1 month apart. If there is incomplete regression of polyps by ICGA, eyes should be retreated with verteporfin PDT monotherapy or verteporfin PDT plus ranibizumab. If there is complete regression of polyps by ICGA, but leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab.

Conclusion:
The proposed guidelines support diagnosis and treatment of patients with PCV patients. Further randomized controlled clinical trials are needed to refine these guidelines.