Sharper peaks than PED and peripapillary location

Multiple PED’s

Polypoidal Choroidal Vasculopathy• Choroidal vascular network ending in an

anuerysmal bulge • Visual loss 2ndary to serosanguinous

detachment of RPE and neurosensory retina

• Pathogenesis not fully understood but PCV and CNV both have increase in VEGF found in aqueous humor

• PCV mainly affects Asians and Pigmented individuals

• Common for PCV lesions to grow near optic nerve

Treatment• Long-Term Results of Photodynamic Therapy of

Polypoidal Choroidal Vasculopathy Akaza, Mori et al. Retina 28:717-722, 2008– 24 month post-PDT follow-up of 47 eyes of 47

patients. 1-6 PDT sessions performed– Improvement of fundus findings in 20 eyes (42%) at 3

months, 34 eyes (74%) at 12 months, and 37 eyes (79%) at the final visit. Ie. Free of bleeding and exudation.

– 39 of 47 eyes (83%) had disappearance of FA leakage at final visit.

– Recurrences noted 12 months after PDT in 6 eyes, and later (29 months after PDT) in 24 eyes.

– At 24 months 9% had improved visual acuity, 70% had preserved visual acuity and 11% had decreased visual acuity.

– Abnormal vascular network continues to expand despite PDT

Treatment• Short-Term Safety and Efficacy of a Single Intravitreal

Bevacizumab Injection for the Management of Polypoidal Choroidal Vasculopathy Song, Byeon et al.Ophthalmologica 2009;223:85-92

• 19 eyes of 18 patients Retrospective review– Of the 19 eyes, (13) 68% of eyes had received some prior therapy.

(PDT, or combo of PDT, intravitreal triamcinolone, and thermal laser). Remaining 6 eyes (32%) got Bevacizumab as primary therapy.

– After three months both visual acuity mean (20/80->20/63) and CRT mean improved (267 to 204 microns) over baseline significantly

– Angiographic findings at 3 months showed reduced leakage and at least partial regression of polyps in more than half of patients but ICG showed no definite change in choroidal branching

– Pathologic vascular structures in PCV do not regress– Two types of polyps in PCV – Alternate treatment for patients who can’t get PDT

Treatment• The Therapuetic Effects of Bevacizumab in patients with

polypoidal choroidal vasculopathy Korean Journal of Ophthalmology 22:(2)92-99; 2008– 12 eyes of 11 patients with active PCV were treated with

intravitreal bevacizumab alone or in combo with PDT. – Intravitreal bevacizumab was repeated every 6 weeks until FA,

OCT or ICG picked up regression of active lesions.– Bevacizumab alone in 8 eyes (Group 1) mean 2.2 inj– Bevacizumab with PDT on same day in 4 eyes (Group 2) mean

2.5 inj– BCVA improved by >/= 2 lines in 58 % eyes and resolution on

OCT/FA confirmed in 83% of eyes– Partial or complete regression of polypoidal vessels and

interconnecting vessels was reported for most cases at last follow-up

– Mean BCVA improved in both groups• 20/63->20/40 in Group 1• 20/63->20/32 in Group 2